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Cardiovascular Module > Aneurysm & Varicosities > Flashcards

Aneurysm & Varicosities Flashcards

1
Q

Aneurysm

A

Localized
Permanent
Abnormal dilation of blood vessel

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2
Q

Two forms of aneurysm

A

True

False

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3
Q

True aneurysm

A

Complete but thinned vascular wall

Blood remains within confine le of vascular tree

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4
Q

False aneurysm ( pseudoaneurysm / pulsating hematoma)

A

Blood filled extra vascular space with fibrous wall

Communicate with intravascular space because of hematoma after vascular rupture

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5
Q

Aneurysm classification based on morphology

A

Saccular aneurysm

fusiformaneurysm

Cylindroid aneurysm

Berry aneurysm

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6
Q

Saccular aneurysm

A

Only part of the vessel wall
Spherical outpouching of the wall
orifice maybe small compared to diameter of aneurysm
variation in size but quite quite large
often completely or partially filled with thrombus because of blood stasis

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7
Q

Fusiform aneurysm

A

Complete circumference of the vessel involved

not always symmetrical around the long axis of the artery
Variation in diameter and length but quite large

Maximum diameter in the middle and small size of the proximities

Variable mural thrombus

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8
Q

Cylindroid aneurysm

A

Variant of fusiform aneurysm

No gradual dilatation as in fusiform aneurysm

Abrupt cylindrical dilatation to maximum diameter

Variable symmetry and mural thrombosis

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9
Q

Berry aneurysm

A

Miniature saccular aneurysm

Rarely exceeds 15mm diameter

Most frequently seen in circle of Willis

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10
Q

Etiologic classification of aneurysm

A 
Atherosclerotic
Luetic or syphilitic 
mycotic 
congenital 
vasculitic 
capillary microaneurysms (Charcott Bouchard) 
 cardiac 
traumatic 
racemose or cirsoide
 arterio-venous
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11
Q

Atherosclerotic aneurysm

A

Weakening of the vessel wall due to atherosclerosis with loss of elastic tissue and replacement by fibrous tissue ( due to action of macrophages enzymes on elastic fibers after ischemia)

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12
Q

Main vessel affected by atherosclerotic aneurysm

A

Abdominal Aorta ( Below renal arteries and above bifurcation)

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13
Q

Incidence of atherosclerotic aneurysm

A

Usually after 60 years
Most common in males
50% of patients are hypertensive

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14
Q

Main type of morphology of atherosclerotic aneurysm

A

Fusiform

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15
Q

Effects of atherosclerotic aneurysm

A

Emboli of mural thrombi to legs vessels

Occlusion of renal, superior/inferior mesenteric arteries due to compression of aneurysm or blockade by thrombi => ischemia

Massive or fatal hemorrhage if rupture of aneurysm

Can stimulate intra abdominal tumor

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16
Q

Luetic or syphilitic aneurysm

A

Secondary to syphilitic mesaortitis from inflammation and proliferated endarteritis

Ischaemic damage due to fibrosis and loss of elasticity

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17
Q

Main vessel affected by syphilitic aneurysm

A

Thoracic aorta (diffuse dilatation of ascending and loop of aorta )

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18
Q

Main morphology of syphilitic aneurysm

A

Fusiform aneurysm and saccular aneurysm

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19
Q

Effects of syphilitic aneurysm

A

Aortic Incompetence through aortic valve dilatation

Lead to left ventricular hypertrophy and failure

syndrome of superior mediastinal compression due to pressure on surrounding structures

Thrombosis of great veins and displacement

congestion of head and neck

dysphagia if esophagus involved

chronic cough and suppurative bronchopneumonia if there’s pressure on a major Bronchus

Paralysis of left vocal cord due to left recurrent laryngeal nerve occlusion by transverse aorta loop

Vertebral erosion

Rupture not common but happens in massive fatal hemorrhage

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20
Q

Mycotic aneurysm

A

Weakening of the arterial wall secondary to bacterial or fungal infection

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21
Q

Origin of mycotic aneurysm

A

Septic embolus
Extension of an adjacent suppurative process
Circulating organism

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22
Q

Most common zone of mycotic aneurysm

A

Cerebral arteries which can cause intracerebrak hemorrhage

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23
Q

Congenital aneurysm

A

Small d’acculer aneurysm

Also called berry aneurysm which occur at branching point of circle Willis

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24
Q

People more at risk of congenital aneurysm

A

Young hypertensive

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25
Q

Congenital aneurysm , acquired or not ?

A

Acquired

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26
Q

Complication of congenital aneurysm

A

Subarachnoid hemorrhage
Visual field defect if in circle of Willis
Bitemporal hemaniopa
Ipsylateral eye

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27
Q

Main site of cerebral berry aneurysm

A

Anterior communicating artery (40%)

Middle cerebral artery (34%)

Posterior communicating artery (20%)

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28
Q

Vasculitic aneurysm

A

Caused by inflammatory vasculitides

Such as PAN , Kawasaki syndrome

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29
Q

Traumatic aneurysm

A

Due to Injury to wall of artery

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30
Q

Racemose aneurysm

A

Masses of interconnecting small arteries and veins

May be due to a blow of the head or congenital

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31
Q

Capillary micro aneurysm

A

Caused by Hypertension (middle cerebral artery ) and diabetic vascular disease

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32
Q

Arteriovenous aneurysm

A

Dilated vessels due to artrriovenous fistula

Special type is carotid cavernous sinus aneurysm

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33
Q

Cardiac aneurysm

A

Complication of IHD
Stretching of healed myocardial infarction
Laminated thrombus

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34
Q

Aortic dissection

A

Blood forced through transverse intimai tear and create blood filled space in aortic media between middle and outer thirds

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35
Q

Common location of dissection aorta

A

60% in ascending aorta.

30% in beginning of descending aorta

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36
Q

Main cause of aorta abdominal dissection

A

Trauma

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37
Q

Main population affected by aortic dissection

A

Male
50-70 years
Black
Individuals with localised congenital abnormality of connective tissue (Marfan syndrome, osteogenesis perfecta, ehlers danos syndrome pseudonoma elastic Kim and cutis laxa)

38
Q

Characteristics of aortic dissection

A

Cystic medial necrosis

Multi focal destruction of elastic and muscular components of media

Accumulation of mucous material

39
Q

Conditions affected with aortic dissection

A 
70% hypertension 
Pregnancy 
Atherosclerosis 
Trauma 
Aortic valvular stenosis
Coarctation of aorta
Arterial catheterization
40
Q

Why is there higher incidence of intimai medial tears in ascending aorta

A

Due to hemodynamics factors

41
Q

Complications of aortic dissection

A

Fatal hemopericardium (cardiac tamponnade) due to rupture

Infarction due to obstruction of arteries

42
Q

Retrograde dissection

A

Dissection in root of aorta
Can disrupt aortic valve
Cause valvular incompetence

43
Q

3 types of aortic dissection

A

Type I (75% ) - ascending thoracic aorta extending distally to involve descending aorta

Type II (5%)- confined to ascending aorta

Type III- aorta distal to origin of left subclavian without ascending portion

44
Q

Clinical presentation of aortic dissection

A

Episodic pain

Compression of regional arteries (create symptoms based of organs )

45
Q

Prognosis of aortic dissection

A

90% of patients die within 3months if untreated

15% - 20% mortality with treatment

46
Q

Varicose vein

A

Dilatation and tortuosity of veins

Due to chronic or recurrent increase in pressure of blood within veins because of gravity or obstruction to major veins

47
Q

Types of varicosity

A

Gravitational

Obstructive

48
Q

Gravitational varicosity

A

Saphenous system of legs affected

49
Q

Gravitational varicosity people at risk

A

Women

Occupations with prolonged standing

Hereditary predisposition-43%

50
Q

Gravitational varicosity cause

A

Prolonged standing upright causing rise in pressure and distension of long saphenous vein

51
Q

Gravitational varicosity pathogenesis

A

Rise in pressure and distension of vein
Permanently stretched veins
Incompetent veins
Swollen and tortuous veins

52
Q

Clinical effects of Gravitational varicosity

A

Nutrition of skin impaired due to stagnation of blood

Oedema and hypoxia

Eczematous and pigmented skin

Indolent varicose ulcer

Dilated veins with profuse bleeding

Thrombosis which can organise and form phlebolith

53
Q

Varicocele

A

Gravitational varicosity involving pampiniform plexus of veins which is commoner on the left Than the right

Distended vein like bag of worms

54
Q

Haemorrhoids

A

Varicosities of haemorrhoidal plexus

At ano rectal junction

55
Q

Hemorrhoids common. In

A

Pregnancy (pressure of Travis uterus on pelvic veins)
Chronic constipation
Portal hypertension

56
Q

Complications of hemorrhoids

A

Bleed - iron deficiency anemia
Rupture into perianal subcutaneous
Thrombosis
Prolapse through anal sphincter

57
Q

Obstructive varicosity

A

Chronic obstruction to portal venous blood mostly due to cirrhosis causing varicose

58
Q

Most important site of obstructive varicosity

A

Lower esophagus and gastric mucosa

Inferior vena cava

59
Q

Parhogenesis of obstructive varicosity

A

Early stage :
Muscular hypertrophy
Intimai fibro elastic thickening occurs

Later stage :
Thickened muscular wall replaced by fibrous tissue
Atrophy of valves, smooth muscle , elastic tissue

Thinning and pouch like dilatation
Venous wall mainly with fibrous tissue
Spotty calcifications

60
Q

Traumatic aneurysm

A

Due to Injury to wall of artery

61
Q

Racemose aneurysm

A

Masses of interconnecting small arteries and veins

May be due to a blow of the head or congenital

62
Q

Capillary micro aneurysm

A

Caused by Hypertension (middle cerebral artery ) and diabetic vascular disease

63
Q

Arteriovenous aneurysm

A

Dilated vessels due to artrriovenous fistula

Special type is carotid cavernous sinus aneurysm

64
Q

Cardiac aneurysm

A

Complication of IHD
Stretching of healed myocardial infarction
Laminated thrombus

65
Q

Aortic dissection

A

Blood forced through transverse intimai tear and create blood filled space in aortic media between middle and outer thirds

66
Q

Common location of dissection aorta

A

60% in ascending aorta.

30% in beginning of descending aorta

67
Q

Main cause of aorta abdominal dissection

A

Trauma

68
Q

Main population affected by aortic dissection

A

Male
50-70 years
Black
Individuals with localised congenital abnormality of connective tissue (Marfan syndrome, osteogenesis perfecta, ehlers danos syndrome pseudonoma elastic Kim and cutis laxa)

69
Q

Characteristics of aortic dissection

A

Cystic medial necrosis

Multi focal destruction of elastic and muscular components of media

Accumulation of mucous material

70
Q

Conditions affected with aortic dissection

A 
70% hypertension 
Pregnancy 
Atherosclerosis 
Trauma 
Aortic valvular stenosis
Coarctation of aorta
Arterial catheterization
71
Q

Why is there higher incidence of intimai medial tears in ascending aorta

A

Due to hemodynamics factors

72
Q

Complications of aortic dissection

A

Fatal hemopericardium (cardiac tamponnade) due to rupture

Infarction due to obstruction of arteries

73
Q

Retrograde dissection

A

Dissection in root of aorta
Can disrupt aortic valve
Cause valvular incompetence

74
Q

3 types of aortic dissection

A

Type I (75% ) - ascending thoracic aorta extending distally to involve descending aorta

Type II (5%)- confined to ascending aorta

Type III- aorta distal to origin of left subclavian without ascending portion

75
Q

Clinical presentation of aortic dissection

A

Episodic pain

Compression of regional arteries (create symptoms based of organs )

76
Q

Prognosis of aortic dissection

A

90% of patients die within 3months if untreated

15% - 20% mortality with treatment

77
Q

Varicose vein

A

Dilatation and tortuosity of veins

Due to chronic or recurrent increase in pressure of blood within veins because of gravity or obstruction to major veins

78
Q

Types of varicosity

A

Gravitational

Obstructive

79
Q

Gravitational varicosity

A

Saphenous system of legs affected

80
Q

Gravitational varicosity people at risk

A

Women

Occupations with prolonged standing

Hereditary predisposition-43%

81
Q

Gravitational varicosity cause

A

Prolonged standing upright causing rise in pressure and distension of long saphenous vein

82
Q

Gravitational varicosity pathogenesis

A

Rise in pressure and distension of vein
Permanently stretched veins
Incompetent veins
Swollen and tortuous veins

83
Q

Clinical effects of Gravitational varicosity

A

Nutrition of skin impaired due to stagnation of blood

Oedema and hypoxia

Eczematous and pigmented skin

Indolent varicose ulcer

Dilated veins with profuse bleeding

Thrombosis which can organise and form phlebolith

84
Q

Varicocele

A

Gravitational varicosity involving pampiniform plexus of veins which is commoner on the left Than the right

Distended vein like bag of worms

85
Q

Haemorrhoids

A

Varicosities of haemorrhoidal plexus

At ano rectal junction

86
Q

Hemorrhoids common. In

A

Pregnancy (pressure of Travis uterus on pelvic veins)
Chronic constipation
Portal hypertension

87
Q

Complications of hemorrhoids

A

Bleed - iron deficiency anemia
Rupture into perianal subcutaneous
Thrombosis
Prolapse through anal sphincter

88
Q

Obstructive varicosity

A

Chronic obstruction to portal venous blood mostly due to cirrhosis causing varicose

89
Q

Most important site of obstructive varicosity

A

Lower esophagus and gastric mucosa

Inferior vena cava

90
Q

Parhogenesis of obstructive varicosity

A

Early stage :
Muscular hypertrophy
Intimai fibro elastic thickening occurs

Later stage :
Thickened muscular wall replaced by fibrous tissue
Atrophy of valves, smooth muscle , elastic tissue

Thinning and pouch like dilatation
Venous wall mainly with fibrous tissue
Spotty calcifications

Cardiovascular Module (21 decks)

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