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MD3001 > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

How may we classify vascular disease ? Give examples of such a classification.

A

By the type of vessel they affect.

ARTERIES
-Arteriosclerosis=
When arteries “become thick and stiff — sometimes restricting blood flow to your organs and tissues”. Atherosclerosis is a specific type of arteriosclerosis, involving build up of fatty substances.

VEINS
-Thrombosis=
Could be phlebothrombosis, i.e. thrombosis in a vein forms independently from the presence of inflammation of the vein or Thrombophlebitis i.e. vein inflammation related to a thrombus
-Formation of varicosities (swollen, distended, and knotted veins, usually in the subcutaneous tissues of a LL)

ALL VESSELS

  • Vasculitis (inflammation)
  • Radiation damage
  • Tumours
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2
Q

Describe age-related vascular changes. Are these normal ?

A
  • Fibrosis of intima and media
  • Accumulation of ground substance
  • Fragmentation of elastic lamellae

Yes, these are normal with increasing age.

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3
Q

Which kinds of vessels does atherosclerosis affect ? Identify its main characteristics.

A

Large and medium-sized elastic and muscular arteries

Lipid deposition, fibrosis and chronic inflammation

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4
Q

What is another name of atherosclerosis ?

A

Atheroma

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5
Q

Identify the main risk factors for atherosclerosis.

A
  • Age
  • Sex
  • Hypertension
  • Hyperlipidaemia (particularlyLDL)
  • Diabetes
  • Smoking
  • Obesity
  • Sedentary lifestyle
  • Low socio-economic status
  • Low birth-weight
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6
Q

Describe the morphology of atherosclerosis.

A
  • Atheromatous (fibro-fatty, fibro-lipid) plaque • Patchy and raised white to yellow 0.3-1.5cm
  • Core of lipid
  • Fibrous cap (smooth muscle cells, macrophages, foam cells, lymphocytes)
  • Necrotic center (cell debris, foam cell, cholesterol crystals)
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7
Q

Identify complications of Atherosclerosis.

A
  • MI, cardiac failure
  • Cerebral infarction
  • Emboli causing transient ischaemic attacks or cerebral infarcts (due to the carotid atheroma)
  • Aortic aneurysm (rupture would cause immediate death)
  • Peripheral vascular disease with intermittent claudication
  • Gangrene
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8
Q

Define peripheral vascular disease.

A

Atheroma of distal aorta/iliac/femoral arteries, usually causing ischaemia of lower limbs

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9
Q

What are the possible effects of peripheral vascular disease ?

A
  • Intermittent claudication (pain in the leg that a person experiences when walking or exercising. The pain is intermittent and goes away when the person rests)
  • Pain
  • Ulcers
  • Gangrene
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10
Q

Define aneurysm.

A

Localised, permanent, abnormal dilatation of blood vessel or the heart

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11
Q

Identify the main types of aneurysms.

A
  • Atherosclerotic
  • Dissecting aortic
  • Berry
  • Micro-aneurysms
  • Syphilitic
  • Mycotic
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12
Q

Where do atherosclerotic aneurysms usually occur ?

A

Usually abdominal aorta, distal to renal arteries

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13
Q

Describe the demographic distribution of atherosclerotic aneurysms (any over-affected groups ?).

A

Women

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14
Q

Describe the morphology of atherosclerotic aneurysms.

A
  • saccular (resembling a sac) or fusiform (spindle-shaped)
  • 15 to 25 cm in length
  • Wall diameter > 50% of normal diameter
  • frequently contains mural thrombus
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15
Q

Identify the main clinical consequences of atherosclerotic aneurysms.

A
  • Thrombosis
  • Embolism
  • Rupture
  • Obstruction of a branch vessel (ischemic injury)
  • Impingement on an adjacent structure
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16
Q

How do atherosclerotic aneurysms present ?

A

Presents as an abdominal pulsating mass

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17
Q

To what extent is an atherosclerotic aneurysm repairable.

A

It can be repaired

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18
Q

Describe the demographic distribution of dissecting aortic aneurysms (any over-affected groups ?).

A
  • Men x3 more than women
  • Men 40 to 60 with hypertension
  • Younger patients with systemic or localized abnormalities of connective tissue
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19
Q

Describe the morphology of a dissecting aortic aneurysm.

A
  • usually initiates in tunica intima, 1-2 cm from aortic valve (blood accumulates between intima and media)
  • dissection can extend
    1) along the aorta retrograde toward the heart or
    2) distally, sometimes into the iliac and femoral arteries
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20
Q

Identify a possible complication of dissecting aortic aneurysms.

A

Dissection travels upwards around pericardium, causing accumulation of
blood around pericardial sac (cardiac tamponade, can be fatal)

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21
Q

Identify the clinical symptoms of a dissecting aortic aneurysm.

A

The sudden onset of excruciating pain:
-beginning in the anterior chest, radiating to the back, between the scapulae, and moving downward as the dissection progresses (the pain can be confused with that of myocardial infarction)

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22
Q

What are the most common causes of death associated with dissecting aortic aneurysms ?

A

Rupture of the dissection outward into the pericardial, pleural, or peritoneal cavities

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23
Q

Where do berry aneurysms usually occur ?

A

Circle of Willis

24
Q

Describe the demographic distribution of Berry aneurysms (any over-affected groups ?).

A

Young people

Often hypertensive

25
Q

What is an event which is associated with Berry aneurysms.

A

Associated with Subarachnoid haemorrhage (if they rupture)

26
Q

Where do capillary micro-aneurysms usually occur ?

A

Branches of middle cerebral artery

27
Q

Describe the demographic distribution of capillary micro-aneurysms (any over-affected groups ?).

A

Patients with hypertension or diabetes mellitus

28
Q

What is an event which is associated with capillary micro-aneurysms.

A

Associated with intra-cerebral haemorrhage

29
Q

Where do syphilitic aneurysms usually occur ? Why do they occur ?

A

Usually affects thoracic aorta

Occur resulting from tertiary syphilitic aortitis

30
Q

What are the main characteristics of Mycotic aneurysms ?

A
  • Wall of artery weakened by infection (due to bacteria or fungi)
  • Often in brain, secondary to embolism
31
Q

Define varicose veins.

A
  • Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support.
  • Venous valves become incompetent and leads to stasis, congestion, oedema, pain, and thrombosis
32
Q

What are risk factors for varicose veins ?

A

Age, sex, heredity, posture, obesity

33
Q

Where do varicose veins most often occur ? Where else may they occur ?

A
  • Usually, in lower limbs (saphenous system)
  • Oesophageal
  • Haemorrhoids (in or around rectum)
  • Varicocele (scrotal swelling)
34
Q

What are clinical issues associated with varicose veins ?

A
  • Cosmetic problems
  • Aching in legs
  • Stasis dermatitis
  • Skin ulceration and bleeding
35
Q

Define vasculitis.

A

Inflammation and necrosis of blood vessels

36
Q

Explain the pathogenesis of vasculitis.

A

•Cell immune-mediated inflammation → Deposition of immune complexes → Direct attack by circulating antibodies (against own vessels)

OR Direct invasion of vascular walls by infectious pathogens

37
Q

True or False: Vasculitis is often part of multi-system disease.

A

True

38
Q

List the main types of vasculitis.

A

1) Giant-cell (temporal) arteritis
2) Takayasu arteritis (pulseless disease)
3) Polyarteritis nodosa (PAN)
4) Kawasaki disease (children < age 4)

39
Q

Describe the demographic distribution of giant-cell (temporal) arteritis.

A

> age 50 (average onset age 70)

Women > men

40
Q

Explain the main features of giant-cell temporal arteritis.

A
  • granulomatous inflammation of large to small-sized arteries (temporal, vertebral and ophthalmic)
  • Cord like nodular thickening
41
Q

Describe the demographic distribution of Takayasu arteritis (pulseless disease).

A

Particularly women aged <30

42
Q

Explain the main features of Takayasu arteritis (pulseless disease).

A

Granulomatous vasculitis of medium and larger arteries of upper limbs (+arch of aorta)

43
Q

Explain the main features of Polyarteritis nodosa (PAN).

A
  • Medium small size muscular arteries of the kidneys, heart, liver, and gastrointestinal tract are involved
  • Fibrinoid necrosis could be fatal without steroid treatment
44
Q

Describe the demographic distribution of Kawasaki disease.

A

Children < age 4

45
Q

Explain the main features of Kawasaki disease.

A

High fever, conjunctival and oral lesions. Self-limited

46
Q

What is the general duration of giant-cell temporal arteritis.

A

6-12 months

47
Q

To what extent is giant-cell temporal arteritis self-limited ?

A

Could be self-limited

48
Q

What are the main symptoms of giant-cell temporal arteritis ?

A
  • Patchy lesion
  • Throbbing temporal pain
  • Malaise
  • Fever
49
Q

What are the main symptoms of Takayasu arteritis ?

A
  • Dizziness
  • Visual disturbances
  • Dyspnoea
  • Intermittent claudication upper limbs
  • Asymmetric BP
50
Q

How is Takayasu arteritis treated ?

A

Steroid treatment

51
Q

What is the term for benign vascular tumour ?

A

Angioma

52
Q

What is the term for malignant vascular tumour ?

A

Angiosarcoma

53
Q

Identify the main types of angiomas, and state where each is usually found.

A

1) Haemangioma (proliferation of blood vessels)
- Juvenile (=stawberry), often happens on the skin (disappears by itself)
- Capillary (=ruby spots), can be in skin, spleen, kidneys
- Cavernous (=port wine stains), can be on skin, spleen, liver, pancreas

2) Lymphangioma (proliferation of lymphatics)
- Capillary
- Cavernous

54
Q

Identify the main types of angiosarcomas, and state where each is usually found.

A

In general Angiosarcoma seen in skin, soft tissue, breast, bone, liver and spleen
-E.g. Kaposi’s sarcoma specifically, in skin and mucosal surfaces

55
Q

What is so special about Kaposi’s sarcoma ?

A

It is associated with HIV/AIDS.

MD3001 (75 decks)

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