2-3-12 Friday

PHYS/PATH

Thrombophlebitis (lesser, great saphenous vein)/DVT: popliteal, femoral, iliac vein
veins have become obstructed with clot
usually calves, thighs, pelvis
feels like a guitar string
Thrombi=stationary clots; travel usually to lung
this is a 911 emergency
***Virchow Triad (factors that greatly affect having clot)
1-injury to endothelium (inner lining of artery/vein)
2-hypercoagulability: easy clots
3-venous stasis

possible triggers: trauma, varicose veins, infection, immobility, decrease circulation, preg and childbirth, certain cancers, surgery, smoking, birth control, genetic condition
S&S: may show pitting edema
diag: ultrasound
tx: vena cava filter if they have multiple events

Aortic Aneurysm: bulge in blood vessel wall or heart
usually at aorta or in brain; Marfan at risk
rupture leads to extensive bleeding and death
as aneurysm grows, walls get thinner
factors are smoking, smooth mm compromise, trauma, inflammation, congenital weak arterial wall mm, untreated syphilis
S&S sometimes silent, may press on other structures- dysphagia, chest pain, hoarseness, coughing, back pain
Diag: blood makes specific sound- bruit; palpable; CT, MRI
complication: pressure on surrounding structure
blood clots
rupture, hemorrhage

Atherosclerosis: hardening of arteries due to plaque
we see: 1, endothelial damage- carbon monoxide, triglycerides (chronic inflammation with sugar and startch)(diabetics at high risk)
2)monocytes: arrive and become,
3macrophages: take up LDL
4, foam cells
5 platelets arrive
LDL is "bad". it goes to the tissu
HDL is "good" and returns to liver
CRP, homocysteine, fibrinogen, bleeding time (cardiovascular health)
Factors: heredity, genetics, gender, age,kidney disorder, changeble smoking, increase cholesterol/bp, sedentary lifestyle, diabetes
S&S: none early, 50% of blockage to show signs
complications, increase bp, aneurysm, arrthtmia, thrombus, E., angina
Tx: #1 is diet and exercise

Hypertension: high BP. major contributing factor to heart and other problems
stress is a big driver bp 140/90
1 in 3 adults
factors are obesity, smoking, water retentino, high cholesterol, artheroscleroisis, genetic
pressure inside pushing out
pressure outside of vessel
blood volume
vessel diameter
Types: essential -95%
secondary
malignant hypertension: diastolic (liver, kidney) increases very quickly
S&S: silent killer; short breath, ringing ears, vision, swell of ankles, dizzy/headache, sweating, anxiety
complication: edema, stroke, atherosclerosis, aneurysm, enlarged heart/failure, kidney disease, vision problems
Tx: DASH, diet-low sodium, drugs-diuretics, vasodilatoin, beta blockers, side effects low bp, decrease sex drive etc.


Raynaud Syndrome: vasoconstriction in extremities plus ears, nose, lips
secondary raynaud phenomenon: complication of underlying disorder
autoimmune-mostley women 15-40
arterioles spasm, cold and stress triggers
Red, White, and Blue: cycle of colors, episodes last 1 minute to hours
Tx: no caffine, soda, chocolate, smoking

Varicose Veins, varix=twisted
valves superficial veins collapse
can lead to hemoroids
W>M, progesterone weakens
history of preg-half people 50 years or older
in the leg
damage valves in superficial veins
wear and tear
standing all day
watching for underlying systemic problem; kidney, liver
S&S: lumpy, wandering lines, protrude from skin, throbbing pain, clots and dvts are a risk
Tx: support hose, elevate feet
M: local, telangiectasias (spider veins) are okay

Heart Attack: damage to cardiac mm from ischemia
CAD
mm tissue doesn't repair; replaced by scar tissue
damaged area=infarct
heart attack=myocardial infarction
#1 cause of death
fit vs. healthy
risk: sedentary, hypertension, high cholesterol, smoking, weight,
M 45+, W 55+, family history, F 35+ birth control
etiology: usually clot/thrombus

cardiac cells die of ischemia, seriousness determined by size, location of infarct
impairs mm function
damage conduction system
S&S: pressure, pain in chest
spreading pain, lightheaded, nausea, sweating, short breath, anxiety, fainting, cold sweat, stomach pain
Angina Pectoris: spasms in blood vessels
stable angina: triggered by extra effort (common)
unstable angina: sudden, no trigger
complication: embolism, atrial and ventricular fibrillation (uncoordinated heart beat), aneurysm, heart failure, shock
Tx: break it up, thrombolytics, pain management, lifestyle changes

Heart Failure: progressive loss of heart function
not cardiac arrest
mostly among survivors of heart attack
cor pulmonoli
resistance= compensates= cardiomegaly
can be congenital weakness with mm or valves
systolic- left ventrical
diastolic- both sides ventrical
Left: resistance in arteries; back up fluid in lungs
Right: cor pulmonoli/pulmonale: resistance in lungs, backup fluid into legs; can also cause liver, kidney (main fluid regulator) damage
biventrical
S&S: depends on which side
Tx, rest, change in diet, diuretics, vasodialator

Chapter 15- LYMPH

system tissues and vessels, scattered thoughout body
service alomst all reigons
fluid balance
protect from infection
absorption of fat in digestive system? lacteal
Circulation
-one way system
-begins in tissues, ends in bloodstream
capillaries (more leaky)
capillary walls (endothelium) are flattened epithetial cells
more permeable than blood capillaries
overlapping cells form one way valves
arise blindly (closed at one end)
lacteal absorb digested fats
vessels-superficial and deep, nodes, right lymphatic duct
*Thoracic duct (left lymphatic duct) 3/4th of body- cisterna chyli

Mvmt: segments and vessels between valves contract rhythmically
skel mm compress vessel

nodes: structure: fiberous connective tissue
hilum indent?, groups

Spleen: cleanses blood, filtration, phagocytosis destroys old RBC, produces RBC before birth reservoir for blood

Thymus: early immune system development, produces thymosin
develops T lymphocyte cells, promotes lymphocyte growth
promotes lymphoid tissue activity, shrink after puberty

Tonsils: removes contaminates and traps pathogens
palative tonsils, pharyngeal tonsil (adenoids), lingual tonsils

Appendix
Gut-associated lymphoid tissue (GALT
-peyer patches
mucosal- associated lymphoid tissue (MALT)

Reticuloendothelial: cell that destroys worn out cells, bacteria, cancer cells, harmful foreign substance
-monocytes
-macrophages: Kupffer cells (liver), dust cells (lung
non specific/Innate: gonna work on whatever infection
adaptive/acquired/active/specific: B cells (antibodies); T cells -T helper ( tell other what to do); -cytotoxic and NK (enforcers/ natural killers)