gen path final pt2 Flashcards
ARTERIOSCLEROSIS
category
etiology
demographics
CATEGORY
* Injury
ETIOLOGY
* “Hardening of the arteries”
* Arterial wall thickening
* Loss of elasticity
DEMOGRAPHICS
* Virtually ubiquitous in developed nation
arteriosclerosis
clinical presentation
diagnose
treatment
CLINICAL PRESENTATION
* Generally asymptomatic
DIAGNOSIS
* Imaging
TREATMENT
* Dependent on cause
* Atherosclerosis is most common cause
ATHEROSCLEROSIS
category
etiology
demographics
CATEGORY
* Injury
ETIOLOGY
* Atheromatous plaques on vessel walls impinge on lumen
* Necrotic lipid core (cholesterol)
* Can calcify
DEMOGRAPHICS
* Virtually ubiquitous in developed nations
* Risk factors:
* Genetic abnormalities
* Family history
* Increasing age
* Male gender
* Hyperlipidemia
* Hypertension
* Cigarette smoking
* Diabetes
* Inflammatio
ATHEROSCLEROSIS
clinical presentation
diagnose
treatment
CLINICAL PRESENTATION
* Generally asymptomatic
DIAGNOSIS
* Coronary calcium scan
* Other imaging
* Often a presumed diagnosis
TREATMENT
* Tackle the modifiable risk factors
* Reduce cholesterol in diet
* Increase omega-3 fatty acid intake
* Exercise
* Statins and other cholesterol-lowering medications
* Treat hypertension if present
* Smoking cessation
* Treat diabetes if presen
ATHEROSCLEROSIS - PATHOGENESIS
- Chronic damage to endothelium
- Increased permeability
- Lipids can leak into intima
- Inflammatory response makes
damaged endothelium “sticky” - Leukocyte and monocyte adhesion
- Macrophages ingest lipids, creating
foam cells - Smooth muscle proliferation
- Collagen and ECM deposition
Sequelae of atherosclerosis are most common cause of death in the US
t/f
TRUE
ATHEROSCLEROSIS – POSSIBLE SEQUELAE
- Stenosis
- Occlusion of the vessel
- Can cause ischemia
- Angina (coronary arteries)
- Ischemic bowel disease
- Plaque rupture or erosion
- Cause thrombosis
- Myocardial infarction (coronary arteries)
- Stroke (cerebral artery)
- Weaken medial wall
- Can cause aneurysm
What is the primary component of atherosclerotic
plaques?
Lipid-laden macrophages
(foam cells)
THROMBOSIS
category
etiology
demographics
CATEGORY
* Injury
ETIOLOGY
* Complete or partial obstruction of a vessel by a blood clot
* Virchow’s triad
* Endothelial injury
* Stasis or turbulent blood flow
* Hypercoagulability
DEMOGRAPHICS
* More common in older adults
* Risk factors
* Atherosclerosis
* Immobility
THROMBOSIS
clinical presentation
diagnose
treatment
CLINICAL PRESENTATION
* Arterial thrombosis
* Ischemia and infarction of tissue downstream
* Myocardial infarction (heart), stroke (brain), peripheral artery
disease (limbs)
* Venous thrombosis
* Pain, swelling, and redness of affected limb (deep vein
thrombosis)
* Risk of pulmonary embolism
DIAGNOSIS
* Imaging (ultrasound, CT, or MRI angiograph)
TREATMENT
* Anticoagulation therapy
* Thrombolytic therapy
* Surgical intervention
* Risk factor modification
* Smoking cessation
* Hypertension management
* Hyperlipidemia management
HYPERLIPIDEMIA.
category
etiology
demographics
CATEGORY
* Metabolic
ETIOLOGY
* Elevated levels of lipids in the blood
* Primary (genetic)
* Secondary (diabetes, obesity, lifestyle factors)
DEMOGRAPHICS
* Common in adults
* More prevalent with:
* Increasing age
* Poor dietary habits
* Lack of physical activity
HYPERLIPIDEMIA
clinical presentation
diagnose
treatment
CLINICAL PRESENTATION
* Often asymptomatic
* Heart attack, stroke
* Xanthelasma can be a clinical sign
DIAGNOSIS
* Lipid panel
* Total cholesterol
* Low-density lipoprotein (LDL) “bad”
* High-density lipoprotein (HDL) “good”
* Triglycerides
TREATMENT
* Lipid-lowering medications (statins)
* Lifestyle modifications
* Reduced intake of saturated fats, trans fats, and cholesterol
* Increased intake of fiber and omega-3 fatty acid
HYPERLIPIDEMIA
Which of the following is considered “bad
cholesterol” and is associated with an increased risk
of atherosclerosis?
LDL
AORTIC DISSECTION
category
etiology
demographics
CATEGORY
* Injury
ETIOLOGY
* Tear in intimal layer of aorta
* Blood flows between layers of vessel wall
DEMOGRAPHICS
* More common in males from 40-60 years of age
* Young patients with connective tissue abnormalities (Marfan
syndrome)
* Risk factors
* Hypertension
* Smoking
* Marfan syndrome
AORTIC DISSECTION
clinical presentation
diagnose
treatment
CLINICAL PRESENTATION
* Sudden onset severe chest pain
* May radiate to back
DIAGNOSIS
* CT angiography
TREATMENT AND PROGNOSIS
* Rapid blood pressure control
* Surgical repair
* 65-85% success rate
ANEURYSM
category
etiology
demographics
clinical presentation
diagnose
treatment
CATEGORY
* Developmental or injury
ETIOLOGY
* Dilation of blood vessels or the heart
* Occur when structural integrity of arterial media is
compromised
DEMOGRAPHICS
* Inadequate connective tissue synthesis
* Genetic conditions
* Excessive connective tissue degradation
* Increased MMPs in atherosclerotic plaques
* Loss of smooth muscle cells or change in phenotype
* Atherosclerosis
* Hypertension
CLINICAL PRESENTATION
* Dependent on location
DIAGNOSIS
* Dependent on location
TREATMENT
* Dependent on location
ABDOMINAL AORTIC ANEURYSM
category
etiology
demographics
CATEGORY
* Injury or developmental
ETIOLOGY
* Localized dilation of abdominal aorta
* Most often due to atherosclerosis
* Less common causes include genetic conditions, infection,
and trauma
DEMOGRAPHICS
* Older men (over 50)
* Risk factors
* Smoking
* Atherosclerosis
* Hypertension
ABDOMINAL AORTIC ANEURYSM
clinical presentation
diagnose
treatment
CLINICAL PRESENTATION
* Often asymptomatic until rupture
* Sudden, severe pain indicates rupture
(emergency)
DIAGNOSIS
* Abdominal ultrasound
* CT
TREATMENT
* Monitoring
* Surgical repair sometimes indicated
* When large or symptomatic
CLINICAL CONSEQUENCES
* Obstruction of a branch of the aorta
* Ischemia of subsequent tissue
* Embolism
* Impingement on adjacent structure
* Vertebrae, ureter, etc.
* Abdominal mass
* May palpably pulsate
* Rupture
* Leading to massive (often fatal) hemorrhage
What is the most common cause of abdominal
aortic aneurysm?
Atherosclerosis
