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CJ: UoL Medicine Semester Two (ESA2) > Pathology - Atherosclerosis > Flashcards

Pathology - Atherosclerosis Flashcards

1
Q

What is atherosclerosis?

A

The accumulation of intracellular and extracellular lipid in the intima and media of large/medium arteries leading to thickening and hardening of arterial walls

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2
Q

What is arteriosclerosis?

A

The thickening of the walls of arteries and arterioles, usually as a result of hypertension or diabetes mellitus

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3
Q

What is the same given to a yellow, slightly raised lipid deposit in the lumen of an artery?

A

Fatty streak

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4
Q

How does a simple plaque appear in the lumen?

A

Raised yellow/white, irregular outline, widely distributed, can enlarge and coalesce

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5
Q

Why is a complicated plaque more dangerous than a simple plaque?

A
  • can lead to thrombosis
  • can lead to haemorrhage into plaque
  • can lead to calcification of arteries
  • may cause aneurysm formation
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6
Q

Give some common sites of atherosclerosis

A

Aorta (especially abdominal), coronary arteries, carotid arteries, cerebral arteries, leg arteries

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7
Q

What are the EALRY microscopic features of atherosclerosis?

A

Proliferation of smooth muscle cells, accumulation of foam cells, extracellular lipid

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8
Q

What are the ADVANCED microscopic features of atherosclerosis?

A

Fibrosis, necrosis, cholesterol clefts, inflammatory cells, disruption of internal elastic lamina, damage extends into media, ingrowth of blood vessels, plaque fissuring

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9
Q

Give some clinical effects of atherosclerosis which relate to ischaemic heart disease

A

Ischaemic heart disease:

  • sudden death
  • myocardial infarction
  • angina pectoris
  • arrhyhmias
  • cardiac failure
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10
Q

Give some clinical effects of atherosclerosis which relate to cerebral ischaemia

A
  • transient ischaemic attack
  • cerebral infarction
  • multi-infarct dementia
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11
Q

Give some effects of atherosclerosis which relate to mesenteric ischaemia

A

Ischaemic colitis, malabsorption, intestinal infarction

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12
Q

Give some clinical effects of atherosclerosis which relate to peripheral vascular disease

A
  • intermittent claudication
  • Leriche syndrome
  • ischaemic rest pain
  • gangrene
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13
Q

Give some pre-disposing factors for atherosclerosis

A
  • age (risk increases as get older)
  • gender (women protected before menopause)
  • hyperlipidaemia (high plasma cholesterol associated with atherosclerosis)
  • cigarette smoking
  • hypertension (possibly due to endothelial damage caused by raised pressure)
  • diabetes mellitus
  • alcohol
  • infection (chlamydia pneumoniae, H. Pylori, cytomegalovirus)
  • lack of exercise/obesity
  • soft water
  • oral contraceptives
  • stress (uncertain)
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14
Q

How is atherosclerosis associated with apolipoprotein E?

A
  • genetic variations in Apo E are associated with changes in LDL levels
  • polymorphisms of these genes can be used as risk markers for atherosclerosis
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15
Q

Give some physical signs of familial hyperlipidaemia

A
  • corneal arcus
  • tendon xanthomas
  • xanthelasma
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16
Q

What was the thrombogenic theory of atherosclerosis?

A

Plaques formed by repeated thrombi, lipid is derived from these. Overlying fibrous cap forms

17
Q

What was the insulation theory of atherosclerosis?

A

Endothelial injury leads to inflammation and increased permeability to lipid from plasma

18
Q

What is the reaction to injury hypothesis of atherosclerosis?

A
  • plaques form in response to endothelial injury
  • injury increases permeability and allows platelet adhesion
  • monocytes penetrate endothelium
  • smooth muscle cells proliferate there and migrate
19
Q

What is the monoclonal hypothesis of plaque formation?

A

Each plaque is monoclonal, so they may represent abnormal growth control - could be a benign tumour

20
Q

Which cell types are involved in atherosclerosis?

A
  • endothelial cells
  • platelets
  • smooth muscle cells
  • macrophages
  • lymphocytes
  • neutrophils
21
Q

What is the role of endothelial cells in atherosclerosis?

A
  • altered permeability to lipoproteins
  • production of collagen
  • stimulation of proliferation/migration of smooth muscle cells
22
Q

What is the role of platelets in atherosclerosis?

A

Stimulate proliferation and migration of smooth muscle cells

23
Q

What is the role of smooth muscle cells in atherosclerosis?

A

Take up LDL and other lipids to become foam cells, synthesise collagen and proteoglycans

24
Q

What are the roles of macrophages in atherosclerosis?

A
  • oxidise LDL
  • take up lipids to become foam cells
  • secrete proteases which modify the matrix
  • stimulate proliferation and migration of smooth muscle cells
25
Q

What are the roles of lymphocytes in atherosclerosis?

A
  • stimulate proliferation and migration of smooth muscle cells
  • TNF may affect lipoprotein metabolism
26
Q

What is the role of neutrophils in atherosclerosis?

A

Secrete proteases leading to continued local damage and inflammation

27
Q

What methods can be used to help prevent atherosclerosis?

A
  • no smoking
  • reduce fat intake
  • treat hypertension
  • not too much alcohol
  • regular exercise/weight control
28
Q

What interventions can be used to help prevent a high risk individual from developing atherosclerosis?

A
  • stop smoking
  • modify diet
  • treat hypertension
  • treat diabetes
  • lipid lowering drugs
29
Q

What is the unifying hypothesis of atherosclerosis?

A

Endothelial injury (due to raised LDL, toxins, hypertension, haemodynamic stress) causes platelet adhesion, PDGF release, SMC proliferation/migration, migration of monocytes into intima and a few other events.

Stimulated SMC produce matrix material. Foam cells secrete cytokines causing further SMC stimulation and recruitment of other inflammatory cells

CJ: UoL Medicine Semester Two (ESA2) (87 decks)

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