Vascular Disease

Question 1

What are the different types of vascular disease

Answer 1

Arteries - Atherosclerosis,
Veins - Thrombosis,
All vessels - Vasculitis and radiation damage.
Tumours

Question 2

What are some age related vascular changes?

Answer 2

Fibrosis of intima and media, accumulation of ground substance and fragmentation of elastic lamellae

Question 3

What is the elastic lamellae?

Answer 3

layer of elastic tissue that forms the outermost part of the tunica intima of blood vessels

Question 4

Briefly describe atherosclerosis

Answer 4

Atheroma - Effects large and medium sized elastic and muscular arteries, it is characterised by lipid deposition, fibrosis and chronic inflammation.

Question 5

What are the risk factors for atherosclerosis?

Answer 5

Age, sex, hypertension, hyperlipidaemia, diabetes, smoking, obesity, sedentary lifestyle, low socio-economic status and low birth weight.

Question 6

Describe the appearances of atheromatous plaques

Answer 6

Patchy and raised white to yellow bump 0.3-1.5cm. It has a necrotic core of lipids and a fibrous cap

Question 7

What are some of the complications of atherosclerosis?

Answer 7

Cerebral infarction, carotid atheroma, myocardial infarction, aortic aneurysms, peripheral vascular disease with intermittent claudication and gangrene.

Question 8

What causes PVD, which does it cause and what are its effects?

Answer 8

Caused by atheroma of distal aorta/ illiac/ femoral arteries. It causes ischaemia of lower limbs and its effects are; Intermittent claudication, pain, ulcers and gangrene.

Question 9

Define aneurysms

Answer 9

Localised, permanent, abnormal dilation of blood vessels or heart.

Question 10

What are the different types of aneurysms

Answer 10

Atherosclerotic, dissecting, berry, micro-aneurysms, syphilitic and mycotic

Question 11

Describe some of the features of atherosclerotic aneurysms

Answer 11

• Usually found in abdominal aorta, distal to renal arteries.
• It can occur in saccular or fusiform
• Some clinical consequences are thrombosis, embolism, rupture, obstruction of branching vessel and impingement on adjacent structure.
• It can present as an abnormal pulsating mass but can be repaired surgically

Question 12

What is the difference between saccular and fusiform aneurysms and what is a false aneurysm?

Answer 12

Saccular - bulging on one side of tissue wall.
Fusiform - Bulging on both sides of vessel walls and,
False - breach in vessel wall so blood leaks but it is contained by advintita so it creates a buldge

Question 13

Who are the most common patients that present with dissecting aortic aneurysmss?

Answer 13

Men aged 40-60 and younger patients with systemic or localised abnormalities of connective tissue

Question 14

Describe the morphology of dissecting aortas

Answer 14

Usually initiates with an intimal tear. The dissection can extend along the aorta retrograde towards heart or sometimes as distally as illiac or femoral arteries.

Question 15

Describe the clinical symptoms of dissecting aortic aneurysms

Answer 15

Sudden onset of excruciating pain which begins in anterior chest and radiates to the back between scapulae and moves downwards as the dissection continues. Often describe as ripping or tearing sensation. Most common cause of death is rupture.

Question 16

What are berry aneutysms? Who di they occur in and what are they associated with?

Answer 16

Aneurysms of the circle of willis, seen in young people with hypertension. Associated with sub-arachnoid haemorrhage

Question 17

What are capillary micro-aneyrusms?

Answer 17

Small aneurysms of branches of middle cerebral arteries. They are associated with hypertension, diabetes mellitus and often cause intra-cerebral haemorrhage

Question 18

What are syphillitic arteries associated with?

Answer 18

Affecting the thoracic aorta

Question 19

What causes Mycotic aneurysms and where are they most often found?

Answer 19

Wall of the artery is weaken by infection, most commonly bacteria or fungi. It is often in the brain, secondary to embolism

Question 20

Define varicose veins

Answer 20

Abnormal dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support.

Question 21

What are the risk factors for varicose veins?

Answer 21

Age, sex, heredity, posture and obesity.

Question 22

Where are common sites for varicose veins?

Answer 22

Lower limbs, usually saphenous system, oesophageal varices, haemorrhoids and varicoele.

Question 23

What are some of the complications with varicose veins?

Answer 23

Cosmetic problems, itching in legs, steasis dermatitis, skin ulceration and bleeding.

Question 24

What is vasculitis?

Answer 24

Inflammation and necrosis of blood vessels

Question 25

What is the pahtenogenesis of vasculitis?

Answer 25

Cell immune mediated inflammation, deposition of immune complexes, direct attack by circulating antibodies, invasion of vascular walls by infectious pathogens

Question 26

What are the different types of vasculitis?

Answer 26

Giant cell arteritis, Takayasu arteritis, polyarteritis nodsa and kawaski disease

Question 27

Describe features of giant cell arteritis

Answer 27

Granulomatous inflammation of large to small arteries. It gives cord like nodular thickening. Can get throbbing temporal pain, malaise or fever

Question 28

Describe features of Takayasu arteritis

Answer 28

Ganulomatous vaculitis of medium to larger arteries of the upper limb and arch or aorta. Can occur in younger women with symptoms of dizziness, visual disturbances, dysponea, intermittent claudication and asymmetrical BP

Question 29

Describe features of polyarteritis nodosa

Answer 29

Medium sized muscular arteries of kidneys, heart, liver and GI tract. The fibrinoid necrosis may be fatal without steroid treatment

Question 30

Name some benign vascular tumours

Answer 30

Angioma, Haemangioma, Juvenile (skin which disappears by age 3/4), Caillary, cavernous, lymphangioma.

Question 31

Name some malignant vascular tumours

Answer 31

Angiosarcoma - effect skin, soft tissue, breast, bone, liver and spleen.

Kaposi’s sarcoma - associated with HIV/AIDS