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Spp Amp > Cvs: aneurysm > Flashcards

Cvs: aneurysm Flashcards

1
Q

An aneurysm is a ________ __________ of an artery caused by _________________________, forming a swelling along the course of the artery or a______ communicating with an artery.

A

localized dilatation
stretching of the wall
cavity

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2
Q

CLASSIFICATION of an aneurysm is based on 2 things?

A

• Based on the composition of wall
• Based on the shape

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3
Q

A. Based on the composition of wall, we have

A

True aneurysm and false aneurysm

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4
Q

a true aneurysm is that in which?

4 examples include?

A

the sac is formed by the of vessel or the attenuated wall of the heart

e.g,
atherosclerotic
syphilitic
congenital
ventricular aneurysm in myocardial infarction.

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5
Q

• False aneurysm is one in which the sac is formed by

Example include?

It contains either _______ or ______

A

the surrounding structure

e.g
extra vascular haematoma (pusatile haematoma)

it contains either haemorrhagic fluid or blood.

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6
Q

B. Based on the shape we have 5 types

{Save Seat For Coming Congregation}

A
  1. Saccular aneurysm
  2. Fusiform aneurysm
  3. Cricoid or racemose aneurysm
  4. Cylindrical aneurysm
  5. Serpentine or varicose aneurysm
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7
Q

Sacular aneurysm represents a_____ dilatation, which bulges from _______ of the artery and may be connected to it by a small ______.

A

sac-like
one side
aperture

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8
Q

Fusiform aneurysm is __________ stretching of the circumference. The ________ & ________ of this type of aneurysm are variable.

A

asymmetrical
circumference and length

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9
Q

Cricoid’s or ________ aneurysm is a __________ swelling consisting of ________& dilated arteries and ______

A

racemose

pulsatile

tortuous

veins

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10
Q

Cylindrical aneurysm with a_______ parallel dilatation e.g ?

A

continuous

dissecting aneurysm.

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11
Q

Serpentine or _______ which has _______ dilatation of vessel

A

varicose

tortuous

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12
Q

AETIOLOGY of aneurysm 8

TIM SAM CD

A

•1. Atheromatous aneurysm
•2. Syphilitic aneurysm
•3. Dissecting aneurysm
• 4. Infection mycotic aneurysm
• 5. Congenital aneurysm
6. Micro aneurysm
7. Traumatic aneurysm
8. Mycotic aneurysm

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13
Q

Dissecting aneurysm types
HEM

A

a. Hypertension
b. Erdheim’s medial calcification
c. Marfan’s syndrome

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14
Q

Congenital aneurysm types

CC

A

a. Cerebral or berry aneurysm
b. Circoid or Racemose aneurysm

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15
Q

If artery dilation is aneurysm. Vein is ?

A

Varicose vein

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16
Q

_____ aneurysm is not the same size of dilatation

A

Fusiform

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17
Q

______ aneurysm moves with pulse

A

Pulsatile

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18
Q
  1. the most common cause of aneurysm is
    __________________
A

atherosclerosis: atheromatous aneurysm

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19
Q

Atheromatous aneurysm are more common in_____ after the age of.
They are ______ or _______.

A

male
50 years

fusiform or saccular

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20
Q

Atheromatous aneurysm are ____cm in greatest diameter and of variable length

most commonly occur in 6 places

A

15cms

Ascending aorta
arch of aorta
abdominal aorta
mesenteric artery.
renal artery
Common iliac artery

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21
Q

Pathogenesis of atheromatous aneurysm

A

the aneurysm forms as a results of weakening and thinning of media underlying atheromatous ulcer

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22
Q

Microscopy of atheromatous aneurysm:

wall of aneurysm consist of all the layers of____. There is atheroma with marked _____ and ______

later on 4 things which are?

A

aorta

leukocytic infiltration
Fatty debris

perianeurysmal lymphocytic infiltration
macrophages
giant cells
fibrosis.

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23
Q

Fate(effect) of Atheromatous aneurysm

CAR

A

I. Rupture
II Arterial occlusion
III compression of adjacent structures

24
Q

I. Rupture: the aneurysm may rupture while still small, into peritoneal cavity with _________ or _________haemorrhage causing acute surgical abdominal emergency. It gives rise to potentially fatal haemorrhage.

Death occurs from _______ that led to ______

A

retroperitoneal or intraperitoneal

Exsanguination
Hypovolemic shock

25
Q

• 2. Arterial occlusion:
Aneurysmal sac is filled with the thrombus causing ischaemia of leg either by occluding the ____ arteries. Obstruction _______, ______ or of _______ arteries (supplying the spinal cord)

occurs by _____ from atheroma.

There is ____________ of distal organ due to pressure effect

A

iliac
mesenteric
renal
vertebral

mural thrombus

Ischaemia/infarction

26
Q

III. Compression:
Abdominal aorta aneurysm causes compression of ureter or erosion. Impingement of vertebrae on adjacent structures such as, into peritoneal cavity. It presents as _____ _______ ______that simulates a _____

A

pulsatile abdominal mass

tumour

27
Q
  1. Syphilitic/ ______ aneurysm are most common in the _______ & _________ because it is most frequently affected by syphilitic ______.

Syphilitic aortitis is common above the age of ___years.

A

Leutic
ascending aorta and arch of aorta
mesoaortitis

40

28
Q

• Pathogenesis of syphilitic aneurysm
it is due to __________________ and _____________ resulting in weakening of the wall.

A

focal loss of elastic and muscles of media

29
Q

Gross pathology of syphilitic aneurysm

A

Gross:
The aneurysm may be fusiform or saccular.

Usually 3-5cm in diameter aneurysmal bulging gives rise to stellate scars.

Intima of the involved segment is pearly white, irregular and wrinkled- the appearance that has been likened to the bark of tree

30
Q

Microscopy of syphilitic aneurysm

A

Microscopically:
Earliest change is mesoaortitis. There is perivascular cuffing by lymphocytes, plasma cells and destruction of the elastic and muscle fibres of media

Due to the loss of elastic and muscle tissue in the media there is weakening of the wall, which may become dilated.

• As aneurysm from elastic tissues and muscles of the artery wall soon degenerates and sac comes to be composed of fibrous tissue.

31
Q

Fate or effect of syphilitic aneurysm

A

Cardiac dysfunction
Thrombosis
Pressure effect
Rupture

32
Q

Cardiac dysfunction: if dilatation of root of aorta occurs it results, in _______________. Owing to aortic insufficiency, the ________ wall can undergo massive volume overload hypertrophy.
Sometimes ____grams referred to as______.

A

aortic valve incompetence
left ventricular

1000 ( 400-450 is hypertension)
cow’s heart

33
Q

Thrombosis: laminated thrombus forms on roughened surface and clot incorporated with the wall of the sac. Blood may infiltrate in the wall of the aneurysm and ooze for some distance into the tissue around.

A
34
Q

• Pressure effect: the subjective effect symptoms are due to pressure surrounding structure leading to what syndrome?

A

(superior mediastinal compression syndrome).

35
Q

Rupture: Rupture of aneurysm results into an adjacent body cavity or any hollow viscous. it may rupture externally through the chest wall. Embolism is common. Laminated thrombus forms on roughened surface and clot incorporated with the wall of the sac.

A
36
Q

Syphilitic aneurysm
• Pain is due to

A

• - stretching of the wall
• - erosion of bodies of vertebrae and incorporation into the wall of the sac.
• - irritation of intercostals nerve roots.

37
Q

Syphilitic
• .Great veins may be displaced and undergo _______
• .Congestion of head and neck veins causes?
• .Pressure on major bronchus causes ______ and ________

A

thrombosis

engorgement of collateral veins.

chronic cough and suppurating bronchopneumonia.

38
Q

Syphilitic

• .Compression and stretching of ___________ causes paralysis of the left vocal cord and hoarsensess of voice.

• Sympathetic symptoms are _____,_____&______

• _________offer greater resistance to absorption and persist longer.

A

left recurrent laryngeal nerve

dilatation of pupil, retraction of upper eyelid and exophthalamos

Intervertebral discs

39
Q

• 3. Dissecting aneurysm
• Also know as ______ or _______. It is common in men, most often encountered between _____ years of age.
It is a true aneurysm T/F

A

aortic dissection or dissecting haematoma
40 -70

F

40
Q

In dissecting aneurysm There is a tear in inner part of wall of aorta through which blood enters and track between ______ & _____ of media dissecting the wall into inner and outer layer.

Initial tear usually occur in the ________ less than _____ in length usually ____ of the aortic valve but may involve whole circumference.

A

inner 2⁄3rd and outer 1/3rd

ascending aorta
5cm
10cm

41
Q

Complications or fate if dissecting aneurysm

A

I. Rupture
II. Cardiac disease

42
Q

• Rupture: in some cases the blood reaches the_____ and ruptures into pericardial cavity causing death from___________.

.

A

aorta ring
cardiac tamponade

{ring occurs when a part of the body’s main artery, called the aortic arch, or its branches form a ring around the trachea or esophagus or both.}

43
Q

It may track along the ______, __________________,_______ &______arteries and

rupture may result in fatal haemorrhages into
_____,______,_______ and______

A

arch, abdominal aorta mesenteric arteries; iliac arteries and renal arteries

mediastinum, pleura, retroperitoneal tissue and peritoneal cavity

44
Q

II. Cardiac disease: obstruction of coronaries results in __________. Involvement of aortic valve results in _________.

Occasionally second intimal tear is seen in distal part of the dissection so that the blood enters the false lumen through the proximal tear and reenters the true lumen through the distal tear, ________ aorta is formed

A

myocardial infarction
aortic incompetence

double barred

45
Q

Dissecting aneurysm
• Etiopathogenesis
1. Hypertension is associated with over ___% of cases.

  1. Weakening of the vessel wall of aorta is due to ___________ or ____________.
    There are degenerative and cystic changes in media , elastic and muscles being lost are replaced by _________ material. There are small areas of necrosis with softening.
A

90

cystic medial necrosis aka Erdheim’s media degeneration

metachromatic mucoid

46
Q

Dissecting aneurysm
• Etiopathogenesis

  1. • Similar morphological changes are also seen in the media in Marfan’s Syndrome. it is a ______________ disorder inherited as ________, characterized by inadequate elastic fiber formation of aorta, cardiovascular and ocular disturbances. Disturbance of vision results from ___________
  2. • Iatrogenic trauma as a complication of canalization during diagnostic catheterization or cardio-pulmonary bypass cause weakening of vessel wall.
A

connective tissue
autosomal dominant
subluxation of the lens

47
Q

Now list the 4 pathogenesis of dissecting aneurysm

A

Hypertension
Mariah syndrome
Iatrogenic trauma
Erdheim’s media degeneration

48
Q

AETIOLOGY
• 4. Infective mycotic aneurysm

• It may occur at the beginning of the aorta by direct extension of micro-organism from vegetations in acute bacterial endocarditis particularly _________. The organism settle on the intima, an infective thrombus forms, invasion and weakening of the wall follow and acute aneurysm is produced which may rupture.

A

staphylococcus aureus

49
Q

• In small arteries , infected emboli in the lumen of the artery may give rise to acute inflammatory softening with rupture and? .
• A mycotic aneurysm is sometimes seen in the wall of ________ pulmonary cavity which may cause fatal haemorrhage.

A

cerebral haemorrhage

tuberculous

50
Q

Congenital aneurysm
a. Cerebral or berry aneurysm
• : berry aneurysm are small, ______ lesion like a blue berry, normally ___ in diameter, which bulges out from one side of an artery.

They are important only in the ______. Berry aneurysm occurs in _%of people. They are rarely found in people less than _ years old.

A

spheroid
1cm

cerebral artery
5%
30

51
Q

LESION: over 80% berry aneurysm of the cerebral arteries occur in ________
____% of patient with berry aneurysm have congenital weakness of the arterial wall. Over ____of patients are hypertensive.

A

Circle of Willis.
1 to2%
50%

52
Q

Complication/fate of berry aneurysm

• Rupture: causes ?
• Space occupying lesion: A berry aneurysm up to ___cm across and acts as a space-occupying lesion.
• Thrombosis: occasionally a berry aneurysm becomes filled with thrombus.

A

subarachnoid haemorrhages
10cm

53
Q
  1. Congenital aneurysm
    b. _______or Racemose aneurysm
    Local malformations of the blood vessels often with abnormal connection between ———-&——— occur in many part of the body, known as ________ aneurysm or circoid aneurysm from the greek for a varicosity of vein.

Commonest site is _____ and congenital in origin. It may occur as a result of ________.

A

Circoid
arteries and veins
arteriovenous

Scalp
Brain injury

54
Q
  1. Micro aneurysm
    • multiple microaneurysm occur on the small ______ in hypertenive subjects above the age of ____years. They are multiple, ____in diameter.
A

arterial twigs
50
2mm

55
Q

• 7. Traumatic aneurysm
• rupture of aorta may results from damage of its wall from outside, as by the perforation of an impacted fish-bone or other sharp foreign body in the esophagus, also from very severe injury such as crushing of the chest. Injury to arterial wall occur in stab injury or bullet wound.
Carcinoma of bronchus or esophagus may invade the aortic wall and cause fatal haemorrhage.

A

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