systemic pathology 400 (CV class 4)

Question 1

telangiectasis

Answer 1

aka “ spider veins”

Question 2

what are spider veins (telangiectasia)

Answer 2

Vascular lesion formed by dilation of a group of small blood vessels

Question 3

where can spider veins occur? whre are they most common

Answer 3

Can occur anywhere on the skin

Most frequently seen on the face and thighs

Question 4

is spider veins a serious issue

Answer 4

generally just a cosmetic condition –> generally no functional effect on health

Question 5

how can spider veins appear?

spider veins vs childhood

Answer 5

May appear as a birthmark or become apparent in young children

“Spider telangiectasias are fairly common and look like little red lines on a child’s skin. They are usually nothing more than a cosmetic problem. They form as a result of abnormal blood vessels (a.k.a. a vascular anomaly). Spider telangiectasias don’t cause any health problems.”

Question 6

risk factors / associated factors (telangiectasis)

Answer 6

May be associated with

long term sun exposure,
standing,
age,
varicose veins,
gender,
pregnancy,
trauma,
steroid treatment,
rosacea, etc.

Question 7

telangiecstasis etymology

Answer 7

telos = end

angeion = vessel

ektasis = dilatation

Question 8

frostbite

Answer 8

Localized medical condition whereby damage is caused to skin and other tissues due to extreme cold.

Question 9

frostbite – etiology / risk factors

Answer 9

Extreme cold/wind chill
Wet clothes
Poor circulation
Blood vessel d/o
Low body fat
Age
Medications
Smoking, alcohol, drugs
Homelessness

Question 10

frostbite – pathogenesis

Answer 10

Vasoconstriction upon exposure to cold

—> This helps to preserve core body temperature

Ice crystals form in tissues and expand into extracellular spaces
—> cell membrane rupture
—> disruption of enzyme activity
—> tissue death

Question 11

retrostasis vs hunting response

Answer 11

retrostasis at first

hunting response after 10-15 or 20 (?) minutes
—> alternating vasodilation/constriction to prevent superficial tissue damage

when cold continue however, – body goes back to RETROSTASIS –> b/c the vital organs need to maintain temperature to prevent death

—> thus superficial tissue loses blood supply, and can die d/t anoxia

Question 12

frostbite classification

(superficial classification)

Answer 12

Superficial frostbite affects skin and subcutaneous tissue

—> Discoloration of the skin, burning and/or tingling, swelling

Question 13

(deep frostbite)

Answer 13

Deep frostbite extends beyond the superficial tissue

—> White skin, pain, blisters, tissue necrosis, gangrene

—> ultimately turns black (?) when dead

Question 14

frostbite Dx

Answer 14

Based on history and clinical presentation

Bone scan

Question 15

frostbite and bone scan

Answer 15

if frostbite/necrosis has reached bone –> then amputation must take place

“It is concluded that scintigraphy is an excellent means of evaluating patients with severe frostbite of the extremities: as early as day 2 after the injury it can indicate whether amputation is necessary, and between days 2 and 8 it provides valuable information on the efficacy of treatment.”

Question 16

scintigraphy

Answer 16

a technique in which a scintillation counter or similar detector is used with a radioactive tracer to obtain an image of a bodily organ or a record of its functioning.

Question 17

frostbite tx

Answer 17

Vasodilators

Rewarm the area without rubbing or massaging
—> Reperfusion injury is a serious complication

Pain meds

Surgery, amputation

Question 18

reperfusion ?

Answer 18

“Reperfusion is the restoration of blood flow to an organ or tissue after having been blocked, and may refer to: Reperfusion injury, tissue damage caused when blood supply returns to the tissue.

Reperfusion therapy, the medical treatment that restores blood flow through blocked arteries, typically after a heart attack.”

Question 19

why does reperfusion cause tissue damage

Answer 19

The inflammatory response is partially responsible for the damage of reperfusion injury. White blood cells, carried to the area by the newly returning blood, release a host of inflammatory factors such as interleukins as well as free radicals in response to tissue damage.

Question 20

diabetic microangiopathy

Answer 20

Years of poorly controlled hyperglycemia leads to vascular complications that affect small (microvascular) vessels, large (macrovascular) vessels, or both.

Question 21

pathogenesis (diabetic microangiopathy)

Answer 21

Vascular disease due to:

Glycosylation of serum and tissue proteins

Superoxide production

Activation of signaling molecules
—> increase vascular permeability
—> endothelial dysfunction

Hypertension

Arterial microthromboses

Hyperglycemia/hyperinsulinemia
—> inflammation and prothrombotic effects
—> impaired vascular autoregulation

Hyperglycemia
—> impaired cellular immunity
—> immune dysfunction

Question 22

glycoxidation

Answer 22

“Glycoxidation is a process whereby glycated proteins chemically generate oxygen free radicals.”

Question 23

why superoxide production

Answer 23

However, in diabetic conditions, the uncoupling of eNOS in diabetic vascular endothelial cells leads to the overproduction of superoxide anion (O2* −), which decreases NO availability, impairs the endothelium and ultimately increases superoxide in blood vessels [23].

Question 24

1) diabetic microangiopathy VS Diabetic retinopathy

Answer 24

No early symptoms or signs, but blurring, retinal detachment, and partial or total vision loss eventually develop

Question 25

diabetic retinopathy is...

Answer 25

Most common cause of adult blindness in the US

Question 26

2) diabetic microangiopathy vs Diabetic neuropathy

Answer 26

The result of nerve ischemia from microvascular disease, direct effects of hyperglycemia on neurons, and intracellular metabolic changes that impair nerve function

Question 27

diabetic retinopathy pathogenesis (?)

Answer 27

The pathologic process involved in DME is the resultant fluid leaking into the retina and depositing under the macula. Sediment left behind from this edema leads to waxy, yellow lipid byproducts referred to as hard exudates. (Diabetic macular edema (DME))

Question 28

diabetic nephropathy

Answer 28

Involves glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes

Question 29

diabetic nephropathy is

Answer 29

The number one cause of renal failure in the US

Question 30

note about diabetic neuropathy (as a result of diabetic microangiopathy)

Answer 30

also recall CHARCOT'S neuropathy

Question 31

decompression sickness

Answer 31

AKA caisson disease, the bends, divers disease

Question 32

what is decompression sickness?

Answer 32

Decompression sickness occurs when rapid pressure reduction (e.g. during ascent from a dive, or ascent to altitude) causes gas previously dissolved in blood or tissues to form bubbles in blood vessels.

Question 33

decompression sickness and Henry's law

Answer 33

The solubility of a gas in a liquid is directly proportional to the pressure exerted on the gas and liquid.

Question 34

steps during decompression sickness

Answer 34

during descent (diving) ---> nitrogen moves from high pressure in lungs too blood (low pressure) swimming up too quickly doesn't give nitrogen enough time to leave blood ---> forms bubbles that lead to SSx whereas a slow ascent would let the nitrogen gradually return to lungs where it is breathed out

Question 35

decompression sickness -- incidence

Answer 35

Approximately 2 to 4/10,000 dives Men > women

Question 36

decompression sickness -- RISK FACTORS

Answer 36

Cold temperature dives Prolonged or deep dives Rapid ascent Dehydration Flying after diving Obesity Older age

Question 37

why is it called the bends?

Answer 37

DCS often causes air bubbles to settle in major joints like knees or elbows, causing individuals to bend over in excruciating pain, hence its common name, the bends.

Question 38

caisson

Answer 38

a large watertight chamber, open at the bottom, from which the water is kept out by air pressure and in which construction work may be carried out under water.

Question 39

why called caisson disease

Answer 39

The original name for DCS was "caisson disease". This term was introduced in the 19th century, when caissons under pressure were used to keep water from flooding large engineering excavations below the water table, such as bridge supports and tunnels.

Question 40

decompression sickness SSx

Answer 40

Dependent on which tissue is affected: Joint and muscle pain N/V dyspnea (shortness of breath) Numbness, tingling, formication Seizures Itching and/or rash Hearing loss

Question 41

formication define

Answer 41

Formication is a symptom where you hallucinate the feeling of insects crawling in, on or under your skin. This symptom can be very upsetting or disturbing, leading to other issues like self-injury from scratching or trying to get the insects out from under or inside of your skin.

Question 42

decompression sickness -- dx, tx

Answer 42

Diagnosis History and clinical manifestation Treatment Oxygen chamber and recompression therapy

Question 43

decompression sickness -- px

Answer 43

Prognosis About 80% of patients recover completely 20% may have long term / chronic SSx

Question 44

varicose veins aka

Answer 44

AKA varicosities

Question 45

what are varicose veins?

Answer 45

An abnormal dilation of veins leading to tortuosity (twisting and turning) of the vessel, incompetence of the valves, and a propensity to thrombosis

Question 46

varicose veins incidence

Answer 46

Women are affected more often than men (secondary to pregnancy) until 70 y.o. 70% of women ages 60-70 have varicose veins Usually develops between ages 30-50

Question 47

varicose veins risk factors

Answer 47

Periods of high venous pressure associated with: Heavy lifting Prolonged sitting or standing Hormonal changes Menopause Pregnancy Heart failure Constipation (hemorrhoids) Hereditary factors* CT disease Valvular incompetence Obesity

Question 48

varicose veins common sites

Answer 48

Lower extremity Saphenous vein Rectum and anal canal – hemorrhoids (can be internal or external) Scrotum - varicocele

Question 49

varicocele risk factors

Answer 49

age genetics anatomy testicular growth physical exertion sedentary lifestyle occupation body weight heat exposure infertility

Question 50

varicose veins genreally @

Answer 50

superficial veins

Question 51

varicose veins -- clinical manifestations

Answer 51

The clinical picture is not correlated with the severity of the varicosities The development of varicose veins is gradual. Most are asymptomatic (perhaps with the exception of hemorrhoids)

Question 52

most common symptom of varicose veins (when symptomatic)

Answer 52

The most common symptom is dull, aching heaviness, tension, or fatigue brought on by standing.

Question 53

varicose veins of scrotum (varicocele)

Answer 53

could be d/t serous fluid production in scrotum

Question 54

"The clinical picture is not correlated with the severity of the varicosities"

Answer 54

I.e. a tiny varicosity could be painful and achy & large amounts of varicosities could be asymptomatic (Recall, similar to osteoarthritis -- amount of wear/damage does not necessarily correlate to SSx/pain)

Question 55

varicose veins -- other notes about clinical manifestations

Answer 55

Clinical Manifestation: Cramps are relieved with elevation of legs Itching may occur The veins are dilated, tortuous and elongated beneath the skin

Question 56

secondary changes of varicose veins

Answer 56

Secondary changes include browning and swelling Veins may become thick and hard to the touch

Question 57

varicose veins -- complicaitons

Answer 57

Ulcers due to compromised circulation Thrombosis Inflammation of the vein - phlebitis

Question 58

how can varicose veins lead to phlebitis

Answer 58

A common pathway for developing phlebitis is when a clot develops in a varicose vein, just underneath the skin surface. Symptoms of phlebitis are caused by inflammation, which represents the body's response to injury or tissue damage. Phlebitis can be triggered by excessive stretching of the leg veins.

Question 59

venous thrombosis

Answer 59

..

Question 60

venous thrombosis define

Answer 60

Venous thrombosis - partial or full occlusion of a vein by a clot

Question 61

phlebothrombitis

Answer 61

inflammation of a vein, predisposing a person to clot formation (also note form previous card -- clot can lead to inflammation, and inflammation can lead to clot (?)

Question 62

thrombophlebitis

Answer 62

partial or complete occlusion of a vein by a thrombus (clot) with a secondary inflammatory reaction in the wall of the vein

Question 63

thrombophlebitis vs phlebothrombitis

Answer 63

"Thrombophlebitis is a condition in which inflammation of the vein wall has preceded the formation of a thrombus (blood clot). Phlebothrombosis is the presence of a clot within a vein, unassociated with inflammation of the wall of the vein (Fig. 27.6)." ---> NOTES DIFFERENT = inflammation is risk factor for the clot vs above: "clot within a vein, unassociated with inflammation of the wall"

Question 64

venous thrombosis -- Classificaiotn

Answer 64

superficial vs deep

Question 65

deep venous thrombosis

Answer 65

Deep (DVT) Usually present in the calf. It is often clinically silent and benign although complications can lead to pulmonary emboli. Thromboses in the popliteal, femoral, iliac veins or inferior vena cava are associated with greater risk of PULMONARY EMBOLISM

Question 66

which DVT locaitons are risk factors for pulmonary embolism

Answer 66

popliteal, femoral, iliac veins or inferior vena cava

Question 67

venous thrombosis -- etiology and risk factors

Answer 67

Surgery – most common Genetics Oral contraceptives Smoking Venous stasis Hypercoagulability of blood

Question 68

venous thrombosis -- incidence

Answer 68

DVT is the third most common CV disease after coronary artery episodes (heart attack) and cerebrovascular accidents (stroke). 2 million Americans die of DVT per year

Question 69

DVT mechanism of death

Answer 69

Deep vein thrombosis can be serious because blood clots in the veins can break loose. The clots can then travel through the bloodstream and get stuck in the lungs, blocking blood flow (pulmonary embolism). When DVT and pulmonary embolism occur together, it's called venous thromboembolism (VTE).

Question 70

venous thrombosis pathogenesis

Answer 70

Trauma to endothelium of the vein exposes subendothelial tissue to platelets and clotting factors, initiating thrombosis Platelets adhering to vessel wall attract fibrin, leukocytes, erythrocytes Clot can undergo recanalization, dissolution, organization, or can persist as a thrombus or break free and become an embolus

Question 71

venous thrombosis -- clinical manifestation

Answer 71

Variable and inconsistent Asymptomatic LE>UE Edema Dull ache Tightness, tenderness Swelling

Question 72

venous thrombosis Dx

Answer 72

Based on signs, symptoms and risk factors Ultrasound

Question 73

venous thrombosis -- Tx

Answer 73

Elastic stockings (COMPRESSION SOCKS) Medications Surgery

Question 74

why do compression socks help with venous thrombosis?

Answer 74

Compression socks, which are made from synthetic materials, are tighter than regular socks. They apply controlled pressure to improve blood flow in the veins of the leg. There are medical-grade compression stockings that are “graduated”—tightest at the ankles, with the compression gradually easing up the legs. "The compression of the socks gently pushes blood flow up the leg, helping to prevent swelling and even blood clots."

Question 75

venous stasis

Answer 75

AKA postphlebitis syndrome, chronic venous insufficiency

Question 76

postphlebitis syndrome vs post-thrombotic syndrome

Answer 76

Post-thrombotic syndrome refers to symptoms and signs of chronic venous insufficiency that develop following deep vein thrombosis (DVT) and is a common, burdensome, and costly complication [1,2]. The term "post-thrombotic" replaces the prior terminology "postphlebitic" syndrome ** "Immediate compression and walking seems also to reduce the incidence of a postthrombotic syndrome." (w/ respect to compression socks and venous thrombosis)

Question 77

so what is venous stasis?

Answer 77

Inadequate venous return over a long period of time

Question 78

VENOUS STASIS -- two relevant risk factors

Answer 78

venous thrombosis and varicose veins

Question 79

venous stasis and venous thrombosis

Answer 79

Venous stasis syndrome is typically considered a long-term sequel of deep vein thrombosis (DVT; also known as post-thrombotic syndrome or post-phlebitic syndrome in the post-DVT setting). The cumulative incidence of venous stasis syndrome after DVT is 20–50%, with a third being severe venous stasis syndrome4–9. Note: that's why venous stasis is aka post-thrombotic synrome

Question 80

venous stasis and varicose veins

Answer 80

Conclusions. Increasing patient age and BMI, prior DVT (particularly left leg DVT), longer time interval since DVT and varicose veins are independent risk factors for venous stasis syndrome.

Question 81

venous stasis typically follows...

Answer 81

Follows most severe cases of DVT

Question 82

venous stasis can also occur secondary to

Answer 82

varicose veins, leg trauma, or neoplasms

Question 83

venous stasis -- clinical manifestations

Answer 83

Progressive edema of the leg Thickening, coarsening, and brownish pigmentation of the skin around the ankles (stasis dermatitis) Venous stasis ulceration ---> Painful, shallow wounds ---> Large amounts of drainage

Question 84

stasis dermatitis (note individuals with brown ankles)

Answer 84

Stasis dermatitis involves skin changes that are caused by poor circulation and the resulting pooling of blood in the lower legs. Also called gravitational dermatitis and venous eczema, this condition could develop with aging, but it could also indicate the presence of another condition, like kidney or heart disease.

Question 85

venous stasis -- Dx & Tx

Answer 85

Diagnosis: History and examination Treatment: Treatment is as for varicose veins. Prognosis: Poor

Question 86

Treatment: Treatment is as for varicose veins.

Answer 86

Rest and elevation Exercise Elastic stockings (COMPRESSION SOCKS) Surgery, if necessary

Question 87

venous stasis aka

Answer 87

chronic venous insufficiency

Question 88

Raynaud's

Answer 88

Raynaud’s disease: Occurs on its own and isn’t connected with another disease or condition. This is also called primary Raynaud’s syndrome. Raynaud’s phenomenon: Occurs due to an underlying condition, medication or lifestyle factor. This is also called secondary Raynaud’s syndrome. Raynaud’s syndrome: Refers to either the primary or secondary form of the condition.

Question 89

Raynaud's is

Answer 89

Intermittent episodes of small artery or arteriole constriction of the extremities causing temporary pallor and cyanosis of the digits and changes in skin temperature

Question 90

why does Raynaud's take place

Answer 90

Occurs in response to cold temperature, anxiety or excitement

Question 91

Primary Vasospastic Disorder (Raynaud’s Disease)

Answer 91

Idiopathic

Question 92

Raynaud’s Phenomenon

Answer 92

Secondary to another disease or underlying cause

Question 93

RAYNAUD’S -- incidence / risk factors

Answer 93

Usually more common in women Age Smoking, alcohol may be a factor.

Question 94

Raynaud's can also be associated with

Answer 94

occlusive arterial disease, neurogenic lesions, TOS, frostbite, trauma, the chronic use of vibrating equipment, repetitive stress injuries to the small vessels of the hands,

Question 95

vibration Raynaud's

Answer 95

Vibration white finger is a type of secondary Raynaud's phenomenon. In this type, blood vessels, nerves, and other tissue become damaged due to chronic vibration.

Question 96

also a known risk factor

Answer 96

Possibly a disturbance in the control of vascular reflexes ---> overactive sympathetic nervous system in that area ---> vasoconstriction

Question 97

Raynaud's clinical manifestation

Answer 97

White, blue, then red digits ---> MORE OFTEN IN UE than LE Throbbing, paresthesia, swelling ---> Sensory changes, such as numbness, stiffness, diminished sensation, aching pain often occur.

Question 98

what can prolonged Raynaud's do to hands/fingers

Answer 98

Over time, frequent prolonged episodes can cause the fingertips to thicken and the fingernails to become brittle.

Question 99

Raynaud's typical phases

Answer 99

phase 1: Ischemia phase 2: Cyanosis phase 3: Rubor

Question 100

Raynaud's Dx

Answer 100

Diagnosis based on clinical presentation and history

Question 101

Raynaud's disease (primary Raynaud's) Dx

Answer 101

Raynaud’s disease – history of symptoms for at least 2 years with no progression and no evidence of underlying cause (idiopathic)

Question 102

Raynaud's Tx

Answer 102

Avoid triggers Decrease smoking Physical therapy Relaxation techniques Exercise Heat

Question 103

Raynaud's Px

Answer 103

Untreated and uncontrolled Raynaud’s may damage or destroy affected digits. (long term) Disability and loss of function can occur. RECALL: "Over time, frequent prolonged episodes can cause the fingertips to thicken and the fingernails to become brittle. "