Notes on Vascular Disorders

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Chylomicron:

• Diet-derived triglyceride transport.

• Requires B-48.

• Source of fatty acid and glycerol.

VLDL:

• Liver-derived triglyceride transport.

• Requires B-100.

• Source of fatty acid and glycerol.

LDL:

• Bad cholesterol.

• Cholesterol transport.

• Chylomicrons falsely lower calculated LDL levels.

Functions of cholesterol:

• Synthesis of vitamin D, bile salts and acids, adrenal cortex hormones.

HDL:

• Good cholesterol.

• Increased with exercise, wine, estrogen.

• Source of apolipoproteins; removes cholesterol from atherosclerotic plaques.

Disorders of lipoproteins:

Type II hyperlipoproteinemia:

• Increased LDL.

• Caused by: hypothyroidism, nephrotic syndrome.

Familial hypercholesterolemia:

• AD disorder; LDL deficiency.

• Tendon xanthomas; xanthelasma.

Type III hyperlipoproteinemia:

familial dysbetalipoproteinemia:

• Deficiency of apolipoprotein E.

• Increased serum cholesterol and triglyceride.

Findings:

• Palmar xanthomas; risk for coronary artery disease.

Type IV hyperlipoproteinemia:

• Increased VLDL.

• Cause due to: alcohol, progesterone in oral contraceptives, diabetes mellitus.

Familial hypertriglyceridemia:

• AD disorder; eruptive xanthomas; risk for coronary artery disease.

Apolipoprotein B deficiency:

• Abetalipoproteinemia.

• AD disorder; decreased B-48 and B-100.

• Deficiency of chylomicrons, VLDL, LDL; decreased cholesterol and triglyceride.

Findings:

• Malabsorption, ataxia, anemia.

Arteriosclerosis:

• Arterial walls are thick and inelastic.

• Dystrophic calcification.

• No clinical consequence unless atherosclerosis.

Atherosclerosis:

• Endothelial damage of muscular and elastic arteries.

• Caused by: hypertension, tobacco, LDL, homocysteine.

• Macrophages and platelets adhere to damaged endothelium; cytokines released and extracellular matrix produced.

• Fibrous cap develops; becomes ulcerated, calcified.

• Increased serum C-reactive peptide (CRP).

• Abdominal aorta is most common site.

Complications:

• Vessel weakness, thrombosis, hypertension, peripheral vascular disease.

Arteriolosclerosis:

• Hardened arterioles.

• Protein deposition occludes lumen.

• Caused by diabetes mellitus; hypertension.

• Onion skin appearance of arterioles.

Aneurysms:

• Weak vessel walls followed by dilation.

• Tendency of vessel wall to rupture.

Abdominal aortic aneurysm:

• Atherosclerosis weakens wall.

• Increased vessel diameter; lumen fills with debris and clots.

• Findings: usually asymptomatic.

Complication:

• Rupture causes severe back pain followed by hypotension.

Mycotic aneurysm:

• Vessel weakening due to infection.

Berry aneurysm of cerebral arteries:

• Defective junction of communicating branches of main cerebral arteries.

• Severe occipital headache.

• Complications: death.

Syphilitic aneurysm:

• Complication of tertiary syphilis due to Treponema pallidum.

• Vasa vasorum infection in aortic arch.

• Aortic dialation.

• Aortic valve regurgation: blood draining back into left ventricle.

• Brassy cough.

Aortic dissection:

• Elastic tissue degeneration.

• Seen in Marfan syndrome and Ehlers-Danlos syndrome.

• Increased wall stress caused by: pregnancy, hypertension, coarctation.

• Severe retrosternal chest pain radiating to back.

• Aortic valve regurgitation due to ring dilation.

• Loss of upper extremity pulse.

• Rupture.

Venous disorders:

Varicose veins:

• Distended, lengthened, tortuous veins.

• Most common: superficial saphenous veins.

• Hemorrhoids, varicocele.

• Causes: valve competence, familial, secondary to DVT.

Phlebothrombosis:

• Thrombosis of vein without inflammation.

• Caused by: stasis of blood flow, hypercoagulability.

• Often located in deep vein of calf.

• DVT findings: swelling, pain, edema.

• Pulmonary thromboembolism, stasis dermatitis.

Thrombophlebitis:

• Pain and tenderness on superficial vein.

• Venal cannulation.

• Infection.

• Pancreatic carcinoma.

• Tender and palpable cord; erythema and edema.

Superior vena cava syndrome:

• SVC compression commonly due to lung cancer.

• Puffiness; retinal hemorrhage; stroke.

Thoracic outlet syndrome:

• Compression of neurovascular compartment of neck.

• Heavy weight-lifting.

• Adson test is positive.

• Arm is numb while person is asleep.

Lymphatic disorders:

Acute lymphangitis:

• Cellulitis by S. pyogenes.

Lymphedema:

• Collection of lymphatic fluid in tissue of body cavity.

• Eg., in Turner's syndrome.

Vasculitic disorders:

• Inflammation of small vessels.

• Type II/III hypersensitivity.

• ANCA cause neutrophil activation.

• c-ANCA (against proteinase 3) and p-ANCA (myeloperoxidase).

• Skin is hemorrhagic, raised, painful to palpate.

• Eg., Henosch-Schonlein purpura.

Medium-sized vessel vasculitis:

• Thrombosis, infarctions or aneurysms.

• Muscular artery vasculitis; eg., Kawasaki disease.

Large vessel vasculitis:

• Findings: loss of pulse or stroke.

• Elastic artery vasculitis; eg., Takayasu arteritis.

Hypertension:

• BP over 140/90 mm Hg.

Depends on:

• Diastolic blood pressure.

• Systolic blood pressure.

• Sodium level.

Essential hypertension:

• 95% cases of hypertension.

• Genetic factors reduce Na elimination; unknown factors cause vasoconstriction of arterioles.

• Obesity, stress.

Secondary hypertension:

• 5% cases of hypertension.

• Renal artery occlusion.

• Activation of renin-angiotensin-aldosterone system.

• Renal artery has beaded appearance.

Additional Reading:

Basic Pathology

1. Cell Injury
2. Inflammation and Repair
3. Immunopathology
4. Water, Electrolyte, Acid-Base, Hemodynamic Disorders
5. Genetic and Developmental Disorders
6. Environmental Pathology
7. Nutritional Disorders
8. Neoplasia
9. Vascular Disorders
10. Heart Disorders
11. Red Blood Cell Disorders
12. White Blood Cell Disorders
13. Lymphoid Tissue Disorders
14. Hemostasis Disorders
15. Blood Banking and Transfusion Disorders
16. Upper and Lower Respiratory Disorders
17. Gastrointestinal Disorders
18. Hepatobiliary and Pancreatic Disorders
19. Kidney Disorders
20. Lower Urinary Tract and Male Reproductive Disorders
21. Female Reproductive and Breast Disorders
22. Endocrine Disorders
23. Musculoskeletal Disorders
24. Skin Disorders
25. Nervous System Disorders
26. Notes on Tissue Regeneration
27. A Table of Bleeding Disorders
28. FAQ on Structure and Function of Red Blood Cells
29. FAQ on Components of Blood
30. Notes on Hemostatic Mechanisms
31. What is Fever?
32. What is Edema?
33. FAQ on Blood Pressure
34. FAQ on principles of fluid and flow dynamics of Blood
35. Causes of Thrombocytopenia
36. Squamous cell carcinoma of head and neck mucosa
37. Four tumors which never metastasize to the brain
38. What is caustic injury?
39. What causes Peripheral Edema?

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