Blood Vessels, thrombosis, etc

Question 1

Elastic arteries

Answer 1

Multiple elastic layers (laminae) in media
Aorta, arch vessels, brachial, iliacs, pulmonary trunk, main and lobar arteries
Conduits, deliver large volumes

Question 2

Muscular arteries

Answer 2

2 elastic laminae ( IEL and EEL) inside and outside muscular media
Contribute to vascular tone and vasoconstrict

Question 3

Arterioles

Answer 3

Greatest effects on peripheral vascular resistance. SM cells, endothelial cells, no elastic layer
Greatest number compared to other types

Question 4

Adventitia

Answer 4

Layer with abundant elastic tissue in veins

Question 5

Arterial intima

Answer 5

Consists of basement membrane, ground substance, and endothelial cells within IEL
Accumulation of smooth muscle cells and fibroblasts a non-specific response to injury

Question 6

Hypertensive vascular disease

Answer 6

Most susceptible are small vessels - renal, retinal, cerebral arteries

Question 7

Arterionephrosclerosis

Answer 7

Hypertensive renovascular disease. Hyaline arteriolar sclerosis (fibrosis, scarring) or hyperplastic arteriolosclerosis- Concentric thickening with elastosis of muscular arteries (onion-skinning)
Associated with malignant HTN, may cause ischemic damage

Question 8

Arteriosclerosis

Answer 8

Any type of arterial thickening. Ex renovascular changes, medical calcification

Question 9

Atherosclerosis

Answer 9

Intimal disease of elastic and muscular arteries- intimal thickening with addition of LIPID material (atheroma)
Aorta, iliacs, carotid, coronary arteries most susceptible
Endothelial damage initiating event

Question 10

Atheroma

Answer 10

During atherosclerosis, activated ECs allow adhesion and migration of macrophages and lymphocytes, LDL enters, mac and lymph stimulate proliferation of SMCs, apoptotic cell death allows for accumulation of cell debris with leads to

Question 11

Atherogenesis

Answer 11

Angiogenesis in growing atheroma, leaking red cells and fibrin into core, endo damage results in small luminal thrombi, large thrombi result in rupture of fibrous cap, or erosin of large areas of denuded endo
Acute syndromes generally based on sudden narrowing by thrombus

Question 12

Media

Answer 12

The wall of a true aneurysm is composed of

Question 13

Congenital aneurysms

Answer 13

Cerebral (berry), Marfan syndrome, Ehlers Danlos syndrome type IV, fibromuscular dysplasia associated with

Question 14

Dissecting aneurysms

Answer 14

Usual site is ascending/thoracic aorta. Predisposing factors are HTN, Marfan’s, bicuspid aortic valve.

Question 15

AAA

Answer 15

most common spot is between renal and iliac arteries

Question 16

IVC thrombosis

Answer 16

Usually caused by tumors (RCC, hepatocellular carincoma, testicular germ cell tumors) infiltrating the lumen

Question 17

Budd-Chiari Syndrome

Answer 17

Thrombosis of hepatic vein, resulting occlusion of mesenteric and hepatic circulation
Leads to liver failure, massive ascites, hepatosplenomegaly
Cause: idiopathic, tumor (HCC), thrombotic states

Question 18

Portal vein thrombosis

Answer 18

Thrombosis in venous supply to liver. Caused by infections (pylephlebitis, appendicitis, diverticulitis, umbilical cord infections)
Frequent in cirrhosis
Results in PORTAL HTN

Question 19

Edema

Answer 19

increased EC fluid (transudate- water, electrolytes). Collects in interstitium and serosal cavities
Causes are increased hydrostatic pressure, decreased plasma osmotic pressure

Question 20

Exudate

Answer 20

edema from inflammation or damage where blood cells also leak out ??

Question 21

Effusion

Answer 21

Edema from serosal cavity

Question 22

Ascites

Answer 22

Edema fluid in peritoneal cavity- hepatic circulation
Increased hydrostatic P due to scarring (central vein obstruction)
Intrinsic liver disease OR right heart failure (liver goes to R heart)
May have osmotic component because of hypoproteinemia
Splenomegaly

Question 23

Anasarca

Answer 23

Edema all through body

Question 24

Dependent edema

Answer 24

Edema in systemic circulation. Heart failure is MOST COMMON CAUSE. For children, protein losing conditions (ex nephrotic syndrome) are also a cause

Question 25

Pulmonary edema

Answer 25

Due to heart failure (acute and chronic, increases hydrostatic pressure), infections (aspiration, bacterial pneumonia) , toxins (kidney disease, cocaine, smoke) , non-inflammation endothelial damage (HAPE)

Question 26

Heart failure

Answer 26

Most common cause of pulmonary edema

Question 27

Albumin

Answer 27

Made in the liver, so when liver fails, hypoproteinemia

Question 28

Decreased osmotic pressures

Answer 28

Nephrotic syndrome, cirrhosis, protein-losing enteropathy, malnutrition, and shock will give generalized edema because of

Question 29

Vascular congestion

Answer 29

Increased fluid (blood) WITHIN vascular channels, usually associated with edema and most common are pulmonary and liver

Question 30

Hemosiderin macrophage

Answer 30

“Heart failure cells”. Sign of chronic heart failure. Increased capillary pressures and small hemorrhages result from pulm congestion and you see these cells
red/brown cells

Question 31

Chronic right heart failure (hepatic into IVC)

Answer 31

Chronic liver congestion (Nutmeg liver) is caused by

Pressure backup causes necrosis

Question 32

Splenic congestion

Answer 32

Obstruction at level of portal vein leads to congestion where?

Question 33

Centrolobular liver congestion

Answer 33

Obstruction at the level of the right heart or central vein causes congestion where?

Question 34

Pulm congestion with hemosiderin macrophages

Answer 34

Obstruction at level of pulm veins/left heart causes

Question 35

Hematoma

Answer 35

Clot outside a vessel

Question 36

Endothelial injury, hypercoagulability, abnormal blood flow (stasis)

Answer 36

Virchow’s triad of prothombotic factors

Question 37

Systemic embolism

Answer 37

Embolism usually from cardiac source (valves, ventricles) or iatrogenic (therapeutic tumor embolization)

Question 38

Pulmonary embolism

Answer 38

Source of embolism usually in leg veins. Most common embolus the causes symptoms

Question 39

Paradoxical embolism

Answer 39

Embolism with venous source that ends up in brain. Crosses oval foramen to reach systemic circulation

Question 40

Shock

Answer 40

Systemic hypotension resulting in tissue hypoperfusion and hypoxia