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1

define atherosclerosis

degeneration of arterial wall characterised by fibrosis, lipid deposition and inflammation which limits blood circulation and predisposes to thrombosis.

2

which vessels or positions on vessels are commonly affected by atherosclerosis.

Bi furcations (tubulent flow)
Abdominal aorta
Coronary arteries
Popliteal arteries vessels in the leg
Carotid vessels
Circle of willis.

3

what are the common non modifiable risk factors of atheroscerlosis.

age, male, FH, genetics.

4

what are the common modifiable risk factors of atheroscerlosis.

Hyperlipidaemia (LDL:HDL)
Hypertension
Smoking
Diabetes
Other: CRP, ↑homocysteine,(metabolic condition)?
Stress

5

what causes the atherosclerotic process to begin

chronic injury and repair of the endothelium
First step is endothelial injury.

6

what causes endothelial injury

Haemodynamic injury, chemicals, immune complex deposition, irradiation.

7

In which layer of the artery does lipid deposit in hyperlipademia.

intima

8

what factors are produced upon damage of the endothelium

adhesion factors.

9

what cells migrate to the intima engulfing lipid and forming foam cells

monocytes

10

what is the the name for the point at which monocytes engulf lipid and form foam cells

fatty streak.

11

what do the foam cell secrete to circulate more macrophages, lymphocytes and smooth muscle cells.

chemokines

12

what is the function of smooth muscle cells in the atherosclerotic plaque

proliferate and secrete connective tissue.

13

what forms the fibrous cap of a atheroscleotic plaque

smooth muscle, macrophages, foam cells, lymphocytes, collagen, elastin and proteoglycans.

14

what forms the necrotic centre of the atherosclerotic plaque

cell debris, cholesterol crystals, foam cells and calcium.

15

what pathology follows atherosclerosis

occlusion
weakening of vessel wall- aneurysm
erosion (of fibrous cap)- thrombus

16

define thrombus

Solidification of blood contents formed in the vessel during life.

17

what are the characteristics of a clot which make it different to a thrombus

stagnant
enzymatic process
elastic
adopt to the shape of the vessels

18

what are the characteristics of a thrombus which make it different to a clot.

during life
dependent on platelets
firm.

19

what cell is needed in thrombus formation

platelets.

20

what bone marrow cell gives rise to platelets

megakaryocytes.

21

what is the function of platelets, to what molecule do they bind in endothelial injury

circulate in the blood stream
Bind to collagen exposed by endothelial damage and become activated

22

what molecules do platelets secrete.

Alpha granules: fibrinogen, fibronectin, PDGF
Dense granules: chemotactic chemicals

23

how is virchow's triad important in atherosclerosis formation

platelet adhesion and subsequent thrombus formation requires change in intimal surface of the vessel, blood flow and blood constituents.

24

what is the pathogenesis of arterial thrombosis

plaque ruptures- turbulent flow and intimal change.
Hyperlipidaemia- change in blood constituents.
Platelets bind and fibrin is produced entrapping RBC.
Thrombus propagation-infront of thrombus is laminar flow and behind thrombus is turbulent flow.

25

what is the pathogenesis of venous thrombosis.

intimal change- valves
change in bloodflow immobile
change in blood constituents- prothrombogenic
Factor V leiden
oestrogen
inflammatory mediators

26

what are thrombi of the heart also known as

mural thrombi.

27

How does MI predispose the heart to thrombi

surface of the heart becomes sticky so the platelets adhere

28

How does arrhythmia's predispose the heart to thrombi

stasis occurs and hence a thrombus can form.

29

what does a thrombus predispose you to

occlusion of a vessel
resolution
incorporation into the vessel
recanalisation
embolisation

30

define embolisation

A mass of material in the vascular system able to lodge in a vessel and block it