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CLS > Vascular disease > Flashcards

Vascular disease Flashcards

1
Q

Define arterosclerosis/arteriosclerosis

A

Thickening and hardening of wall of artery/arteriole

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2
Q

Define atheroma

A

Important disease of L and M arteries in high pressure system of systemic arterial system.
NEVER VENOUS

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3
Q

Define atherosclerosis

A

Arteriosclerosis due to atheroma

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4
Q

Outline the impacts of hypertension

A

Replacement of wall structure by amorphous hyaline material
Decreased lumen size and less response to endocrine stimuli
Hypertrophy of media, fibroelastic thickening of SM intima, elastic lamina reduplication

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5
Q

Outline the consequences of hypertension

A

Decreased lumen size, reduced flow, ischaemic changes in tissues
Increased rigidity of vessel wall, loss of elasticity
unreactive to vasodilators

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6
Q

How does age affect atheroma?

A

Worsens with age

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7
Q

Which layers of the artery wall is affected first?

A

Tunica intima then media

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8
Q

Describe the stages of atheroma

A
  • Blood lipids migrate to the intima, forms damaged endothelium
  • Lipids phagocytosed by macrophages in intima (oxidised LDLs)
  • Formation of raised fatty streak
  • Lipids released from MP form lipid plaque
  • MPs secrete cytokines, stim myofibroblasts to secrete collagen- early damage in elastic lamina and media
  • Collagen covers plaque surface- forms fibroliquid plaque
  • Muscle fibres replaced by collagen
    Lipids in intima are calcified, surface of fibrolipid plaque ulcerates due to endo loss
  • Initiates coagulation cascade- blood clot
  • Thinning of media- weakness and inactivity
  • Complicated atheroma
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9
Q

List examples of the consequences of atheroma

A

Coronary arteries- angina
Leg arteries- intermittent claudication (leg cramps)
Mesenteric arteries- ischaemic colitis
Cerebral and verterbral arteries- cerebral ischaemic events

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10
Q

Describe the causes of atheroma within infarcted tissue

A

Occlusion by atheroma, atheroma and thrombus, atheroma and plaque fissure, occlusion by embolus

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11
Q

Describe the six changes that occur within infarcted tissue

A

0-12 hrs: early cell death
12-24 hrs: Necrotic tissue visible microscopically
24-72 hrs: Acute inflam reaction
3-14 days: macrophagic removal of debris and vascular granulation tissue formation
14-21 days: fibrovascular granulation tissue formation
21-56 days: scar forms and cauterisation (healing)

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12
Q

Describe venous infarction

A

Occurs when entire venous drainage from an organ or tissue is and remains obstructed

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13
Q

Describe two causes of venous infarction

A

Testis infection- torsion

Bowel infection- volvulus, hernia

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14
Q

Describe the mechanism by which tissue necrosis occurs due to venous infarction

A

Veins obstructed by extrinsic pressure
Tissue congested with blood
Venules and caps engorged with blood that can’t escape
Pressure in venules and caps increases-rupture
leakage of blood
Arterial blood can’t enter
Tissues become congested and necrotic

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15
Q

Outline changes that occur in infarcted tissue, use MI as an example

A

MI- necrosis of heart muscle due to occlusion of supplying coronary artery
Outcome- sudden death, survival- infarct replaced by granulation tissue- fibrous scar
Death due to problems in infarct healing process

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16
Q

Describe 2 late complications of MI

A

Ventricular aneurysm

Chronic LVF

17
Q

Describe 5 early complications of MI

A

SUDDEN DEATH due to cardiac disarrhythmia/acute LV failure
Rupture of myocardium- HAEMOPERICARDIUM
Rupture of papillary muscle- acute valve failure- LVF
Mural thrombus on infant- embolism-stroke

18
Q

Define thrombus

A

Normal physiological mechanism to prevent bleeding when a vessel wall is breached
Becomes pathological when not controlled by fibrinolysis

19
Q

Describe the process of thrombosis

A
  • Vessel wall breached
  • Circulating platelets aggregate- plug gap and release factors to trigger coagulation cascade
  • Coag cascade converts fibrinogen- insoluble fibrin
  • Long fibrin mols bind together platelets and entrap RBCs and WBCs- form a haemostatic plug
20
Q

Describe the process of fibrinolysis

A

Fibrin holds thrombus together, if broken down thrombus dissolves: FIBRINOLYSIS

  • Plasma contains inactive plasminogen (becomes activated)- plasmin
  • Plasmin fragments convert fibrin into fibrin degradation products
  • Plasminogen- plasmin by plasminogen activators (t-PA) secreted by endo cells
  • tPA and plasminogen bind to fibrin- degrades fibrin
  • Controls size of thrombus
21
Q

Describe how pathological thrombus occurs

A

Thrombus enlarges beyond vessel healing requirements
Physically affect bv and blood flow- intrinsic fibrinolytic system incapable of controlling size
- Fibrinolysis fails- thrombus grows by ACCRETION of layer on layer
- If it continues, brown-red mass produced in vessel lumen

22
Q

What is Virchow’s triad

hint: DSC

A

Factors that predispose to thrombus formation:
- Damage to bv wall
- Slow turbulent blood flow (stasis)
Change in blood character eg more platelets, RBCs, viscocity

23
Q

What are the common causes of pathological arterial thrombus

A

Vessel wall damage eg atheroma, coronary artery

24
Q

What are the main causes of pathological venous thrombosis?

A

Stasis eg DVT- tenderness, pitted oedema, embolism

25
Q

What are the main causes of pathological heart thrombosis in the heart?

in the ventricles, atrium and valves

A

In ventricles- chamber wall damage eg thrombosis on damamged endo- myocardial ischaemia

  • Atrium due to stasis
  • Heart valves due to surface damage eg thrombus on mitral valve- bacterial endocarditis
26
Q

List the consequences of occlusion of a vessel by a thrombus

A

1- Lysis by intrinsic fibrinolysis- rare
2- Blood flow stops- cuts off O2 to tissue- infarction
3- In veins- venous infarction and congestion
4- Organisation and recanalisation- healing
5- Extend locally- propagation
6- Fragment or detach completely, travel elsewhere in circulation: THROMBO EMBOLISM

27
Q

List types of material which may embolise within the cirulation

A 
Cancer cells (metastasis)- malignant tumours
Fat
Marrow
Air
N2 
Amniotic fluid
28
Q

What is the effect of thromboembolus in the brain arteries?

A

Stroke

29
Q

What is the effect of thromboembolus in the leg arteries?

A

Gangrene

30
Q

What is the effect of thromboembolus in the mesenteric arteries?

A

Bowel necrosis

31
Q

What is the effect of thromboembolus in the renal arteries?

A

Kidney infarct

32
Q

What is the effect of thromboembolus in the splenic artery?

A

Splenic infarct

33
Q

Describe the circumstances where pulmonary thromboembolism can occur

A

Thrombus in a systemic vein embolises to a pulm artery branch- pulmonary embolus
Small embolus- small peripheral lung infarct
Large embolus- sudden death

34
Q

Defne thromboembolism

A

Transference of abnormal material by the blood stream with eventual impaction of the material in a vessel distal to its site of origin

Different effects depending on origin

CLS (11 decks)

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