Q51 Tissue ischemia, venostasis etiology, examples, compensation, outcomes Ischemia restriction of blood supply, decrease blood supply

ply decrease oxygen supply, decrease nutrients resulting tissue damage or dysfunction Read Q13 Cell injury Ischemia can lead to hypoxia o Hypoxia condition when body deprived of oxygen supply (Q65) Eg- in exercise, V/Q mismatch in COPD, shunt, hypoventilation, anemia, decreased amount of oxygen in air Not necessarily due to ischemia but ischemia 1 of major causes

Ischemia sudden occlusion of artery o due to embolism, thrombus (atherosclerotic plague), trauma (vascular injury) read Q45 thrombus, embolism

clinical presentation of ischemia (6P) : o o o o o Pain Pallor Pulselessness Cold Paresthesia

Acute ischemia sudden occlusion of artery Chronic ischemia decrease in blood supply due to partial occlusion or partial stenosis o Eg: atherosclerosis (Q52), Buerger disease (Thromboangitis obliterans)

Outcomes of ischemia (consequences) Ischemia decrease blood supply decrease oxygen supply (hypoxia) ischemic cascade initiate

Ischemic cascade (takes about 34 minutes before becoming irreversible): o Hypoxia cause body to start using anaerobic metabolism for ATP production Increase production of lactic acid lactic acidosis Anaerobic respiration cease ATP ion transport pumps become dysfunction influx of Ca into cells Calcium cause generation of harmful processes to cell (calcium hypothesis origin of disease Q20) Free radicals & ROS Endonuclease damage nucleus chromatin Excitotoxicity - nerve cells are damaged and killed by excessive stimulation by neurotransmitters such as glutamate and similar substances ATPase, phospholipase (membrane damage) Protease

o o

Causing cell damage, cell membrane damage cell contents leak out toxins, apoptotic bodies, edema Finally cell die necrosis

Reperfusion injury - Restoration of blood flow after a period of ischemia can actually be more damaging than the ischemia o Cause oxidative stress trigger inflammatory response (in the presence of already damaged cell and hypoxia)

 Variation of ischemia o o o Heart cardiac ischemia (Q62) Brain stroke Bowel ischemic colitis decrease blood supply to bowel Lead to sepsis, gangrene, ulceration, perforation

Outcomes of ischemia infarction - area of tissue death (necrosis) due to a local lack of oxygen o o Eg- myocardial infarction, cerebral infarction, spleen, limbs Myocardial infarction Q63

Venostasis (phlebostasis)- abnormally slow flow of blood in the veins, which are usually distended Shear stress - tangential force of the flowing blood on the endothelial surface of blood vessel.

Causes venostasis o o o o long periods of immobility trauma to vein blood clot formation inflammation - Q7 read chronic venous insufficiency - Congenital absence of or damage to venous valves cant prevent back flow thus venous pooling

increase risk of DVT and superficial vein thrombosis, ulceration