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TBL 4- Vascular

TBL 4- Vascular. 1. A 75 y/o man experiences sudden, severe lower abdominal pain and hypotension. The surgeons repair a dilated abdominal aorta. This condition is called:. A. Abdominal aorta thrombus- blood clot B. Abdominal aorta embolus- part of the thrombus has been dislodged

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TBL 4- Vascular

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  1. TBL 4- Vascular

  2. 1. A 75 y/o man experiences sudden, severe lower abdominal pain and hypotension. The surgeons repair a dilated abdominal aorta. This condition is called: A. Abdominal aorta thrombus- blood clot B. Abdominal aorta embolus- part of the thrombus has been dislodged C. Abdominal aorta lines of zahn- pink area with the fibrin and D. Abdominal aorta angiogenesis- granulation tissue and in organizing thrombus E. Abdominal aorta aneurysm

  3. 2. All of the following tissue reactions can follow a thrombus except: A. Fibrinolysis B. Organization C. Propagation D. Malignant transformation E. Embolization

  4. 3. An 18 y/o girl dies in a motor vehicle accident. The pathologist notes thin yellow lines in her abdominal aorta. You predict these would have the following microscopic appearance: A. Deposits of calcium B. Deposits of amyloid C. Macrophages with glycogen D. Macrophages with ingested red blood cells E. Macrophages with lipid- you can get fatty streaks starting infancy

  5. 4. A 55 y/o man experiences an acute myocardial infarction. An eccentric lesion is noted in his left anterior descending coronary artery. You predict this lesion has these histopathologicfeatures: A. Transmural necrosis B. Transmural thrombus C. Ruptured fibrous cap- atherosclerotic plaque, is better with a stable cap. The problem is more with how stable the plaque is. D. Transmural neutrophils E. Ruptured angiogenesis

  6. CASE ONE- Thrombus formation from endothelial damage fr Surgery A 40 y/o woman has chronic renal failure from diabetes and receives renal dialysis while awaiting a kidney transplant.She experiences acute pain and erythema in her left arm at the site of vascular access created for dialysis • What does the pain and erythema suggest? - Acute inflammation secondary to infection at site of dialysis port • - You want to make the vein a lot more tougher, bc you are now connecting the artery to the vein. • - Now you are trying to create this vascular access site. • Anytime you obstruct low through any one area, you will get an infection in that area. • We all have bacteremia at different points. If the bacteria find a spot where they can land it can lead to infection • This vascular injury thrombus (acute), but atherosclerosis (chronic) • Thrombus leads to congestion

  7. The surgeon excises the vascular structures and creates a new access site.View the virtual image: https://sommedia.ucdmc.ucdavis.edu/slides/display.cfm?Magnification=20&Filename=/slides/Pathology/160.pff&XML=160.xml2.) List three pathologic features in these vessels1. Lines of Zahn2. Recanalization and Angiogenesis3. Macrophage infiltration due to chronic inflammation3.) Did the thrombus form in the pre-operative setting?- - The Lines of Zahn would be indicative of thrombus formation in the pre-operative setting. It takes a while for the lines to form therefore it would occur in the pre-operative setting.- This patient underwent 2 surgeries. The reason why it was there is endothelial injury due to creating an access site.

  8. this sample has a complete thrombus in it and is forming inflammatory response. -this pt had a catheter in his arm and has caused the plaque formation. The lumen contains a central thrombus with an eccentric area, from 12-3 o’clock, of tissue characterized by fibroblasts, small capillaries and scattered Neutrophils.

  9. CASE TWO- Atheromatous Plaque A 55 y/o man dies from metastatic lung carcinoma. The pathologist notes firm eccentric lesions in his coronary arteries.

  10. - These plaques will form mostly on one side versus the other. - We can see collagen deposition fr fibroblasts - Here we have a lipid core with a fat necrotic lesion - It is possible if the patient has partial angina due to stenosis. - OLD LESION bc macrophages have died with Cholesterol clefts View the virtual image: https://sommedia.ucdmc.ucdavis.edu/slides/display.cfm?Magnification=20&Filename=/slides/Pathology/570.pff&XML=570.xml • 4.) List three pathologic features 1. Atherosclerotic plaque- Complex, raised lesion containing smooth muscle cells, macrophages, T cells, collagen and elastic fibers, and lipid. 2. Dystrophic Calcification 3. lipid necrotic center 4.. Eccentric Lesion- Increased cholesterol deposition within the intima and media 5. Thick Fibrous Cap 5.) Is this a stable plaque? - This is a stable plaque because it has a very thick fibrous cap.

  11. CASE THREE- Ruptured Atherosclerotic plaque Thrombus formation A 55 y/o man experiences an acute myocardial infarction.  The image represents the critical lesion in his left anterior descending coronary artery.

  12. View virtual image: https://sommedia.ucdmc.ucdavis.edu/slides/display.cfm?Magnification=20&Filename=/slides/Pathology/358.pff&XML=358.xml 6.) List three pathologic features • Large areas of foam cells and lipid • - Prothombogenic, where there is a thrombus that a exposed endothelial and lipids • Thin fibrous caps • Less calcification along the sclerotic plaque • Here we have a fairly small plaque with a thin fibrous cap. • Clusters of inflammatory cell • - Neutrophils within the thrombus and cholesterol clefts • - There is some ongoing remodeling 7.) Is this a stable plaque? • - No this is not a stable plaque, there is thin fibrous cap.

  13. CASE FOUR- Marfan Syndrome Intimal tear Aortic dissection A  42 y/o man has Marfan’s syndrome and experiences sudden chest pain.  The lesion is surgically removed View the virtual image: https://sommedia.ucdmc.ucdavis.edu/slides/display.cfm?Magnification=20&Filename=/slides/Pathology/354.pff&XML=354.xml

  14. View the virtual image in Trichrome stain: https://sommedia.ucdmc.ucdavis.edu/slides/display.cfm?Magnification=20&Filename=/slides/Pathology/355.pff&XML=355.xml Note : Elastic tissue stains black in the Trichrome. 8.) What abnormality do you note in the elastic tissue? - Intimal tear (media is being split by an evolving thrombus) - Elastic tissues in the media are deforming 9.) What is your diagnosis? - With Marfan’s syndrome you will have damage with Fibrilin which is a molecule upon which elastic fibers are laid down, so if there’s a disruption of the elastic tissues, there will be problems in the media and it will be easier to tear through - Disorganized elastic tissues led to increased turbulent blood flow intimal tear splitting of media aortic dissection (false aneurysm) Trichrome staining- with elastic (blk), collagen (blue/green) Here you can see the tear in the intima would find those areas, and would go through the path of least resistance and the vessel will split apart

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