Arteriosclerosis: Definition, Senile arteriosclerosis, Hypertensive arteriosclerosis, Types of Hypertensive arteriosclerosis, Mönckeberg’s arteriosclerosis And MCQs for NEET, GPAT, CSIR NET JRF

INTRODUCTION :-

1.] Arteriosclerosis is a general term used to include all conditions with thickening and hardening of the arterial walls.

2.] Following morphological entities are included under arteriosclerosis :-

• Senile arteriosclerosis (it affects arteries).
• Hypertensive arteriosclerosis (affects arteries).
• Mönckeberg’s arteriosclerosis (medial calcific sclerosis as it affects arteries).
• Atherosclerosis (affects arteries).

SENILE ARTERIOSCLEROSIS :-

1.] It is the thickening of media and intima of the arteries seen due to the ageing in senile arteriosclerosis.

2.] The changes seen in senile arteriosclerosis is non – selective and it affects most of the arteries.

3.] Senile arteriosclerosis is caused by the stress and strain on the vessel walls during life.

4.] Following are the changes that occurs in the senile arteriosclerosis :

• Fibroelastosis : The intima and media are thickened due to the increase in collagen and elastic tissues.
• Elastic reduplication : The internal elastic lamina is split or it is reduplicated so that two ways layers are seen.

HYPERTENSIVE ARTERIOSCLEROSIS :

1.] Hypertension is the term used to describe an elevation in blood pressure.

2.] Arteriosclerosis is the term used to describe three morphological forms of vascular disease affecting arterioles and muscular arteries. These are as follows :

• Hyaline arteriosclerosis.
• Hyperplastic arteriosclerosis.
• Necrotising arteriosclerosis.

These above three mentioned types are common in hypertensive arteriosclerosis, but may cause by other reasons as well.

A.] HYALINE ARTERIOSCLEROSIS :

• It is an common arteriolar lesion that may physiologically seen due to aging and may pathologically occur in benign nephrosclerosis in hypertensive.
• Pathogenesis : The exact pathogenesis is not known. However, following hypothesis have been proposed like –
• The lesion result may probably from leakage of components of plasma across the vascular endothelium.
• An alternate possibility has also been made in which lesion may occur due to the immunologic reaction.
• Some have also considered it to be normal aging process.

B.] HYPERPLASTIC ARTERIOSCLEROSIS :

• The hyperplastic or proliferative type of the arteriosclerosis is a characteristic lesion of malignant hypertension.
• Pathogenesis : The pathogenesis of hyperplastic intimal thickening is unclear. The changes occur may be due to endothelial injury from systemic hypertension, hypoxia or immunologic damage leading to increased permeability.

C.] NECROTISING ARTERIOSCLEROSIS :

• In case of severe hypertension and malignant hypertension, part of small arteries and arterioles show changes of hyaline sclerosis and part of these show necrosis.
• Pathogenesis : Since necrotising arterioles occurs in vessels in which there is sudden and great elevation of pressure, the changes are said to result from direct physical injury to the vessel wall.

MÖNCKEBERG’S ARTERIOSCLEROSIS :-

• Mönckeberg’s arteriosclerosis is calcification of the media of large and the medium sized muscular arteries.
• It occurs especially in the arteries of extremities and of the giant tract in the person pasts the age of 50.
• The condition is an age related degenerative process and therefore is an example of dystrophic calcification.
• Pathogenesis : Pathogenesis of these condition is not known but it is considered as an age related physiologic change due to the prolonged effect of the vasoconstriction.

MULTIPLE CHOICE QUESTIONS :-

1.] Mönckeberg’s calcific sclerosis affects the medium sized muscular arteries by involving the structure of ?

a. Intima

b. Media

c. Adventitia

d. All of the above

2.] In malignant hypertension hyperplastic arteriosclerosis is seen in all except?

a. Heart

b. Kidney

c. Pericardial fat

d. Peri pancreatic fat

3.] Medial calcification is seen in ?

a. Atherosclerosis

b. Arteriosclerosis

c. Mönckeberg’s sclerosis.

d. Dissecting aneurysm

4.] Onion skin thickening of anterior wall is seen in ?

a. Atherosclerosis

b. Median calcific sclerosis

c. Hyaline arteriosclerosis

d. Hyperplastic arteriosclerosis

5.] Commonest histological finding in benign hypertension ?

a. Proliferating endartheritis

b. Necrotising arteriolitis

c. Hyaline arteriosclerosis

d. Cystic medial necrosis

6.] Which of the following is the common histological finding in benign hypertension ?

a. Proliferative end aterititis

b. Necrotising arteriolitis

c. Hyaline arteriosclerosis

d. Cystic medial necrosis

7.] Hallmark feature of hyaline arteriosclerosis ?

a. Hylaine arteriosclerosis

b. Cystic medial necrosis

c. Fibrinoid necrosis

d. Hyperplastic arteriosclerosis

8.] Which of the following cells provide major proliferative stimuli for the cellular component of atherosclerosis plaques ?

a. Neutrophils

b. Eosinophils

c. Platelet

d. Erythrocytes

9.] Accelerated phase of hypertension is characterized microscopically by ?

a. Fibrinoid necrosis of anterior wall

b. Hyaline arteriosclerosis

c. Elastosis of intima

d. Marked calcification the media.

10.] Vascular pathology of benign hypertension include ?

a. Segmental fibrinoid necrosis

b. Hyaline arteriosclerosis

c. Periarteries

d. Loss of internal elastic lamina

SOLUTION :-

1.] (b) media

2.] (a) heart

3.] (c) Mönckeberg’s sclerosis

4.] (d) Hyperplastic arteriosclerosis

5.] (c) Hyaline arteriosclerosis

6.] (c) Hyaline arteriosclerosis

7.] (a) Hyaline arteriosclerosis

8.] (c) Platelets

9.] (a) Fibrinoid necrosis of anterior wall

10.] (b) Hyaline arteriosclerosis

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 371 – 373.

2.] Robbin’s Basic Pathology; 5th edition; Page no. 488 – 489.