Pathology

Question 1

what is hypercholestrolaemia?

Answer 1

the condition in which a patient has elevated blood concentrations of LDL cholestrol

Question 2

describe the process of atherosclerosis

Answer 2

1. LDL get out membrane and are modified and interact with macrophages and other inflammatory mediators
2. smooth muscle cells migrate into lesion and form a fibrous plaque - protective
3. this keeps on growing in a vicious circle and reduces lumen size
4. the plaque often ruptures and induces formation of thrombus
5. thrombus can completely block flow of blood

Question 3

what can hypertension do to the heart (conditons)?

Answer 3

LV hypertrophy, angina, CHF, coronary disease

Question 4

what can hypertension do to the vessels?

Answer 4

peripheral vascular disease

Question 5

where does atherosclerosis affect?

Answer 5

large and medium arteries

Question 6

where does arteriolosclerosis affect?

Answer 6

small arteries and arterioles

Question 7

what can hypertension do to the brain?

Answer 7

TIA, stroke, vascular dementia

Question 8

what can hypertension do to the kidneys?

Answer 8

chronic kidney disease

Question 9

what can hypertension do the eyes?

Answer 9

retinopathy

Question 10

what are the physiological effects of hypertension to the heart?

Answer 10

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

Question 11

what is the most common cause arteriosclerosis in large/ medium arteries?

Answer 11

atheroma

Question 12

what is a major risk factor in atheroscelerosis?

Answer 12

hypertension

Question 13

what can damage to aorta result in?

Answer 13

atheroma, aortic dissection, abdo aortic aneurysm

Question 14

what pathologies are common within arterioles?

Answer 14

hyaline arteriolosclerosis
hyperplastic arteriolosclerosis
hyperplasia of intima (onion skin)
fibrinoid necrosis

Question 15

what is hyaline arteriolosclerosis?

Answer 15

common vascular lesion
accumulation of serum proteins in subendothelial space

Question 16

what pathologies are common within small arteries?

Answer 16

hyperplastic sclerosis
hypertrophy of media
reduplication of internal elastic lamina
fibrotic thickening of intima

Question 17

how does an aortic dissection occur?

Answer 17

pressure/ ischaemia
blood enters media causing a split in vessel wall
can rupture into adventitia causing haemorrhage into mediastinum or pericardium

Question 18

what is an anuerysm?

Answer 18

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

Question 19

what are the risk factors for an atheroma?

Answer 19

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

Question 20

what is thrombosis?

Answer 20

damaged and ulcerated endothelium leads to thrombus
occludes lumen

Question 21

what is plaque fissure formation?

Answer 21

blood seeps into atheromatous plaque and causes expansion
blood may seep into plaque and clot

Question 22

what is restonosis?

Answer 22

when vessel returns to be thinned after stenting/ angioplasy

Question 23

what is venous insufficiency?

Answer 23

when veins have trouble sending blood back from limbs to heart – causing blood to pool

Question 24

what does venous return equal?

Answer 24

• Venous return to flow of blood from peripheries back to RA and this equals cardiac output

Question 25

what is chronic venous insufficiency (CVI)?

Answer 25

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

Question 26

what structures can be affected by CVI?

Answer 26

- Can occur in deep, superficial and perforating veins

Question 27

how many people are affected by varicose veins?

Answer 27

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

Question 28

what does CVI do to capillaries?

Answer 28

Pathophysiology: CVI raises pressure in legs and this can cause the tiniest capillaries to burst

Question 29

what can CVI do to the skin?

Answer 29

- 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)

Question 30

what are symptoms of CVI?

Answer 30

* 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

Question 31

what therapies can be used to treat CVI?

Answer 31

compression therapy medications sclerotherapy ligation and stripping vein bypass

Question 32

what does compression therapy do in CVI?

Answer 32

* Compression therapy: helps ease swelling and discomfort in legs – compression socks and bandages

Question 33

what medications can be used to treat CVI?

Answer 33

* 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

Question 34

what is sclerotherapy?

Answer 34

* Sclerotherapy: infects foma or liquid solution into spider veins causing it to collapse or disappear

Question 35

what is endovenous thermal ablation?

Answer 35

* Endovenous thermal ablation: targets large veins and uses lasers with intense heat to close up deceased veins and leaves minimal bleeding or bruising

Question 36

what is ligation and stripping?

Answer 36

* Ligation and stripping: surgeon will cut and tie off problem veins and then surgically remove larger veins through two small incisions

Question 37

what is a vein bypass?

Answer 37

* Vein bypass: takes part of a healthy vein from else where and uses that to reroute around damaged vein  used in most severe cases

Question 38

describe janeway lesions

Answer 38

painless flat red macules on palms of hands and soles of feet