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Pathology > Shock & Atheroma > Flashcards

Shock & Atheroma Flashcards

1
Q

what is shock

A

complex syndrome with a variety of aetiologies

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2
Q

what does show causes result in

A

acute circ fail wth hypotension and inadequate tissue perfusion

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3
Q

what are some major types of shock

A 
hypovolaemic
septic
cariogenic
anaphylactic
neurogenic
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4
Q

what is chemical shock

A

acute pancreatitis

acute peritonitis from perforated gastric ulcer

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5
Q

what is hypovolaemic shock

A

reached blood volume

  • haemorrhage
  • burns
  • comit
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6
Q

what are the effects of hypovolaemic shock

A

inadequate circ vol
susceptible influence of age and prior health
elderly and hypertensive pt

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7
Q

what is max loss no symptoms blood loss

A

10% asymptomatic

rapid loss of half blood volume lead to coma and death

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8
Q

what is septic shock

A

severe infection
gm -ve bacilli = endotoxins
LPS - bind and activates macrophages and ends cells
set off TNF enzyme cascade

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9
Q

wha are the effects of septic shock

A 
peripheral vasodilation
tissues under perfused
injury end cells
leak fluid
oedema
activated coagulation 
disseminated intravascular coagulation
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10
Q

what do endotoxins do

A

activate macrophages and ends cells and trigger roads pathways

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11
Q

what is acrdiogenic shock

A

due tos every acute reduction in CO duet pump fail

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12
Q

decreased CO leads to

A

dec tissue perfusion
hypoxic injury
circ effects
metab effects - meat acidosis, hypoxia, distress syndrome

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13
Q

what happens in hypoxia cellular level

A 
increase in anaerobic glycolysis 
lead to acidosis
dec energy supply
dec activity of mem 
incorrect Na K levels in cells 
cells swell
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14
Q

what is anaphylactic shock

A

type 1 hypersensitivity

massive asa cell degranulation causes release vasodilators and perm factors

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15
Q

what is example of neurogenic shock

A

acute brain or spinal cord injury

lack tissue perfusion

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16
Q

what are th compensatory mechs

A 
early stages mech which maintain good flow to vital organs 
- CNS
- heart
-kidneys
reused perfusion in other tissues
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17
Q

what is example of compensation mech

A

increased simp activity - fight/flight
rennin angiotensin-aldosterone system
CNS, heart and kidney auto regulate their own perfusion

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18
Q

if tissue perfusion not restored

A

ischaemia cases multiorgna fail and ultimate death

- fluid into pt to maintain adequate tissue perfusion

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19
Q

result shock in lung

A

diffuse (widespread) alveolar injury

- ARDS

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20
Q

result shock in heart

A

ischaemia - inefficient blood to pump

failure

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21
Q

result of shock input

A

ischaemia - segmented areas

endotoxaemia - release endotoxins

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22
Q

result of shocking adrenal organs

A

initially stimulated (simp activity) then failing

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23
Q

result of shock in bain and kidneys

A

initially auto regulate blood supply

later loss of consciousness and acute renal fail

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24
Q

shocked pt shows

A

restless
confused
pale - blood diverted away
cold
sweaty
rapid pulse - CV system increase to get blood around
weak pulse - not enough blood lack perfusion
low BP
increased rate and depth - try to compensate
drowsy - comatose

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25
Q

organs effected by shock

A 
key vital organs 
- heart
- kidney
brian
0 gut
26
Q

normal artery

A

edno
lamina
muscularis
adventitia

27
Q

what si the aorta

A

multiple layers of elastic tissue to absorb impulse of cardiac systole and maintain blood flow in diastole

28
Q

what to medium sized arteries regale

A

hist blood to various rogans
restriction
constriction
dilation so process thick media wall less elastic tissue

29
Q

what is arteriosclerosis

A

hardening of artery

affecting arteries and arterioles

30
Q

how does arteriosclerosis occur

A

due to gradual replace vasc smooth muscle by collagen and depo plasma proteins in smooth muscle

31
Q

what i arteriosclerosis accelerated by

A

age

hypotension and diabetess

32
Q

what is the most imp disease of arteries

A

atherosclerosis

33
Q

what does atherosclerosis cause

A

ischaemic heart disease
stroke
peripheral vasc disease

34
Q

hat does atherosclerosis arise for

A

as an inflam respone of vessel to chronic multifactorial injury

35
Q

incidence fo ischaemic heart disease

A

indicator of extent of terosclerosis in community

36
Q

rik actors of atheroma

A 
family history
male
age
cigarette smoke
hypertension
diabetes
hyperlipidaemis
exercise leve
37
Q

what are the two types of risks

A

modifiable

non modiafiables

38
Q

what reaches the risk of atehrom

A 
family history
pre menopausal female
non smoker
BP control
DM control
diet
exercise
low/mod alcohol
39
Q

what is atherosclerosis

A

focal accumulation of lipid in intimate of arteries with inflammation and fibrosis - plaque

40
Q

what does atherosclerosis affects

A

medium to large arteries - aorta, coronary,carotid ,cerebral

41
Q

what does atherosclerosis cause

A

narrowing lumen with ischaemia in brain, heart, lower limbs

42
Q

what does plaque rupture

A
  • thrombosis causes acute ischaemia and infarct
43
Q

what is the pathogenesis of atherosclerosis

A

fatty street
early atherosclerosis plaque
advanced plaque
complicated plaque

44
Q

what are lipoproteins

A

fat and protein

- enable fat in bloodstream

45
Q

what is LDL

A
  • LDL - from plasma move free in and out
46
Q

what does an oxidised LDL act as

A

inflam stimulus and invokes
- adhesion mol expression by end cells
- monocyte migration
cytokine production

47
Q

what is oxidised LDL taken up by

A

macrophages

foam cell die = release lipid

48
Q

what does monocytes sticking to end cells in intimate involves

A

endo dysfunction

influx lipid macrophages and t lymphocytes, inflam, smooth muscle prolif, depo collagen and elastic tissue

49
Q

what is the fatty streak

A

easiest lesion seen - foam cells
intact endo
start of plaque

50
Q

what happens to intimal lesions

A

develop and acquire EC lipid, intracellular lipid in foamy macrophages, collagen and other CT matrix prod by smooth muscle

51
Q

what does atherosclerotic place contain

A

collagen cap
core lipid
calcium depo
vascularisation fro vasa vasorum

52
Q

where is early plaque confined to

A

intima

53
Q

where does advanced plaque erode

A

media

54
Q

what are changes in plaque

A

suface ulceration
intraplaque haemorrhage
rupture
thrombosis - imp

55
Q

what are some complications of atheroma

A 
ichaemic heart disease 
cerebrovascular disease
peirpehrla vasc disease
mesenteric vasc disease
renovasc disease
aneurysms
56
Q

what does ischaemic heart disease do

A

sudden death
MI
heart fail

57
Q

what does cerebrovasc disease do

A

Transient Ischaemic As - tiny stroke

cerebral infarction

58
Q

what does periephal vasc disease do

A

intermittent claudication

gangrene

59
Q

what does mesenteric vasc disease

A

mesenteric claudication

intestinal infarction

60
Q

what does renovasc disease do

A

hypertension

renal fail

61
Q

what do aneurysms do

A

atlas 50% locl increase in luminal diameter of an artery

rupture

62
Q

whats atheroma

A

disease process of elastic artery walls
response to injury mechanism
complicate common and serious
degree of prventbailiy

Pathology (13 decks)

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