Pathology Lab :-
⭐️ Vascular Pathology 🌟

#معمل_باثو
#مجموعة_الباثو

مساااكم الله بالخير 🌸
موضوع اليوم بنتحدث فيه عن ال vascular system
وعن الامراض المتعلقة فيه 😊

طبعاً ال vascular system
📌هو الأهم وذلك لأنه يرتبط بجميع ال systems of the body
So: اي خلل فيه سيؤثر على الأجهزة الأخرى في الجسم

📌50% من الوفيات بسبب مضاعفات لأمراض ال vascular system
مثل ال atherosclorosis and hypertention
●Start with Basics:-
🔹Anatomy:-
*Arterial part:- Aorta > large artery > medium a. > small a. >arterioles
*Capillaries
*Venous part:- Vanules > small veins > medium v. > large v. > sup. &inf. Vena cava

🔹Histology:-
3 layers ••
Intima - media - advintitia

1] intima composed of :-
a) endothelial cells (single layer of flat squemous cells).
It's function:- promote permability of B.V. , promote disturbance of clotting factors )
b) Subendothelial C.T.

2] media :- multiple layers of smooth muscle.

3] Adventatia :- C.T. contains (Arterial supply , veinus draining , nerve supply ).

🤔 كيف نقدر نفرق بين
different size of Arteries ؟؟
By it's thickening of media (it disappear at capillaries)

🔹physiology:-
Transmission the blood whole over the body

🔹phathology:-
كالعاده نبدأ بال:-
A]Congenital Anomalies:-
1)Arterio-venous malformation:
Formed mass ▶️ يعني شبكة من الأوعية الدموية متشابكة مع بعض ويحصل
(Blood stasis)

2]Arterio venous shunt (Fastula):
-It's abnormal connection between artery and vein
-it's common
-it's may be acquired by trauma
or by theraputic:-
علاجية مثل :- Urine dialysis غسيل الكلية

🤓the normal connection between artery and vein is Capillary

3]Berry aneurysm:-
🔴Aneurysm:- is abnormal permanent segmental dilatation of the arterial wall.
-Berry aneurysm: is Congenital dilatation of one of the branshes of circle of willis at the brain.

-it is Asymptomatic.
-but if it rupture by any cause (trauma) ▶️ it will lead to fatal intracerebral heamorrhage ▶️ Sudden death.

B] inflammation disease:- (vasculitis)
نقدر نقسمها الى قسمين بحسب السبب infectious &Non infectious

🔹infectious:-
- it caused more by syphilis
-it is rare,
because all immune cells are at the blood
يعني انتحار بالنسبه للميكروب ولكن قد يحصل vasculitis بسبب ميكروب في حالة انه المناعة صارت ضعيفه
😐 بنفس الوقت هذا سلاح ذو حدين صحيح انه صار محمي من ال infection ولكن صار اكثر عرضة لل Auto immune

🔹 Non infectious :- (Autoimmune)
-Common
-Classification according to the size of the effective blood veesels:-
نبدأ بالتقسيمه وبعدين بنشرح كل واحد ع حده 😊✌🏻

1) large size vasculitis:-
1- Takayaso.
2- Temporal Giant cells arteritis.
😌 الاثنين يبدأوا بحرف ال T

2)Medium size vasculitis:-
1- polyarteritis nodosa
2-Kauasaki

3)small size vasculitis:-
1-Microscobic polyangitis.
2- Wegener granulomatosis.
3- Churg-strauss syndrome.

🔹نتحدث اولاً عن ال
Buerger disease:-
-هذا المرض مرتبط بال Smokers
-ويصيب ال artery &vein and nerve ككل
-المريض يجي وفيه edema at the upper limb
And may loss of sensation because obstruction by the inflammed artery and vein.

قبل ما نبدأ بشرح كل نوع لازم نعرف
🔴The general features of Vasculitis:-
1]Thickening of the wall.
2]Narrowing of the lumen.
3] leukocyte infeltration
هذي العلامات بنشوفها بكل نوع

😊 نبدأ الان بشرح كل نوع وايش المميز فيه وكيف نعرف نفرق بينهن بالشرائح

1] large size vasculitis:-
-microcobic features both are the same :-
الاثنين متشابهين تحت المجهر طيب ايش نشوف ؟!
It characterized by Giant cell infltrate the wall ▶️ Granulomatus inflammation هذي علامة مميزه لهذا النوع
( specific histologic feature)

طيب كيف بقدر افرق بين النوعين🧐 ؟!
-They are different clinically
1]Temporal Giant cell arteritis:-
-affect temporal artery and it's branshes. So:-
المريض يعاني من : chronic headache -tenderness - blindness
-affect old patients.

2]Takayasu:-
-affect arch of aorta and it's branches.
-so the problem at vessels which supply upper limb (pulsless) علامة مميزة

🔹Disease:- Temporal Giant cell arteritis or Takayasu vasculitis
هنا نذكر المرضين لانه زي ما قلنا مانقدر نفرق بينهم الا clinically
🔹Features :-
The general features of vasculitis واضحه :-
1)thickening of the wall
2)narrowing of the lumen
3)leukocyte infeltrate
specific feature:- granulomatus inflammation with giant cells

🔹Disease:- Temporal Giant cell arteritis or Takayasu vasculitis .

🔹Features:-
Granulomaus vasculitis with giant cells infiltrating the lumen واضحه في هذه الصورة

نجي الان لل
2]medium size vasculitis:-
-the both are histologically the same:- ايش نشوف في السلايد
Necrotizing vasculitis or fibrionid necrosis or both
🔸necrotizing > means pus (agreggate of neutrophils)
🔸fibrinoid necrosis> amorphus - structurless fibrin mass

# Clinically:-
1]PAN:-
-يصيب اي عمر ولكن ليس الاطفال.
-multi systemic disease affect all organs :- kidney -GIT - skin ... except lung.
- there is heamaturia - proteinurea -GIT bleeding -skin rash & lymphadenopathy.

2]Kawasaki:-
-affect neonate .
-Mucocutaneous lymph node syndrome:-
1)mucocutaneous rash.
2)lymphadenopathy.
3)fever.

🔴 في الشرائح لا نستطيع التفريق بين النوعين الا clinically
Child >> kawasaki
30 years >> PAN

🔹Disease:-
polyarteritis nodosa or Kwasaki.

🔹features:-
-general features of vasculitis observed
-necrotizing vasculitis and fibrinoid necrosis.

🔹Disease:-
polyarteritis nodosa or kawasaki

🔹features:-
appears of general features of vasculitis
fibrinoid necrosis (واضحه اكثر)
and necrotizing vasculitis

نجي الان لاخر جزء في ال vasculitis 🤓
3) small size vasculitis:-
هنا العكس
They are the same at clinical features but they are different histologically "-"
هنا نتوقع بيكون معانا
more systemic disease even the lung is effected

1] wegener's granulomatosis:-
نستطيع تمييزها ب:-
necrotizing granuloma
يعني في
granuloma(epitheloid cells)
وفي وسطها
neutrophil infiltration (pus)

We can't see the blood vessel wall.

-it affect upper and lower RT, kidney.
-the arteioles - capillaries and the surrounding C.T. are also affected.

🔴 necrosis is occur>> perforation of nasal septum - perforation of septum between oral and nasal cavities

2] microscobic polyangitis:-
يشبه ال PAN الذي يصيب ال medium size
-we can see necrotizing vasculitis or fibrinoid necrosis (but rare)

*specific feature:-
Leukocyto clastic fragmentation vasculitis
وهذه العلامه ما تظهر الا في هذا النوع وتعني انه احنا بنشوف مثلا النيتروفل مقسمه مثلا lobe مع شوية cytoplasm وكذا يعني fragments 😐

3] churg streuss syndrome:-
Specific feature:- esinophilia
سواء كان داخل ال tissue
Or at the blood

🔹Disease:-
Wegener's disease

🔹features:-
we can't see the blood vessel wall (there's distruction of the wall and invasion to the surrounding tissue)

*specific feature:-
necrotizing granuloma ( epitheloid cells and neutrophil at the middle)

🔹Disease:-
Wegener's disease

🔹features:-
necrotizing granuloma ( neutropil at the middle)

🔴 الفرق بين الصورتين
انه في الصورة الاولى كانت بداية اكون ال granuloma
اما الثانيه قد تكونت ال granuloam وال neutrophil فيها اكثر

🔹Disease:-
microscopic polyangitis

🔹features:-
leukocyto clastic fragmentation vasculitis( we can see the fragmented leukocyte)

🔹Disease:-
Microscopic polyangitis

🔹features:-
leukocyto clastic fragmentation vascullitis ( infiltrated by fragmented neutrophil)

بعد ما خلصنا من موضوع ال vasculitis
ذكر الدكتور بعض الامراض نذكر بعض الملاحظات عليها 😊😊
Specific vascular disease
مثل:-
🔹Aneurysm:-
Abnormal permanent segmental dilatation of the arterial wall.
-Causes:-
1)Congenital :- Berry aneurysm
2) acquired :- infection - trauma
-it's asymptomatic.
-if rupture lead to death

🔹Arteiolo sclerosis= hypertention
فيها نوعين :-
*Hyaline (amorphous mass):- caused by benign hypertention.
*Hyperplastic (onion shaped):- caused by malignant hypertention.

🔹Raynaud's disease:-
-mechanism :- sever vaso spasm >> vasoconistriction
- it called Raynaiud's phenomen if there is underling cause like SLE.

🔹Atherosclerosis :-
Atheroma:- mass compsed of fat (cholesterol) , fibrin , leukocyte , smooth muscle
Fibrous cap:- it's stablish the atheroma by smooth muscle which migrate to intima

🔹Angiosarcoma
Malignant tumer of blood vessel we see anaplastic change of the endothelial cells with infiltration of the endothelial cells.
كما سنرى في السلايد

🔴 لم نذكر الامراض بالتفصيل سيطول شرحها 😊😊
المعذرة ع اي خطأ غير مقصود والعفو منكم
خلود الفاقوس 😊

🔹Disease:-
Abdominal aortic aneurysm

🔹feature:-
Abnormal permanent segmental dilatation of blood vessels

🔹Disease:-
Arterolosclerosis (Hypertention)

🔹features:-
hyperplastic arteriolosclerosis (Onion shaped)

🔹Disease:-
Arteriolosclerosis (Hepertention)

🔹featuers:-
Hyaline arteriolosclerosis
(Amorphous material)

🔹Disease:-
Raynaud's disease / phenomen

🔹fearures:-
-blue discoloration
-cyanosis