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Pathological Processes > Session 6 > Flashcards

Session 6 Flashcards

1
Q

What is atherosclerosis?

A

The accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries

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2
Q

What is atheroma?

A

Thickening and hardening of arterial walls as a consequence of atherosclerosis

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3
Q

What is arteriosclerosis?

A

Thickening of the walls of arteries and arterioles

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4
Q

Arteriosclerosis is often as a result of… (2)

A

Hypertension

Diabetes mellitus

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5
Q

What causes the fatty streak that can be seen in atherosclerosis?

A

Lipid deposits in tunica intima

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6
Q

What appearance do fatty streaks take in atherosclerosis?

A

Yellow, slightly raised

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7
Q

Describe the appearance of a simple plaque in atherosclerosis

A

Raised yellow/white
Irregular outline
Widely distributed

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8
Q

What can be seen as a result of a ‘complicated plaque’ (4)

A

Calcification
Thrombosis
Haemorrhage into plaque
Aneurysm formation

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9
Q

List some common sisters of atherosclerosis (5)

A 
Aorta (particularly abdominal aorta)
Coronary arteries
Carotid arteries 
Cerebral arteries 
Leg arteries
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10
Q

Name the different layers of an artery from inside to outside

A 
Endothelium 
Sub-endothelial connective tissue (tunica intima)
Internal elastic lamina
Tunica media
External elastic lamina
Tunica adventitia
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11
Q

What early microscopic features might your see in atherosclerosis? (3)

A

Proliferation of smooth muscle cells
Accumulation of foam cells
Extracellular lipid

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12
Q

What later microscopic features might you see in atherosclerosis? (4)

A

Fibrosis
Necrosis
Cholesterol clefts
Inflammatory cells

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13
Q

What further microscopic features (after early and later changes) might be seen in atherosclerosis? (4)

A

Disruption of internal elastic lamina
Damage extends into media
Ingrowth of blood vessels
Splitting/cracking of plaque

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14
Q

Name 4 potential clinical effects of atherosclerosis

A

Ischaemic heart disease
Cerebral ischaemia
Mesenteric ischaemia
Peripheral vascular disease

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15
Q

Name two potential consequences of ischaemic heart disease as a result of atherosclerosis

A

MI

Angina

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16
Q

Name two potential consequences of cerebral ischaemia as a result of atherosclerosis

A

Transient ischaemic attack

Cerebral infarction

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17
Q

Give the colloquial name for a transient ischaemic attack

Give the colloquial name for a cerebral infarction

A

Mini-stroke

Stroke

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18
Q

Name a potential consequence of mesenteric ischaemia as a result of atherosclerosis

A

Ischaemic colitis

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19
Q

Name two potential consequences of peripheral vascular disease

A

Gangrene

Intermittent claudication

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20
Q

What is the main symptom of intermittent claudication

A

Pain in the calves when walking

21
Q

What is a plaque?

A

A raised patch on or within the body resulting from local damage of deposition of material

E.g. Fatty deposit on an artery wall in atherosclerosis

22
Q

List some predisposing factors for atherosclerosis

A 
Age
Gender
Hyperlipidaemia 
Cigarette smoking 
Hypertension 
Diabetes 
Alcohol 
Infection 
Lack of exercise
Obesity 
Soft water
Oral contraceptives
23
Q

How does age work as a predisposing factor for atherosclerosis?

A

Slowly progressive throughout adult life

24
Q

How does gender work as a predisposing factor for atherosclerosis?

A

Women are generally protected before the menopause

25
Q

How does hyperlipidaemia work as a predisposing factor for atherosclerosis?

A

High plasma cholesterol associated with atherosclerosis

26
Q

Which lipoprotein is most significant in contributing to atherosclerosis?

Which lipoprotein is protective against hyperlipidaemia?

A

LDL

HDL

27
Q

What is the most powerful risk factor for atherosclerosis/Ischaemic Heart Disease?

A

Cigarette smoking

28
Q

> __ units a day of alcohol is associated with increased risk of IHD?

A

5

29
Q

Is there genetic predisposition for the onset of atherosclerosis?

A

Yes

30
Q

Name the 4 theories of atherosclerosis pathogenesis

A

Thrombogenic theory
Insudation theory
Monoclonal hypothesis
Reaction to injury hypothesis

31
Q

Describe the thrombogenic theory of atherosclerosis pathogenesis

Describe the insudation theory of atherosclerosis pathogenesis

A

Plaques formed by repeated thrombi, with the lipid derived from thrombi and an overlying fibrous cap

Considered the role of endothelial injury/inflammation in the formation of atherosclerotic plaques. Stated that the plaque gained lipid from the circulating plasma.

32
Q

Describe the monoclonal hypothesis of atherosclerosis pathogenesis

A

Hypercholesterolaemia leads to endothelial damage and as a result plaque formation. Injury increases permeability and allows platelet adhesion. Monocytes penetrate the endothelium. Smooth muscle cells proliferate and migrate.

33
Q

How does the reaction to injury hypothesis further explain atherosclerosis pathogenesis?

A

Has a crucial role for smooth muscle proliferation with each plaque being composed of monoclonal smooth muscle cells

34
Q

Name the 4 main processes involved in atherosclerosis

A

Thrombosis
Lipid accumulation
Production of extracellular matrix
Interactions between cell types

35
Q

List 6 cells that are involved in atherosclerosis

A 
Endothelial cells
Platelets 
Smooth muscle cells 
Macrophages 
Lymphocytes 
Neutrophils
36
Q

Describe the role of endothelial cells in atherosclerosis

A

Important role in haemostasis
Have altered permeability to lipoproteins
Produce collagen
Stimulate proliferation/migration of smooth muscle cells

37
Q

What role do platelets play in atherosclerosis?

A

Important role in haemostasis

Stimulate proliferation/migration of smooth muscle cells

38
Q

How do platelets stimulate the proliferation/migration of smooth muscle cells?

A

Through the production of PDGF

39
Q

What role do smooth muscle cells play in atherosclerosis?

A

Take up LDL and other lipid to become foam cells

Synthesise collagen and proteoglycans

40
Q

What role do macrophages play in atherosclerosis?

A

Oxidise LDL
Take up lipids to become foam cells
Secrete proteases which modify the matrix
Stimulate the proliferation/migration of smooth muscle cells

41
Q

What role do lymphocytes play in atherosclerosis?

A

Produce TNF which can affect lipoprotein metabolism

Stimulate proliferation/migration of smooth muscle cells

42
Q

What do lymphocytes produce that can affect lipoprotein metabolism?

A

TNF

43
Q

What role do neutrophils play in atherosclerosis?

A

Secrete proteases leading to continued local damage and inflammation

44
Q

In a unifying hypothesis of atherosclerosis, endothelial injury occurs which is due to… (4)

A

Raised LDL
Toxins - e.g. Cigarette smoke
Hypertension
Haemodynamic stress

45
Q

In a unifying hypothesis of atherosclerosis, endothelial injury occurs which causes… (3)

A

Platelet adhesion, PDGF release and smooth muscle cell proliferation/migration

Accumulation of lipid, LDL oxidation, uptake of lipid by smooth muscle cells/macrophages

Migration of monocytes into the intima

46
Q

State two cells that can take up lipid in atherosclerosis

A

Smooth muscle cells

Macrophages

47
Q

In atherosclerosis, stimulated smooth muscle cells produce…

A

Matrix material

48
Q

What do foam cells secrete in atherosclerosis?

What does this result in? (2)

A

Cytokines

Further smooth muscle stimulation
Recruitment of other inflammatory cells

49
Q

List 5 preventative measures of atherosclerosis

A 
No smoking 
Reduced fat intake 
Treat hypertension 
Not too much alcohol 
Regular exercise
Weight control

Pathological Processes (10 decks)

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