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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
Q

How do you treat temporal arteritis

A

1, Seek advice

  1. Treat urgently with oral steroids (glucocorticoids)
  2. Investigate further to confirm diagnosis
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26
Q

Name 2 techniques we use to confirm diagnosis of temporal arteritis

A
  1. Blood tests

2. Temporal artery Biopsy

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27
Q

Give examples of blood tests we can take to confirm a diagnosis of temporal arteritis

A
  1. Inflammatory markers eg ESR, CRP would be raised
  2. Haematology (look for normochormic normocytic anaemia)
  3. Liver function tests
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28
Q

How much artery do we need to be able to carry out a temporal artery biopsy? why?

A

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

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29
Q

Describe the histology of giant cell arteritis

A
  1. Intimal thickening
  2. Decreased lumen diameter
  3. IEL destruction
  4. Granulomatous inflammation
  5. Giant cells
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30
Q

What does giant cell arteritis lead to?

A

Vascular occlusion

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31
Q

Talk thorough the steps that lead to tissue damage and death due to giant cell arteritis

A
  1. Chronic granulomatous inflammation
  2. Thickens walls of artery
  3. Narrows lumen
  4. Reduced blood flow
  5. Ischaemia
  6. Tissue damage/ tissue death
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32
Q

Why Is it important to correctly diagnose giant cell arteritis quickly

A

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

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33
Q

What is an aneurysm

A

Localised, permanent abnormal dilatations of blood vessels

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34
Q

List the different types of aneurysms

A
  1. Atherosclerotic
  2. Dissecting
  3. Berry
  4. Microaneurysm
  5. Syphilitic
  6. Mycotic
  7. False
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35
Q

Name the 2 types of aneurysms we characterise by shape

A
  1. Saccular aneurysm

2. Fusiform aneurysm

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36
Q

Name the most common type of aneurysm

A

Atherosclerotic aneurysm

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37
Q

What is the main risk factor for rupture of Atherosclerotic aneurysms?

A 
Size of the aneurysm: 
<4cm 0.01%
4-5cm 1%
5-6cm 11%
>6cm 25%
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38
Q

How do we detect ruptured aneurysms?

A

By USS

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39
Q

How can ruptured aneurysms be repaired?

A

Endovascularly

40
Q

What are some complications associated with Atherosclerotic aneurysms

A
  1. Rupture causing retroperitoneal haemorrhage

2. Embolisation causing limb ischaemia

41
Q

What are dissecting aneurysms

A

When the blood traps into the vessel wall between the media and externa

42
Q

What is a berry aneurysms

A

A small secular lesion that develops in the circle of willis

43
Q

Where do berry aneurysms forms

A

Develop at sites of medial weakness at arterial bifurcations in the circle of willis

44
Q

In whom are berry aneurysms more common

A

Commonly found in young hypertensive patients

45
Q

What can happen if a berry aneurysm ruptures?

A

Can lead to subarachnoid haemorrhage

46
Q

What are micro aneurysms

A

Aneurisms that occur in intracerebral capillaries in hypertensive disease

47
Q

What is another name for micro aneurysms?

A

Charcot Bouchard aneurysms

48
Q

What can rupture of micro aneurysms lead to?

A

Intracerebral haemorrhage (ie stroke)

49
Q

When do syphilitic aneurysms occur?

A

In tertiary syphilis

50
Q

What do syphilitic aneurysms involve

A

Ascending thoracic aorta

51
Q

What can syphilitic aneurysms cause?

A

Ischaemic medial damage, fibrosis and loss of elasticity

52
Q

What are mycotic aneurysms

A

Weakening of arterial walls secondary to bacterial/ fungal infections
These are rare
Organisms can enter media from the vasa vasorum

53
Q

What is a false aneurysm

A

When blood fills space around the vessel usually following traumatic rupture or perforating injury

54
Q

Which tissue is affected by false aneurysms

A

The adventitial fibrous tissue contain the haematoma

55
Q

What is thrombosis

A

The inappropriate activation of normal haemostatic mechanisms which results in the formation of a thrombus

56
Q

What is thrombus

A

Structured solid mass or plug of blood constituents formed within the heart of blood vessels during life

57
Q

Name the 3 factors that contribute to thrombosis (hint virchows triad)

A
  1. Endothelial injury
  2. Hyper coagulability
  3. Abnormal blood flow
58
Q

Name the DOMINANT mechanism needed for thrombosis to occur

A

Endothelial damage

59
Q

Give examples of endothelial damage

A

Atheroscleotic plaque rupture

Exposure of ECM

60
Q

Give an example of a type of abnormal blood flow that can lead to thrombosis

A

Non laminar flow

61
Q

Why is non laminar flow dangerous

A

Platelets contact with vessel wall leading to concentration of clotting factor increasing and EC activation

62
Q

How do we describe abnormal blood flow in the venous system

A

Stasis

63
Q

How do we describe abnormal blood flow in the arterial system

A

Turbulence

64
Q

What is the dominant mechanisms causing venous thrombosis

A

Stasis

65
Q

Where does venous thrombosis occur?

A

Occurs at sites of stasis eg deep veins of the legs

66
Q

What is arterial thrombosis a combination of?

A

Endothelial injury and/ or abnormal Flow (turbulence)

67
Q

What is another name for arterial thrombosis

A

Cardiac thrombosis

68
Q

Where does arterial thrombosis occur?

A
  1. Sites of endothelial injury eg atherosclerosis

2. Sites of turbulent blood flow eg bifurcation, prosthetic valve

69
Q

What can happen after thrombosis

A 
1. Propagation 
2 Dissolution 
3. Organisation 
4. Recanalisation 
5. Embolisation
70
Q

What is embolisation?

A

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
Q

What is embolism?

A

The impaction of an embolus in a vessel whose calibre is too small to allow the embolus to pass leading to vascular occlusion

72
Q

What can embolism cause?

A

Tissue damage and vascular occlusion

73
Q

What are almost all emboli?

A

Thromboemboli

74
Q

What is a Thromboemboli?

A

An embolus that is derived from part of a dislodged thrombus

75
Q

Name some different types of emboli

A
  1. Thromboemboli
  2. Venous emboli
  3. Arterial emboli
  4. Paradoxical
76
Q

What are venous emboli and where are they found?

A

They are emboli found in the venous system most commonly the legs
Can lead to pulmonary embolisms

77
Q

What are arterial emboli and where are they found?

A

They are emboli found in the arterial system eg brain, limbs, organs etc

78
Q

What is a paradoxical embolism?

A

When you have an embolus arising in the venous system that bypasses the lungs and reaches the heart

79
Q

How many deaths a yr in the UK are caused by pulmonary embolism

A

60,000

80
Q

What is the risk of death for a patient with UNTREATED pulmonary embolism

A

87%

81
Q

Where does the thrombus that causes pulmonary embolism come from

A

95% come from venous thrombosis in deep veins of the leg or pelvis (deep vein thrombosis)

82
Q

What causes pulmonary embolisms

A

Blood clots that occlude the large pulmonary arteries are virtually always thromboembolic (DVT) in origin

83
Q

What is a classic history for a patient with pulmonary embolism

A
  1. 5 days post hip replacement
  2. Sudden onset
  3. Dyspnoea
  4. Hypoxia
  5. Tachycardia
84
Q

Stasis is used to describe what?

A

Abnormal blood flow in the venous system

85
Q

What is Dyspnoea?

A

Shortness of breath

86
Q

What determines if a pulmonary embolism is fatal or not?

A

The size of the vessel that is blocked

87
Q

Name the artery that if affected by a pulmonary embolism can be fatal?

A

Main pulmonary artery

88
Q

What happens to a patient if they collapse from pulmonary embolism and you are doing CPR on them?

A

They go into pulseless electrical activity as the blood has no where to go but the heart won’t stop beating

89
Q

What happen if smaller vessels are occluded by a pulmonary embolism?

A

Can lead to Dyspnoea/ pleuritic chest pain

90
Q

What is pleuritic chest pain?

A

Breath catching (sharp pain) when you try and take a deep breath

91
Q

How can you reduce the chance of pulmonary embolism

A
  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
Q

What are TED stocking?

A

ThromboEmbolic Device/ Deterrent

They are graduated compression stockings

93
Q

Where do systemic thromboembolisms occur?

A

In arterial circulation

94
Q

Where do the majority of thrombi that cause systemic thromboembolisms come from

A

80% come from intra cardiac mural thrombi (the heart from myocardial infarction, atrial fibrillation)

95
Q

Turbulence is used to describe what?

A

Abnormal blood flow in the arterial system

96
Q

Other than cardiac mural thrombi where else can systemic thromboembolism come from?

A
  1. Aortic aneurysm thrombus
  2. Atherosclerotic thrombus
  3. Paradoxical embolism
97
Q

What can systemic thromboembolism cause?

A

Ischaemic injury in the limbs, brain etc

3rd yr- IWB- Pathology (11 decks)

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