Pathophysiology Chp 24 Disorders Of Blood Flow

Front 1

3 types of arteries

Back 1

a. large elastic (aorta, and distal branches)
b. medium size,coranary and renal arteries
small arteries and arterioles that pass through the tissues and regulate capillary flow

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Vasculitis:

Back 2

: inflammation of blood vessel wall resulting in vascular tissue injury and necrosis. Arteries, veins, capillaries affected. Can be caused by injury, infectious agents or immune processes.

Front 3

HYPERCHOLESTEROLMIA

Back 3

: increased levels of cholesterol and its implicated in atherosclerosis.
1. 3 reasons for elevated levels.
a. nutrition
b. genetics
c. metabolic diseases

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(Mendelian disorders)

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i. mutant gene at LDL receptor
iii. may not develop symptoms until adulthood (xanthomas) along tendons, atherosclerosis appears. MI before 40 years old. Or if homozygotes MI as early as one to 2 years old.

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Secondary hyperlipoproteinemia

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a. obesity
b. DM

Front 6

CHD (major Risks)

Back 6

LDL cholesterol
b .Smoking
c. HTN
d. Family Hx of 1st degree relative, age men 45yrs, women 55yrs and older
HDL levels <40mg/dl should be less 100mg/dl, if 2 or more risk factors 130mg/dl

Front 7

chylomicrons

Back 7

Chylomicrons transfer triglycerides to cells of adipose, skeletal muscle tissue.
Liver synthesis and releases VLDL, HDL

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Atherosclerosis

Back 8

Hardening and accumulation of plaque in the intimal lining of large, medium arteries such as aorta and its branches, coronary and large vessels that supply the brain

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Vasculitis

Back 9

Involve endothelial cells and smooth muscle cells of arterial wall. Vessels of any type (arteries, veins, capillaries)
a. Vasculitis, angitis, arteritis different name for same thing.
b. Clinical symptoms:
i. fever, myalgia, arthralgia, malaise
ii. can be secondary to other causes:
a. Systemic Lupus erthrematosus
b. Cold (frostbite)
c. Irradiation (sunburn)
d. Mechanical injury, toxins
iii. ANC’s titers can be used as diagnostic marker for these disorders.

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Thromboangitis-Obliterans

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Medium size vessel vasculitides produces necrotizing damage of medium size arteries in major organ systems.

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Polyarteritis Nodosa

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Nodules in muscular arteries found in kidney, liver, intestine, peripheral nerve, skin, muscle, seem more in men and can occur in IV drug users and there is an assoc. with Hep B & C infection.

Front 12

Temporal Arteritis.

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Most common. Focal inflammation. In the branches and arteries of aortic arch, vertebrae, ophthalmic and posterior ciliary arteries.. Seen in old people.

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ARTERIAL DISEASE OF EXTREMETIES

Peripheral vascular disorders,

Back 13

also affect coronaries, cerebral arteries and produce ischemia, pain, impaired function and sometime infarction and tissue necrosis.
2. pathological also the same for both

a. acute arterial occlusion
b. atherosclerotic occlusive disease PVD. In vessels of lower extremeties also called arteriosclerosis obliterans (superficial femoral and popliteal arteries. Claudication.
c. Thromboaniitis Obliterans: (bergers). Causes thrombus formation. (plantar and digital vessels in foot and lower leg. (smoking)
d. Aortic Aneurysms: cause is atherosclerosis and people have HTN
e. Aortic Dissection: hemorrhage into vessel wall and tearing.

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VENOUS CIRCULATION disease OF LOWER EXTREMETIES

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a. varicose veins
b. chronic venous insufficiency
c. venous thrombosis/thrombophlebitis
d. DVT most common.

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Compartment syndrome

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: condition of increased pressure in a limited anatomic space, usually a muscle compartment and produces ischemic tissue injury.l

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Apoproteins

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each type of lipoprotein consists of a large molecular complex of lipids combined with proteins

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The major lipid constituents are

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cholesterol esters, triglicerides, nonesterified cholesterol, and phospholipids

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The function of apoproteins is

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control the interactions and ultimate fate of the lipoproteins. Some of the apoproteins activate the lypolytic enzymes that that facilitate the removale of lipids from lipoproteins, others serve as a reactive site that cellular receptors can recognize and use in the endocytosis and metabolism of the lipoproteins.

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The sites of lipoprotein synthesis is

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small intestine and liver

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Type I - exogenous dietary hypertriglyceridemia

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elevated chylomicrons. mutation in lipoprotein lipase gene

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Type IIA _ familial hypercholesterolemia

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Elevated LDLcholesterol. mutation in LDL receptor gene or in apoprotein B gene

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Type IIB - combined hyperlipidemia

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elevated LDL, VLDL, and triglycerides. mutation in LDL receptor gene or apoprotein B gene

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type III - remnant hyperlipidemia

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incresed remnants (chylomicrons) IDL triglycerides, and cholesterol. mutation in apolipoprotein E gene

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type IV - endogenous hypertriglyceridemia

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elevated VLDL and triglycerides.

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type V - mixed hypertriglucerideia

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elevated VLDL, chylomicrons, and cholesterol; tryglycerides greatly elevated. mutation in apolipoprotein C-II gene

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Xanthomas

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cholesterol deposits

Front 27

Fatty streaks

Back 27

flat yellow, thin, intimal discoloration that progressivley enlarge by becoming thicker and slightly elevated as the grow in length. hysoloically they consist of macrophages and smooth muscle cells that have become distended with lipid to become foam cells

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Fibrous atheromatous plaque

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thq basic lesion of clinical atherosclerosis. it is characterized by the accumulation of intracellular and extracellular lipids, proliferation of vascular smooth muscle cells, and formation of scar tissue.

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the most important complication of atherosclerosis

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thrombus

Front 30

How do activated macrophages effect endothelium

Back 30

AM release free radicals that oxidize LDL. oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to blood components, leading to platlet adhesion and aggregation and fibrin deposits.

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The seven P's of Giant Cell Temporal Arteritis

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1 pistol shot-acute onset. 2 palloe. 3 polar (cold). 4 pulslessness. 5 pain. 6 parasthesia. and 7 paralysis

Front 32

Ratio of ankle to arm (ankle arm index)

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tibial and brachial arteries. systolic BP is used to detect significant obstruction. Normally, systolic pressure in the ankle exceeds that in the brachial artery because systolic pressure and pulse pressure tend to increase as the pressure wave moves away from the heart. with a ratio of 0.9 indicating occlsion.

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Raynauds disease

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a functional disorder caused by intense vasospasm of the arterioles of the fingers, and, less often, the toes.

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Raynauds phenomenon

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is associated with other disease states or known causes of vasospasm. It is often the first symptum of collagen diseases. It occurs in almost 100% of scleroderma cases and can precede the diagnosis of scleroderma by many years

Front 35

Berry aneurism

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a small spherical dilation of the vessel at a bifurcation. (circle of willis)

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fusiform aneurism

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involves the entire circumference of the vessel and is characterized by a gradual and progressive dilation of the vessel.

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saccular aneurism

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extends over part of the circumference of the vessle and appears saclike.

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dissecting aneurism

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is a false aneurism that results from a tear of the vessel wall that allows blood to disect it's layers to create a blood filled cavity.

Front 39

thoracic aortic aneurism

Back 39

less common than abdominal, less than 10% and may present with substernal, back, and neck pain, may have dysnea, stridor or a brassy cough.

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Type A & B disecting aneurism

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A = ascending regardless of the site of the tear.

B = not involving the ascending aorta. A major symptom of a disecting aorta is the abrupt presence of excruciating pain, described as tearing or ripping.