Pathology Final new stuff

What is the mechanism of arterial disease?

atherosclerosis causes narrowing of arteries leading to ischemia, low O2, and necrosis

What are the risk factors for PAD (Peripheral Arterial Disease)?

same as atherosclerosis: smoking, HTN, diabetes, high LDLs

What are signs/symptoms of PAD (Peripheral Arterial Disease)?

no blood flow: no pulse, edema, or drainage, pain when walking, necrosis, and cold extremities

What is the treatment for PAD (Peripheral Arterial Disease)?

hang; better when dangling

What is the mechanism of venous disease?

inadequate venous return due to blockage (DVT) or distended vein/varicose veins

What are the risk factors of PVD (Peripheral Vascular Disease)?

age, female, obesity, pregnancy, and previous leg injury/trauma

What are the signs/symptoms of PVD (Peripheral Vascular Disease)?

blood flow: pulse, increased capillary hydrostatic pressure = edema, drainage, and hyperpigmentation

What is the treatment for PVD (Peripheral Vascular Disease)?

elevate; better with elevation

What is the pathology of DVT (Deep vein thrombosis)?

blood clot (thrombus) forms in deep veins

What are the risk factors of DVT (Deep vein thrombosis)?

Virchow's triad: hypercoagulability, endothelial damage, and venous stasis (slow/stagnant blood)

What are the clinical manifestations of DVT (Deep vein thrombosis)?

unilateral, pain/tenderness, red, warm, localized inflammation

What are the complications of DVT (Deep vein thrombosis)?

potential for detaching from vessel and circulating through the bloodstream = embolus --> can become lodges in smaller blood vessels causing ischemia

What is the pathophysiology of orthostatic hypotension?

slowed response to change (normal regulatory mechanisms are slow to respond to the change in position) or secondary to disease or idiopathic

What are the risk factors for orthostatic hypotension?

altered body chemistry, drugs, prolonged immobility, starvation, and physical exhaustion

What are the clinical manifestations of orthostatic hypotension?

dizziness, blurred vision, syncope, or fainting

What is the complication of orthostatic hypotension?

fall risk

What is the pathology of hypertension?

increase in squeeze and/or volume; SBP >130 or DBP >80

What are the risk factors of hypertension?

greater prevalence in black race and DM; genetics and environment: smoking, obesity, dietary factors, family history, age, alcohol consumption, glucose intolerance (DM), sex (male > female); overactive RAAS + SNS + inflammation; and underlying disorder (renal, endocrine, or medication caused)

What are the clinical manifestations of hypertension?

high BP

What are the complications of hypertension?

heart (MI), decreased blood flow and ischemia, weakened vessel wall, decreased blood flow, increased pressure in arterioles, and eyes (retinas)

What is the pathology of atherosclerosis?

endothelial injury causes inflammation, macrophages oxidize and consume lipids, turn into foam cells, and form a fatty streak which produce toxic oxygen free radicals. foam cells release growth factors and cause fibrous plaque formation

What are the risk factors of atherosclerosis?

endothelial injury, HTN and all its risk factors, smoking, and DM

What are the clinical manifestations of atherosclerosis?

only seen when atherosclerosis has escalated to an arterial insufficiency

What is the pathology of arterial insufficiency?

atherosclerotic disease of arteries that perfuse limbs (especially lower extremities)

What are the risk factors of arterial insufficiency?

endothelial injury, HTN and all its risk factors, smoking, and DM

What are the clinical manifestations of arterial insufficiency?

ischemia from arterial occlusion causes pain w/ ambulation called intermittent claudication

What are the complications of arterial insufficiency?

thrombus can form leading to complete obstruction causing severe pain, loss of pulses, and pallor

What is the pathology of Raynaud's?

vasospasm of small arteries/arterioles

What are the risk factors of Raynaud's?

primary: unknown; secondary: prolonged cold exposure, collagen vascular disease, vasculitis, chemo, cocaine use, hypothyroidism, and stress

What are the signs/symptoms of Raynaud's?

bilateral changes in skin color: pallor, cyanosis, numbness/paresthesia, and pain (white fingers)

What is the pathology of Buerger's?

autoimmune, inflammatory disease of peripheral arteries; clotting and blockage

What are the risk factors of Buerger's?

SMOKING

What are the signs/symptoms of Buerger's?

decreased blood flow: cyanosis, shiny skin, and thick nails (blue/black fingers)

What is an aneurysm?

Local dilation or outpouching of a vessel wall or cardiac chamber
- A weakness in a blood vessel so it bulges out like a balloon in that area
- At risk for rupturing

What can cause an aneurysm?

atherosclerosis (most common), plaque formation erodes and weakens vessel and hypertension, increased vessel wall stress

What are the clinical manifestations of an aneurysm?

pulsatile abdominal mass

What are the complications of an aneurysm?

high risk for rupture leading to hemorrhage, hypovolemic shock, and death

What is a stable angina?

- chest pain that happens when your heart muscle needs more oxygen than usual but it's not getting it at that time
-occurs during activity, better with rest, and predictable/recurrent

What is a prinzmetal angina?

- Heart needs more o2 than its currently getting due to a spasm in the heart's arteries that temporarily reduces blood flow
-occurs during sleep, vasospasm, unpredictable

What is a silent angina?

-the heart temporarily doesn't receive enough blood (and thus oxygen), but the person doesn't notice any effects... dangerous!
-silent ischemia, asymptomatic

What is an unstable angina?

- Heart doesn't get enough blood flow and oxygen
-occurs at rest, precursor to MI

What are the complications of acute coronary syndrome?

acute coronary syndrome leads to infarction and tissue death

What is the pathology of NSTEMI?

subendocardial, ST segment depression, necrosis/infarction involves 1/3 of ventricular wall

What are the risk factors of NSTEMI and STEMI?

persistent ischemia and irreversible tissue death due to prolonged ischemia

What are the clinical manifestations of NSTEMI and STEMI?

left armpit pain that radiates into jaw, sweating/diaphoresis, pallor, fatigue, and weakness

What is the complication of NSTEMI and STEMI?

death

What is the pathology of coronary artery disease?

HTN that leads to atherosclerosis, aneurysm, hemorrhagic shock, CAD, angina, MI, heart failure, death, insufficient perfusion, organ failure (heart and brain causes stroke)

What are the risk factors for coronary artery disease?

atherosclerosis, HTN, venous/arterial insufficiencies, and any disorder that narrows/occludes coronary arteries

What is the pathology of pericarditis?

inflammation AROUND the heart

What is the mechanism of pericarditis?

inflammation and infection leads to fluid backup around the heart and puts pressure on heart/cardiac tamponade

What are the risk factors of pericarditis?

MI, SIRS, and HIV

What are the clinical manifestations of pericarditis?

friction rub, fever, pain, dysrhythmias; pain is worse with inspiration and laying down

What is the pathology of endocarditis?

inflammation IN the heart

What is the mechanism of endocarditis?

inflammation and infection cause adhesion factors to form a biofilm and deposit on the heart (vegetations), especially on the valves!!

What are the risk factors of endocarditis?

central lines, bacterial infections, pacemakers, and valve replacement,

What are the clinical manifestations of endocarditis?

MURMUR, vague symptoms, valve dysfunction causes thrombus formation, vegetation causes lesions, and osler nodes and janeway lesions

What are the symptoms of osler nodes?

painful, red, and on fingers/toes

What are the symptoms of Janeway lesions?

painless and of palms/soles

What is stenosis?

valve can't open (narrowing)

What is regurgitation?

valve doesn't close (leaky)

What is the pathology of aortic stenosis?

Constriction/narrowing of aortic valves causes left ventricle hypertrophy which can lead to ischemia and HF

What is the pathology of aortic regurgitation?

aortic valve doesn't completely close so left ventricle hypertrophy which can lead to ischemia and HF

What is the pathology of mitral stenosis?

constriction/narrowing of mitral valve causes left atrium hypertrophy which can lead to atrial fibrillation and increased risk of MI/stroke

What is the pathology of mitral regurgitation?

mitral valve doesn't completely close so left atrium hypertrophy which can lead to ischemia and HF

What is the pathology of Left sided systolic HF?

low ejection fraction/poor contractility causes heart to not pump enough blood to tissues and blood backs up into lungs

What are the risk factors of left sided systolic HF?

decreased contractility due to MI, increased afterload and increased preload

What are the signs/symptoms of left sided systolic HF?

Lungs: pulmonary edema (pink, frothy sputum, crackles, dyspnea, and cyanosis); decreased perfusion (low CO): decreased urine output, cold extremities, low BP, low HR, fatigue

What is the pathology of left sided diastolic HF?

noncompliance of left ventricle leads to blood backing up to lungs; LV can't fill enough bc of hypertrophy of LV

What are the risk factors of left sided diastolic HF?

ischemia and ventricular remodeling from HTN

What are the signs/symptoms of left side diastolic HF?

lung: pulmonary edema (pink, frothy sputum, crackles, dyspnea, and cyanosis)

What is the pathology of right sided HF?

issue with pumping blood to pulmonary circulation (squeeze) causes blood backup to systemic circulation

What are the risk factors of right sided HF?

left sided HF and cor pulmonale

What is cor pulmonale?

obstruction in lungs and pulmonary artery; ex: pulmonary embolism (increased pulmonary vascular resistant leads to hypertrophy)

What are the signs/symptoms of right sided HF?

backup of systemic circuit: peripheral edema causes weight gain, JVD, GI symptoms like anorexia, ascites, and impaired liver function

What is the pathology of pleural effusion?

fluid in pleural space

What are the risk factors of pleural effusion?

complete heart failure (heart can't pump blood efficiently), TB, cancer, and pneumonia

What are the clinical manifestations of pleural effusion?

SOB, cough, s/sx of CHF

What is the pathology of pneumothorax?

air in pleural space causes partial/complete collapse of lung

What are risk factors of pneumothorax?

stab wounds/GSW, chest trauma (impact), and family history

What are the clinical manifestations of pneumothorax?

sudden pleural pain, dyspnea, tachypnea, tracheal deviation, no breath sounds on affected side, hyperresonance on unaffected side

What is the pathology of empyema?

pus in pleural space (infectious fluid)

What are the risk factors for empyema?

older adults and children as a complication of pneumonia, surgery, trauma, and bronchial obstruction

What are the clinical manifestations of empyema?

s/sx of infection

What are the types of pneumothorax?

closed, open, and tension

What is a closed pneumothorax?

pleural tear is sealed; pleural cavity pressure < atmospheric pressure; lung is open at bottom so air is just escaping out the bottom of lung so the air pools around the bottom of your pleural space and pushes up on your lungs

What is an open pneumothorax?

pleural tear is open; pleural cavity pressure = atmospheric pressure; hole directly from open air to lung causes a lot of air to come in when you inhale and not enough air to escape when you exhale

What is tension pneumothorax?:

pleural tear acts as a ball and valve mechanism; pleural cavity pressure > atmospheric pressure; much worse!!! more likely from trauma; a lot of compression in the lungs which eventually shifts and compresses the lungs

What is the pathology of atelectasis?

collapse of alveoli/lung tissues

What are the risk factors of atelectasis?

anesthesia and immobile (laying in bed a lot)

What are the signs/symptoms of atelectasis?

dyspnea/shallow breathing, decreased breath sounds, and cough

What is the pathology of pulmonary edema?

alveoli are filled with water

What are the risk factors of pulmonary edema?

left sided HF, CAD, and valve disorders

What are the signs/symptoms of pulmonary edema?

dyspnea, hypoxemia, and increased work of breathing

What can pulmonary edema result in?

ARDS

What is the pathology of aspiration?

inhaling food or gastric fluid into lungs

What are the risk factors of aspiration?

dysphagia/trouble swallowing

What are the signs/symptoms of aspiration?

dyspnea, wheezing, cough, and coarse crackles

What can aspiration result in?

pneumonia

What is the pathology of ARDS?

acute injury to alveolocapillary membrane and massive pulmonary inflammation

What are the risk factors for ARDS?

sepsis, burns, pneumonia, pancreatitis, aspiration, blood transfusions, and medication reaction