Aortic and Peripheral Vascular Disease

Question 1

what are the three types of arteriosclerosis?

Answer 1

atherosclerosis, monkeberg medial sclerosis, arteriolar sclerosis

Question 2

what is monkeberg medial sclerosis

Answer 2

calcification and ossification of muscular media

does NOT impinge on vessel lumen

Question 3

what is arteriolar sclerosis

Answer 3

involves arterioles: two types

hyperplastic: intimal thickening “onion skin”
hyaline: acellular thickening, associated with benign hypertension

Question 4

what is the response to injury hypothesis

Answer 4

intimal injury –> inflammation –> smooth muscle recruited to intima –> macrophage activation –> fatty streak –> macrophage and smooth muscle cells engulf lipid –> smooth muscle proliferation, collagen and other ECM deposition, extracellular lipid

Question 5

what is a fatty streak?

Answer 5

earliest lesion
flat
can be seen in normal infants and adolescents
foamy macrophages

Question 6

what is an atheromatous plaque?

Answer 6

raised impinges on vessel lumen
eccentric
can enlargem change shape, calcify
cholesterol clefts in core

Question 7

what is a complicated plaque?

Answer 7

calcified
ulcerated
more thrombosis on surface
can rupture and embolize

Question 8

what are common atherosclerosis sites?

Answer 8

lower abdominal aorta
coronary arteries
popliteal artery
internal carotid artery
circle of willis

Question 9

what is the pathophysiology of aneurysms?

Answer 9

weakening vessel wall (media)
dilatation
rupture

Question 10

what are the types of aneurysm

Answer 10

saccular - berry
fusiform - atherosclerosis
dissecting
mycotic
syphillitic

Question 11

describe abdominal aortic aneurysms

Answer 11

due to atherosclerosis
plaues damage and weaken media
abdominal aorta below renal arteries
M>F, >60yrs
pulsatile abdominal mass
sudden death from rupture --> insanguination + hemodynamic collapse
treatment by placement of aortic graft
fusiform - due to atherosclerosis

Question 12

what are the types of aortic dissection?

Answer 12

hypertensive/atherosclerotic
genetic: marfans
cystic medial degeneration
myxomatous degeneration of aortic wall, fragments elastic fibers, weakens tunica media

Question 13

describe aortic dissections

Answer 13

start in arch or aorta or aortic root
blood –> intima
symptoms: sudden onset of excruciating chest pain radiating to the middle of the back
Chest X-ray: widening of mediastinum (mediastinal hemorrhage)

Question 14

describe a cerebral berry aneurysm

Answer 14

congenital weakening of vessel wall
not atherosclerotic
typically at branch points in circle of willis

rupture results in: subarachnoid hemorrhage, intraparenchymal hematoma

clinical signs: sudden onset of excruciating headache and sudden loss of consciousness

Question 15

describe syphilitic aneurysms

Answer 15

caused by tertiary syndrome
treponema infects vasa vasorum
linear calcification of elastic lamina

results: dilatation of aortic valve ring and ascending aorta and aortic insufficiency

Question 16

Describe mycotic aneurysms

Answer 16

caused by infection of blood vessel
bacterial or fungal
typical is salmonella gastritis
not syphillis
not atherosclerotic

Question 17

Describe thrombophlebitis (inflammation)/ phlebothrombosis (no inflammation)

Answer 17

DVT in lower extremities, pelvic veins, prostativ veins, dural sinuses
hypercoagulable states can predispose
major complication: pulmonary embolus

Question 18

what are varicose veins

Answer 18

tortuous dilation of lower extremity veins secondary to increased venous pressure
standing for long periods of time
pregnancy
venous valves become incompetent
LOW RISK of venous thrombosis

Question 19

superior vena cava syndrome

Answer 19

obstruction of vena cava due to neoplasm (lung cancer, liver cancer)
symptoms relate to area of obstruction

Question 20

what are common venous diseases?

Answer 20

thromboplebitis (inflammation)/phlebothrombosis (no inflammation), varicose veins, superior vena cava syndrome