2. Pathology Of Blood Vessels Ii

Front 1

What is an Aneurysm?

Back 1

A localized, abnormal dilation of a blood vessel or the wall of the heart.

Front 2

Where are aneurysms most commonly seen?

Back 2

In the infrarenal abdominal aorta (AAA)

Front 3

What are 3 less common areas of aortic aneurysms?

Back 3

-Common iliacs
-Aortic arch
-Descending aorta

Front 4

What is the #1 cause of triple A?

Back 4

Atherosclerosis

Front 5

What are 2 other causes of aneurysms?

Back 5

Cystic medial degeneration
Trauma

Front 6

What is a mycotic aneurysm?

Back 6

One that develops a secondary infection due to circulating organisms like Salmonella

Front 7

What is a false aneurysm?

Back 7

A breach of the vascular wall leading to an extravascular hematoma in free communication with the intravascular space.

Front 8

What is a very rare variant of abdominal aneurysm?

Back 8

Inflammatory abdominal aneurysm

Front 9

What are the findings in inflammatory abdominal aneurysm?
What causes it?

Back 9

-Dense periaortic fibrosis
-Chronic inflammation
-Idiopathic

Front 10

What are 4 major complications of aneurysms?

Back 10

ROTIE

Front 11

What is ROTIE?

Back 11

-Rupture (peritoneal/retro)
-Obstruction of later vessels
-Thrombosis/embolism
-Impingement of adjacent structuers (ie ureter)
-Erosion of adjacent structures (ie ureter)

Front 12

What is the MOST FEARED complication of aneurysm?

Back 12

Rupture

Front 13

What determines the risk of aneurysm rupture?

Back 13

The size of the aneurysm

Front 14

What determines the rate of growth of an aneurysm?

Back 14

Blood pressure

Front 15

What is the yearly risk of rupture for aneurysms that are
>5 cm
>6 cm

Back 15

>5 cm = 5-10% risk of rupture

>6 cm = 25% risk of rupture

Front 16

What is the mortality rate for
-Elective surgical repair
-Emergent surgical repair
of an aneurysm?

Back 16

Elective mortality rate = 5%

Emergent mortality rate = 50%

Front 17

What is a syphilitic aneurysm?

Back 17

An aortic arch aneurysm seen in tertiary syphilis

Front 18

How common are syphilitic aneurysms?

Back 18

Rare

Front 19

What causes syphilitic aneurysms to develop in the ascending aortic arch?

Back 19

Inflammation of the vasa vasorum which causes obliterative endarteritis

Front 20

What does obliterative endarteritis lead to?

Back 20

Ischemic destruction of the media

Front 21

What does ischemic destruction of the media lead to?

Back 21

Loss of elastic fibers - dilation - aneurysm

Front 22

What is Cor bovinum and how is it related to syphilitic aneurysms?

Back 22

A heart as big as a cow's - when the obliterative endarteritis involves the aortic valve ring it causes insufficiency and volume overload - hypertrophy ensues to maintain CO/BP

Front 23

When syphilitic aneurysms were more common, what did most patients die of?

Back 23

Heart failure due to aortic valvular incompetence

Front 24

What is aortic dissection characterized by?

Back 24

Bloodflow within the laminar planes of the media forming a blood-filled channel within the aortic wall.

Front 25

In what patients do we see 90% of all aortic dissections?

Back 25

-Men 40-60 yrs old with antecedent hypertension

Front 26

What syndrome is associated with aortic dissection?

Back 26

Marfans in younger patients

Front 27

What are 2 other populations at increased risk for aortic dissection?

Back 27

-Pregnant women
-Cocaine and Amphetamine users

Front 28

What famous actor died from an aortic dissection due to an undiagnosed congenital heart defect?

Back 28

John ritter

Front 29

What is the origin of aortic dissection?

Back 29

A tear in the intima that extends INTO but not through the media.

Front 30

Where in the aorta are the originating tears most commonly found?

Back 30

Within 10 cm of the aortic valve

Front 31

How does aortic dissection cause death most commonly?

Back 31

By rupturing into the pericardial, pleural, or peritoneal space.

Front 32

What are the 2 classes/types of aortic dissections?

Back 32

Type A
Type B

Front 33

What happens when an aortic dissection ruptures back into the aortic lumen instead of going distally?

Back 33

It can form a double barrel aorta

Front 34

What vessels will be involved in retrograde dissection?

Back 34

-Coronary arteries
-Carotid arteries

Front 35

What vessels will be involved in forward/anterograde dissection?

Back 35

-Renal
-Mesenteric
-Iliac

Front 36

What is retrograde dissection capable of disrupting?

Back 36

the Aortic valve

Front 37

What are Type A aortic dissections?

Back 37

Those that involve either:
-both the ascending and descending aorta
OR
-just the ascending

Front 38

What are Type B aortic dissections?

Back 38

Those that involve ONLY the descending aorta

Front 39

What are 2 major risk factors for aortic dissection? Which is more major?

Back 39

-Medial degeneration
-Hypertension - #1 risk factor

Front 40

What is an Aortic Rupture?

Back 40

Tearing of the ligamentum arteriosum where the aorta is tethered

Front 41

What are the 2 most common situations in which aortic rupture is seen?

Back 41

-motor vehicle accidents/trauma
-Deceleration events like falling from high places

Front 42

What are Veins composed of?

Back 42

The same layers arteries are:
-Tunica intima
-Media
-Adventitia

Front 43

How is the media in veins compared to arteries?

Back 43

Much thinner

Front 44

Are there elastic fibers in veins?

Back 44

No

Front 45

What vein pathology is seen in 15-20% of the population?

Back 45

Varicose veins

Front 46

What are varicose veins? What causes them?

Back 46

Abnormally dilated turtuous veins caused by prolonged periods of increased intraluminal pressure - STANDING

Front 47

In what veins are varicose changes most often seen?

Back 47

Superficial veins of the legs

Front 48

What are 2 risk factors for developing varicose veins?

Back 48

-Familial tendency
-Pregnancy

Front 49

What can varicose veins lead to?

Back 49

-Thrombosis and phlebosclerosis
-Stasis dermatitis/ulceration

Front 50

What venous pathology is commonly seen in people with portal hypertension and cirrhosis?

Back 50

Esophageal varices

Front 51

What happens when esophageal varices rupture?

Back 51

Acute GI bleeding

Front 52

What develops as a result of dilation of the anorectal junction veins secondary to pregnancy and portal hypertension?

Back 52

Hemorrhoids

Front 53

What is Phlebothrombosis?

Back 53

Deep vein thrombosis

Front 54

Where do venous thrombi occur in 90% of instances? Why?

Back 54

In the deep veins of the lower extremities - because there is lower pressure and stasis.

Front 55

What patients are at increased risk of DVT?

Back 55

-Hospitalized / inactive
-Post surgical patients