Chapter 8 Blood vessel disorders Flashcards
B/n arteries and veins which is more subject to disease?
Arteries because they contain much higher pressure than veins
Blood pressure
a product of cardiac output & vascular resistance
Which organ plays a major role in Blood Pressure?
○ Kidneys
If pressure falls, blood vessels constrict, including those of the kidney
Atherosclerosis: Determinants
○ begins in the crib and progresses with age
○ begins with vascular endothelial cell damage and associated inflammation
accelerated by life-style
Vascular disease is strongly associated with
○ Smoking
○ High blood pressure
○ Familial genetic influence
Atherosclerosis
○ is a lifestyle disease related to smoking, lack of exercise, obesity, and a high-fat diet
○ Characterized by chronic inflammation, scarring, and cholesterol deposits in large and medium size arteries
○ accounts for about one third of the deaths in the industrialized world
Arteriolosclerosis
○ a disease of small blood vessels that occurs mainly in patients with hypertension and diabetes
○ inflammation, scarring, and cholesterol are not significant factors
○ kidneys, retina, and small vessels in the legs and feet are most often affected
Two types of arteriolosclerosis
Hyaline arteriolosclerosis & Hyperplastic arteriolosclerosis
Hyaline arteriolosclerosis
○ a homogenous thickening of arteriolar walls
○ is an inevitable part of the aging process
○ it is accentuated by hypertension and diabetes
○ detected in the afferent arterioles
Hyperplastic arteriolosclerosis
○ hyperplasia of cells in arteriolar walls, mainly
○ seen in the kidneys in very severe (malignant) hypertension
○ Malignant hypertension is very high blood pressure that comes on suddenly and quickly
Atheroma
○ the basic lesion of atherosclerosis
○ Tend to obstruct arterial blood flow and cause hypoxia of downstream tissue (ischemia)
○ Weaken the arterial wall
○ Cause dilation and possible aneurysm
Takes decades before they become symptomatic
the initial and most crucial lesion in the pathogenesis of atherosclerosis
Endothelial cell damage
Which is an important element in the development of Atherosclerosis?
Cholesterol
Which cell is important in the development of Atherosclerosis?
Arterial smooth muscle cells
Risk Factors for Atherosclerosis
○ Age
○ Sex
○ Genetics
○ Cholesterol
○ Hypertension
○ Smoking
○ Diabetes
○ Homocysteine
○ C-reactive protein
Optimal blood pressure
○ systolic 120 mm hg
○ diastolic 80 mm hg
○ or 120/80
Normal BP
130/85
Hypertension BP
systolic over 140 or diastolic over 90 mm hg
Essential (primary) Hypertension
○ 90% of the hypertension
○ Cause unknown, however the kidney is the prime suspect
Hypertension can do what with atherosclerosis?
initiate atherosclerosis or accelerate existing atherosclerosis
Nephrosclerosis
normal wear and tear change that gradually increases with age
Secondary hypertension may be caused by
○ Pheochromocytoma of the adrenal medulla
○ Tumor or hyperplasia of the adrenal cortex
○ Renal disease- disease of renal arteries that impairs renal blood flow
Severe hypertension may cause
○ impaired vision subsequent to retinal disease
○ seizure when intracranial blood pressure (hypertensive encephalopathy), is increased
Patients with significant nephrosclerosis may have
blood or protein in the urine and increased blood urea nitrogen (BUN) and creatinine
Aneurysm
a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out
cerebral aneurysm
When an aneurysm occurs in a blood vessel of the brain
Dissecting hematoma
○ longitudinal tearing within the wall of an artery, most often the aorta
○ caused by blood that enters the wall through a defect in the lining
LaPlace’s Law
The larger the vessel radius, the larger the wall tension required to withstand a given internal fluid pressure
Symptoms of cerebral aneurysm
○ “leak” a small amount of blood
○ severe headache that a patient may describe as “the worst headache of my life.”
Vasculitis
a general term that applies to a group of uncommon diseases that feature inflammation of blood vessels, especially arteries
Necrotizing vasculitis
vasculitis with acute inflammation so intense that the vessel dies (necrosis)
Polyarteritis nodosa
a distinctive clinical syndrome featuring autoimmune vasculitis of small to medium size vessels
Takayasu arteritis
○ large vessel vasculitis
○ granulomatous inflammation in the aorta and main branches
Temporal arteritis
○ AKA giant cell arteritis
○ chronic inflammation of the temporal and cranial arteries
Thromboangiitis abliterans
○ affects small vessels in the hand and feet
○ Most common in young cigarette smokers
○ frequently leads to ulcers or gangrene of the fingers and toes
Raynaud phenomenon
○ a common condition, usually of the hands and fingers
○ Small blood vessels exhibit exaggeration of normal vasoconstriction and vasodilation reactivity to cold or emotional stress
○ fingers blanches at the tip
varicosity
○ abnormally dilated vein
○ Superficial veins are more often affected
○ Leg veins are most susceptible
Hemorrhoids
○ varicose veins of the anus
○ drain into the portal system and be seen in conjunction with cirrhosis of the liver and portal venous hypertension
lymphatics
Tumors of blood vessels
Karposi sacroma
a malignant vascular tumor caused by an uncommon type of herpesvirus infection
Angiosarcoma
a rare malignant tumor of vascular endothelial cells that can occur in almost any part of the body
