Pathology Flashcards
what is hypercholestrolaemia?
the condition in which a patient has elevated blood concentrations of LDL cholestrol
describe the process of atherosclerosis
- LDL get out membrane and are modified and interact with macrophages and other inflammatory mediators
- smooth muscle cells migrate into lesion and form a fibrous plaque - protective
- this keeps on growing in a vicious circle and reduces lumen size
- the plaque often ruptures and induces formation of thrombus
- thrombus can completely block flow of blood
what can hypertension do to the heart (conditons)?
LV hypertrophy, angina, CHF, coronary disease
what can hypertension do to the vessels?
peripheral vascular disease
where does atherosclerosis affect?
large and medium arteries
where does arteriolosclerosis affect?
small arteries and arterioles
what can hypertension do to the brain?
TIA, stroke, vascular dementia
what can hypertension do to the kidneys?
chronic kidney disease
what can hypertension do the eyes?
retinopathy
what are the physiological effects of hypertension to the heart?
remodelling of the heart - due to pressure/ volume
hypertrophy (increase cell size)
increased mechanical work- more protein synthesis
increase in pressure - cross sectional area increased
in volume overload - new sarcomeres/ increased length
left ventricular failure from longstanding hypertrophy
what is the most common cause arteriosclerosis in large/ medium arteries?
atheroma
what is a major risk factor in atheroscelerosis?
hypertension
what can damage to aorta result in?
atheroma, aortic dissection, abdo aortic aneurysm
what pathologies are common within arterioles?
hyaline arteriolosclerosis
hyperplastic arteriolosclerosis
hyperplasia of intima (onion skin)
fibrinoid necrosis
what is hyaline arteriolosclerosis?
common vascular lesion
accumulation of serum proteins in subendothelial space
what pathologies are common within small arteries?
hyperplastic sclerosis
hypertrophy of media
reduplication of internal elastic lamina
fibrotic thickening of intima
how does an aortic dissection occur?
pressure/ ischaemia
blood enters media causing a split in vessel wall
can rupture into adventitia causing haemorrhage into mediastinum or pericardium
what is an anuerysm?
focal dilation of artery
enlarging plaque leads to atrophy of media
muscle and elastic fibres replaced with collagen (no contractile or recoil)
vessel wall stretches
what are the risk factors for an atheroma?
ATHEROMA
a- arterial hypertension
t - tobacco
h - hereditary
e - endocrine (diabetes, hypothyroidism, postmenopausal oestrogen deficiency)
r - reduced physical activity
o - obesity
m - male gender
a - age
what is thrombosis?
damaged and ulcerated endothelium leads to thrombus
occludes lumen
what is plaque fissure formation?
blood seeps into atheromatous plaque and causes expansion
blood may seep into plaque and clot
what is restonosis?
when vessel returns to be thinned after stenting/ angioplasy
what is venous insufficiency?
when veins have trouble sending blood back from limbs to heart – causing blood to pool
what does venous return equal?
- Venous return to flow of blood from peripheries back to RA and this equals cardiac output
what is chronic venous insufficiency (CVI)?
Chronic venous insufficiency (CVI): occurs when leg veins become damaged and can not work as normal and blood pools in legs causing swelling and ulcers
what structures can be affected by CVI?
- Can occur in deep, superficial and perforating veins
how many people are affected by varicose veins?
Venous disease is very general and varicose veins affects 1 in 3 adults and each year 1 in 50 of those with varicose veins will develop CVI
- CVI usually affects those over 50
what does CVI do to capillaries?
Pathophysiology: CVI raises pressure in legs and this can cause the tiniest capillaries to burst
what can CVI do to the skin?
- Skin goes a reddish-brown colour and can easily break open if bumped or scratches
- Resulting in: tissue inflammation, damage and venous stasis ulcers – open sores on skins surface (they do not heal easily and can lead to cellulitis)
what are symptoms of CVI?
- Achy/ tired legs
- Burning, tingling – pins and needles
- Cramping at night
- Discoloured skin that looks reddish-brown
- Oedema in lower legs and ankles
- Flaking or itching skin on legs and feet
- Full or heavy feeling eet
- Leathery looking feet
- Ulcers – usually on or near ankles
- Varicose veins
what therapies can be used to treat CVI?
compression therapy
medications
sclerotherapy
ligation and stripping
vein bypass
what does compression therapy do in CVI?
- Compression therapy: helps ease swelling and discomfort in legs – compression socks and bandages
what medications can be used to treat CVI?
- Medications: AB to clear skin infections, anticoagulants, medicated wrap – unna boot – multicompression with zinc oxide gel based wound cover to that forms a semi rigid bandage
what is sclerotherapy?
- Sclerotherapy: infects foma or liquid solution into spider veins causing it to collapse or disappear
what is endovenous thermal ablation?
- Endovenous thermal ablation: targets large veins and uses lasers with intense heat to close up deceased veins and leaves minimal bleeding or bruising
what is ligation and stripping?
- Ligation and stripping: surgeon will cut and tie off problem veins and then surgically remove larger veins through two small incisions
what is a vein bypass?
- Vein bypass: takes part of a healthy vein from else where and uses that to reroute around damaged vein used in most severe cases
describe janeway lesions
painless flat red macules on palms of hands and soles of feet
