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Vascular Disorders

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.