Shock & Atheroma

Question 1

what is shock

Answer 1

complex syndrome with a variety of aetiologies

Question 2

what does show causes result in

Answer 2

acute circ fail wth hypotension and inadequate tissue perfusion

Question 3

what are some major types of shock

Answer 3

hypovolaemic
septic
cariogenic
anaphylactic
neurogenic

Question 4

what is chemical shock

Answer 4

acute pancreatitis

acute peritonitis from perforated gastric ulcer

Question 5

what is hypovolaemic shock

Answer 5

reached blood volume

• haemorrhage
• burns
• comit

Question 6

what are the effects of hypovolaemic shock

Answer 6

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

Question 7

what is max loss no symptoms blood loss

Answer 7

10% asymptomatic

rapid loss of half blood volume lead to coma and death

Question 8

what is septic shock

Answer 8

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

Question 9

wha are the effects of septic shock

Answer 9

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

Question 10

what do endotoxins do

Answer 10

activate macrophages and ends cells and trigger roads pathways

Question 11

what is acrdiogenic shock

Answer 11

due tos every acute reduction in CO duet pump fail

Question 12

decreased CO leads to

Answer 12

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

Question 13

what happens in hypoxia cellular level

Answer 13

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

Question 14

what is anaphylactic shock

Answer 14

type 1 hypersensitivity

massive asa cell degranulation causes release vasodilators and perm factors

Question 15

what is example of neurogenic shock

Answer 15

acute brain or spinal cord injury

lack tissue perfusion

Question 16

what are th compensatory mechs

Answer 16

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

Question 17

what is example of compensation mech

Answer 17

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

Question 18

if tissue perfusion not restored

Answer 18

ischaemia cases multiorgna fail and ultimate death

- fluid into pt to maintain adequate tissue perfusion

Question 19

result shock in lung

Answer 19

diffuse (widespread) alveolar injury

- ARDS

Question 20

result shock in heart

Answer 20

ischaemia - inefficient blood to pump

failure

Question 21

result of shock input

Answer 21

ischaemia - segmented areas

endotoxaemia - release endotoxins

Question 22

result of shocking adrenal organs

Answer 22

initially stimulated (simp activity) then failing

Question 23

result of shock in bain and kidneys

Answer 23

initially auto regulate blood supply

later loss of consciousness and acute renal fail

Question 24

shocked pt shows

Answer 24

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

Question 25

organs effected by shock

Answer 25

``` key vital organs - heart - kidney brian 0 gut ```

Question 26

normal artery

Answer 26

edno lamina muscularis adventitia

Question 27

what si the aorta

Answer 27

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

Question 28

what to medium sized arteries regale

Answer 28

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

Question 29

what is arteriosclerosis

Answer 29

hardening of artery | affecting arteries and arterioles

Question 30

how does arteriosclerosis occur

Answer 30

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

Question 31

what i arteriosclerosis accelerated by

Answer 31

age | hypotension and diabetess

Question 32

what is the most imp disease of arteries

Answer 32

atherosclerosis

Question 33

what does atherosclerosis cause

Answer 33

ischaemic heart disease stroke peripheral vasc disease

Question 34

hat does atherosclerosis arise for

Answer 34

as an inflam respone of vessel to chronic multifactorial injury

Question 35

incidence fo ischaemic heart disease

Answer 35

indicator of extent of terosclerosis in community

Question 36

rik actors of atheroma

Answer 36

``` family history male age cigarette smoke hypertension diabetes hyperlipidaemis exercise leve ```

Question 37

what are the two types of risks

Answer 37

modifiable | non modiafiables

Question 38

what reaches the risk of atehrom

Answer 38

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

Question 39

what is atherosclerosis

Answer 39

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

Question 40

what does atherosclerosis affects

Answer 40

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

Question 41

what does atherosclerosis cause

Answer 41

narrowing lumen with ischaemia in brain, heart, lower limbs

Question 42

what does plaque rupture

Answer 42

- thrombosis causes acute ischaemia and infarct

Question 43

what is the pathogenesis of atherosclerosis

Answer 43

fatty street early atherosclerosis plaque advanced plaque complicated plaque

Question 44

what are lipoproteins

Answer 44

fat and protein | - enable fat in bloodstream

Question 45

what is LDL

Answer 45

- LDL - from plasma move free in and out

Question 46

what does an oxidised LDL act as

Answer 46

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

Question 47

what is oxidised LDL taken up by

Answer 47

macrophages | foam cell die = release lipid

Question 48

what does monocytes sticking to end cells in intimate involves

Answer 48

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

Question 49

what is the fatty streak

Answer 49

easiest lesion seen - foam cells intact endo start of plaque

Question 50

what happens to intimal lesions

Answer 50

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

Question 51

what does atherosclerotic place contain

Answer 51

collagen cap core lipid calcium depo vascularisation fro vasa vasorum

Question 52

where is early plaque confined to

Answer 52

intima

Question 53

where does advanced plaque erode

Answer 53

media

Question 54

what are changes in plaque

Answer 54

suface ulceration intraplaque haemorrhage rupture thrombosis - imp

Question 55

what are some complications of atheroma

Answer 55

``` ichaemic heart disease cerebrovascular disease peirpehrla vasc disease mesenteric vasc disease renovasc disease aneurysms ```

Question 56

what does ischaemic heart disease do

Answer 56

sudden death MI heart fail

Question 57

what does cerebrovasc disease do

Answer 57

Transient Ischaemic As - tiny stroke | cerebral infarction

Question 58

what does periephal vasc disease do

Answer 58

intermittent claudication | gangrene

Question 59

what does mesenteric vasc disease

Answer 59

mesenteric claudication | intestinal infarction

Question 60

what does renovasc disease do

Answer 60

hypertension | renal fail

Question 61

what do aneurysms do

Answer 61

atlas 50% locl increase in luminal diameter of an artery | rupture

Question 62

whats atheroma

Answer 62

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