MHD: Vascular disease Flashcards Preview

MHD/Pharm Block 4 > MHD: Vascular disease > Flashcards

Flashcards in MHD: Vascular disease Deck (31):
1

What are the layers of the vascular wall from inside-out?

Intima, media, adventitia

2

Where are elastic lamina found in the vascular wall?

The IEL is found interior to the media layer and the EEL is found exterior to the media layer

3

What is the vaso vasorum?

Small vessels that provide oxygen to the vessel wall. Particularly important in large vessels.

4

What is the vascular response to injury?

Intimal thickening

5

Describe the mechanism of intimal thickening?

Smooth muscle cells enter intima, mitose to expand intimal layer.
Extracellular matrix production also increases

6

What is the general definition of arteriosclerosis?

Hardening of the arteries due to thickening and loss of elasticity

7

What are the morphologic variants of arteriosclerosis?

Atherosclerosis
Monckeberg's medial calcific sclerosis
Arteriosclerosis (due to hypertension)

8

What vessels are mainly affected by atherosclerosis?

Large elastic arteries (aorta, carotid, iliac) and muscular arteries (coronary, popliteal)

9

What are the major risk factors for atherosclerosis

Non-modifiable: genetic, family history, age, male gender
Modifiable: hyperlipidemia, hypertension, cigarette smoking, diabetes mellitus, inflammation

10

What is the definition of atherosclerosis?

Chronic inflammatory response of the arterial wall to endothelial injury

11

What is an atheroma?

accumulation of degenerative material (cell debris, cholesterol crystals, foam cells, calcium) in the tunica intima with a fibrous cap

12

Describe the morphology of an atheroma

Atheromas only effect part of the circumference of the vessel wall, leading to decreased medial thickness and ischemia

13

What complications are associated with atheroma/plaque formation?

Rupture/ulceration/erosion
Emobli
Hemorrhage
Weakened media --> aneurysm
Calcification
Thrombosis

14

On histology, how do you identify an atherosclerotic embolus?

Cholesterol crystals appear like white needles on histological slides

15

What are the clinical complications associated with atherosclerosis?

MI, cerebral ischemia, peripheral vascular disease, aneurysms

16

Describe the pathogenesis of Monckeberg's medial calcific sclerosis

Calcific depositions form in the tunica media
Vessels are not obstructed, so lumenal size is preserved

17

What is hyaline arteriolosclerosis?

Hypertension induced sclerosis of the arterioles often seen in brain and kidneys
-Seen as homogenous pink thickening of vessels with lumenal narrowing

18

What is hyperplastic arteriolosclerosis?

Due to severe acute hypertension
Gives onion skin appearance of vessels due to smooth muscle cells with reduplicated membranes. Lumens narrow progressively.

19

What is an aneurysm?

Localized abnormal dilatation of a blood vessel

20

What is the difference between a true (saccular) aneurysm and a false aneurysm?

A true aneurysm involves the outpouching of a vessel wall whereas a false aneurysm is caused by a ruptured vessel wall leading to a hematoma

21

What is a dissection?

A tear in the tunica intima leads to blood flowing into the media splaying apart layers to form a blood filled channel

22

What genetic conditions are associated with increased risk for aneurysms due to poor intrinsic quality of vascular wall connective tissue?

Marfan syndrome (fibrillin defect)
Ehlers Danlos (type III collagen defect)

23

What conditions can cause ischemia leading to increased risk for aneurysm?

Atherosclerosis, hypertension, syphillis

24

What is cystic medial degeneration?

Degradation of the elastin found within the tunica media and loss of smooth muscle cells

25

What enzymes play a key role in the formation of abdominal aortic aneurysms?

Matrix metalloproteinases

26

What is the classical location of an AAA?

Between the renal arteries and the aortic bifurcation

27

How does diameter of AAA influence the risk of rupture?

Rupture risk increases with increasing diameter. There is a 25% chance of rupture per year with a diameter > 6cm

28

What are the causes of an aortic dissection?

Hypertension, connective tissue disorders, bicuspid aortic valves

29

What are the two classifications of aortic dissection?

A: in the Ascending (proximal) aorta
B: in the Bottom (descending) aorta

30

Which type of aortic dissection is more serious?

Type A is more serious than B, usually requires surgical treatment

31

What is vasculitis?

Inflammation of blood vessels
Can be due to infectious pathogen or immune-mediated