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3rd yr- IWB- Pathology > Circulatory disorders > Flashcards

Circulatory disorders Flashcards

1
Q

Name the 3 layers that make up an artery

A
  1. Tunica intima (innnermost)
  2. Tunica media
  3. Tunica adventitia (outermost)
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2
Q

What is atherosclerosis?

A

Slow progressive intimal disease of large to medium sized muscular and elastic arteries

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3
Q

What does atherosclerosis result in?

A

Results in elevated/ occlusal intimal based lesions (Plaque)

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4
Q

What is an intimal based lesion made up of?

A

Lipids, proliferating smooth muscle cells and extra cellular matrix

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5
Q

What is atherosclerosis usually an underlying pathogenesis for?

A

Coronary, cerebral and peripheral vascular disease

cause for 50 % of all deaths in the west

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6
Q

What can risk factors of atherosclerosis be split into?

A

Non modifiable

Modifiable

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7
Q

List some non modifiable risk factors for atherosclerosis

A
  1. Genetic abnormalities
  2. Family history
  3. Increasing age
  4. Male gender
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8
Q

List some modifiable risk factors for atherosclerosis

A
  1. Hyperlipdemia
  2. Hyper tension
  3. Cigarette smoking
  4. Diabetes
  5. inflammation
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9
Q

What is atherosclerosis a response to?

A

It is a chronic inflammatory healing response to blood vessel injury

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10
Q

Go through the stages that lead to atherosclerosis

A
  1. Damage to blood vessels due to higher BP or substances like toxins in body
  2. Endothelial damage
  3. Monocyte/ platlet adhesion
  4. Macrophage activation. Smooth muscle recruitment
  5. Macrophage and smooth muscle increase lipid take and T cells are activated
  6. Increased smooth muscle leading the formation of plaque in the blood vessel
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11
Q

What are the consequences of plaque formation in blood vessels?

A
  1. Critical stenosis
  2. Occlusion by thrombus (plaque rupture)
  3. Aneurysm and rupture of blood vessel as it is weakened
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12
Q

What can atherosclerosis result in?

A
  1. Gradual mechanical obstruction to flow
  2. Sudden plaque rupture leading to thrombosis and occlusion
  3. Weakening of vessels leading to aneurysm
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13
Q

What are the major clinical consequences of atherosclerosis

A
  1. Angina
  2. Ischaemia heart disease
  3. Myocardial infarction
  4. Cerebrovascular disease (Stroke)
  5. Aortic aneurysm
  6. Mesenteric bowel ischaemia
  7. Peripheral vascular disease
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14
Q

List some age related vascular changes

A
  1. Fibrous thickening of intima
  2. Fibrosis of muscular media
  3. Fragmentation of elastic laminae
  4. Calcification
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15
Q

Define diabetes

A

A metabolic disorder characterised by hyperglycaemia

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16
Q

What can cause hyperglycaemic vascular damage?

A
  1. Production of reactive oxygen species (ROS)
  2. Decreased availability of nitric oxide (NO)
  3. Formation of advanced glycation end products (AGEs)
  4. Activation of inflammatory pathways
  5. Promotion of thrombosis and atherosclerosis
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17
Q

What is another name for giant cell arteritis?

A

Temporal/ cranial arteritis

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18
Q

What is giant cell arteritis

A

Chronic vasculitis of large and medium sized vessels

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19
Q

Who does vasculitis occur in most commonly?

A
  1. Mean age of 72 (virtually never occurs in <50)

2, Happens in the branches of the aorta

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20
Q

Give some signs and symptoms of giant cell arteritis

A
  1. Headache- classical temporal tenderness
  2. Jaw claaudication
  3. Visual symptoms such as amaurosis fugax
  4. Fever, fatigue
  5. polymyalgia rheumatica
  6. Muscloskeletal
  7. Other symptoms depending on the vessel involved
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21
Q

What can amaurosis fugax cause?

A

Blindness

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22
Q

What are the most common symptoms of polymyalgia rheumatica

A

Characteristically present in older women who find it difficult to lift their arms over their head

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23
Q

What is vasculitis

A

Inflammation of blood vessels

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24
Q

Give examples of temporal artery abnormalities

A
  1. Prominent enlarged temporal artery
  2. Temporal artery tenderness
  3. Absent temporal artery pulse
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25
How do you treat temporal arteritis
1, Seek advice 2. Treat urgently with oral steroids (glucocorticoids) 3. Investigate further to confirm diagnosis
26
Name 2 techniques we use to confirm diagnosis of temporal arteritis
1. Blood tests | 2. Temporal artery Biopsy
27
Give examples of blood tests we can take to confirm a diagnosis of temporal arteritis
1. Inflammatory markers eg ESR, CRP would be raised 2. Haematology (look for normochormic normocytic anaemia) 3. Liver function tests
28
How much artery do we need to be able to carry out a temporal artery biopsy? why?
1cm or longer because the inflammatory process within the blood vessels is not continuous so you need a large chunk to see if even a small area is inflamed
29
Describe the histology of giant cell arteritis
1. Intimal thickening 2. Decreased lumen diameter 3. IEL destruction 4. Granulomatous inflammation 5. Giant cells
30
What does giant cell arteritis lead to?
Vascular occlusion
31
Talk thorough the steps that lead to tissue damage and death due to giant cell arteritis
1. Chronic granulomatous inflammation 2. Thickens walls of artery 3. Narrows lumen 4. Reduced blood flow 5. Ischaemia 6. Tissue damage/ tissue death
32
Why Is it important to correctly diagnose giant cell arteritis quickly
Can affect the central or branches of the retinal arterial occlusion Can lead to permanent partial or complete loss of vision in 1 or 2 eyes
33
What is an aneurysm
Localised, permanent abnormal dilatations of blood vessels
34
List the different types of aneurysms
1. Atherosclerotic 2. Dissecting 3. Berry 4. Microaneurysm 5. Syphilitic 6. Mycotic 7. False
35
Name the 2 types of aneurysms we characterise by shape
1. Saccular aneurysm | 2. Fusiform aneurysm
36
Name the most common type of aneurysm
Atherosclerotic aneurysm
37
What is the main risk factor for rupture of Atherosclerotic aneurysms?
``` Size of the aneurysm: <4cm 0.01% 4-5cm 1% 5-6cm 11% >6cm 25% ```
38
How do we detect ruptured aneurysms?
By USS
39
How can ruptured aneurysms be repaired?
Endovascularly
40
What are some complications associated with Atherosclerotic aneurysms
1. Rupture causing retroperitoneal haemorrhage | 2. Embolisation causing limb ischaemia
41
What are dissecting aneurysms
When the blood traps into the vessel wall between the media and externa
42
What is a berry aneurysms
A small secular lesion that develops in the circle of willis
43
Where do berry aneurysms forms
Develop at sites of medial weakness at arterial bifurcations in the circle of willis
44
In whom are berry aneurysms more common
Commonly found in young hypertensive patients
45
What can happen if a berry aneurysm ruptures?
Can lead to subarachnoid haemorrhage
46
What are micro aneurysms
Aneurisms that occur in intracerebral capillaries in hypertensive disease
47
What is another name for micro aneurysms?
Charcot Bouchard aneurysms
48
What can rupture of micro aneurysms lead to?
Intracerebral haemorrhage (ie stroke)
49
When do syphilitic aneurysms occur?
In tertiary syphilis
50
What do syphilitic aneurysms involve
Ascending thoracic aorta
51
What can syphilitic aneurysms cause?
Ischaemic medial damage, fibrosis and loss of elasticity
52
What are mycotic aneurysms
Weakening of arterial walls secondary to bacterial/ fungal infections These are rare Organisms can enter media from the vasa vasorum
53
What is a false aneurysm
When blood fills space around the vessel usually following traumatic rupture or perforating injury
54
Which tissue is affected by false aneurysms
The adventitial fibrous tissue contain the haematoma
55
What is thrombosis
The inappropriate activation of normal haemostatic mechanisms which results in the formation of a thrombus
56
What is thrombus
Structured solid mass or plug of blood constituents formed within the heart of blood vessels during life
57
Name the 3 factors that contribute to thrombosis (hint virchows triad)
1. Endothelial injury 2. Hyper coagulability 3. Abnormal blood flow
58
Name the DOMINANT mechanism needed for thrombosis to occur
Endothelial damage
59
Give examples of endothelial damage
Atheroscleotic plaque rupture | Exposure of ECM
60
Give an example of a type of abnormal blood flow that can lead to thrombosis
Non laminar flow
61
Why is non laminar flow dangerous
Platelets contact with vessel wall leading to concentration of clotting factor increasing and EC activation
62
How do we describe abnormal blood flow in the venous system
Stasis
63
How do we describe abnormal blood flow in the arterial system
Turbulence
64
What is the dominant mechanisms causing venous thrombosis
Stasis
65
Where does venous thrombosis occur?
Occurs at sites of stasis eg deep veins of the legs
66
What is arterial thrombosis a combination of?
Endothelial injury and/ or abnormal Flow (turbulence)
67
What is another name for arterial thrombosis
Cardiac thrombosis
68
Where does arterial thrombosis occur?
1. Sites of endothelial injury eg atherosclerosis | 2. Sites of turbulent blood flow eg bifurcation, prosthetic valve
69
What can happen after thrombosis
``` 1. Propagation 2 Dissolution 3. Organisation 4. Recanalisation 5. Embolisation ```
70
What is embolisation?
Formation of a detached intravascular solid, liquid or gaseous mass that is carried by the blood to ta site distant from its point of origin
71
What is embolism?
The impaction of an embolus in a vessel whose calibre is too small to allow the embolus to pass leading to vascular occlusion
72
What can embolism cause?
Tissue damage and vascular occlusion
73
What are almost all emboli?
Thromboemboli
74
What is a Thromboemboli?
An embolus that is derived from part of a dislodged thrombus
75
Name some different types of emboli
1. Thromboemboli 2. Venous emboli 3. Arterial emboli 4. Paradoxical
76
What are venous emboli and where are they found?
They are emboli found in the venous system most commonly the legs Can lead to pulmonary embolisms
77
What are arterial emboli and where are they found?
They are emboli found in the arterial system eg brain, limbs, organs etc
78
What is a paradoxical embolism?
When you have an embolus arising in the venous system that bypasses the lungs and reaches the heart
79
How many deaths a yr in the UK are caused by pulmonary embolism
60,000
80
What is the risk of death for a patient with UNTREATED pulmonary embolism
87%
81
Where does the thrombus that causes pulmonary embolism come from
95% come from venous thrombosis in deep veins of the leg or pelvis (deep vein thrombosis)
82
What causes pulmonary embolisms
Blood clots that occlude the large pulmonary arteries are virtually always thromboembolic (DVT) in origin
83
What is a classic history for a patient with pulmonary embolism
1. 5 days post hip replacement 2. Sudden onset 3. Dyspnoea 4. Hypoxia 5. Tachycardia
84
Stasis is used to describe what?
Abnormal blood flow in the venous system
85
What is Dyspnoea?
Shortness of breath
86
What determines if a pulmonary embolism is fatal or not?
The size of the vessel that is blocked
87
Name the artery that if affected by a pulmonary embolism can be fatal?
Main pulmonary artery
88
What happens to a patient if they collapse from pulmonary embolism and you are doing CPR on them?
They go into pulseless electrical activity as the blood has no where to go but the heart won't stop beating
89
What happen if smaller vessels are occluded by a pulmonary embolism?
Can lead to Dyspnoea/ pleuritic chest pain
90
What is pleuritic chest pain?
Breath catching (sharp pain) when you try and take a deep breath
91
How can you reduce the chance of pulmonary embolism
1. On flights move around and drink plenty of water 2. TED stockings 3. Anti coagulation eg heparin, aspirin 4. IVC filter (green field filter)
92
What are TED stocking?
ThromboEmbolic Device/ Deterrent | They are graduated compression stockings
93
Where do systemic thromboembolisms occur?
In arterial circulation
94
Where do the majority of thrombi that cause systemic thromboembolisms come from
80% come from intra cardiac mural thrombi (the heart from myocardial infarction, atrial fibrillation)
95
Turbulence is used to describe what?
Abnormal blood flow in the arterial system
96
Other than cardiac mural thrombi where else can systemic thromboembolism come from?
1. Aortic aneurysm thrombus 2. Atherosclerotic thrombus 3. Paradoxical embolism
97
What can systemic thromboembolism cause?
Ischaemic injury in the limbs, brain etc

3rd yr- IWB- Pathology (11 decks)

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