ALU 201: Intermediate Medical Life Insurance Writing PDF

Introduction disease, and select vasculitis syndromes. transporting deoxygenated blood back to the heart and lungs. The lymphatic system is a separate bloodstream. structural elements and their arrangement within vessel walls. Vessels above a certain lumen 1. 2. surrounded by collagen and elastic ti...

Introduction disease, and select vasculitis syndromes. transporting deoxygenated blood back to the heart and lungs. The lymphatic system is a separate bloodstream. structural elements and their arrangement within vessel walls. Vessels above a certain lumen 1. 2. surrounded by collagen and elastic tissue. 3. vessel wall. 1. 2. 3. 4. 5. endothelium basement membrane elastic tissue collagen smooth muscle Elastic tissue encompasses the endothelium and basement membrane. Collagen (a major protein vascular system that regulates vasoconstriction and dilation. Page 419 ALU 201: Intermediate Medical Life Insurance Writing Arterioles are small arteries, which lead, in turn, to capillaries. Capillaries, the smallest blood Veins have larger diameters, larger lumens, and thinner, more distensible walls, making the Atherosclerosis Atherosclerosis is a pathologic condition that causes coronary, cerebral, aortic, and peripheral arterial diseases. It develops primarily in elastic arteries (e.g., aorta, carotid, and iliac arteries) Criteria 0 1 2 3 Description Initial lesion Fatty streak 4 lipid raised lesion 5 plaque, or raised lesion calcium Page 420 6 Complicated lesion or thrombosis Atherosclerotic Peripheral Arterial Disease Clinical Presentation The symptoms are usually brought on by walking and are relieved by rest. The most common treating physician will erroneously attribute the symptoms to arthritis, muscular pain, or aging. Misdiagnosis as an orthopedic back problem is especially common when the aortoiliac artery is involved since that causes hip, thigh, or buttock pain. Claudication can also present as the hip or Diagnosis relieved when the individual stops. It does not occur while the individual is merely standing. With pseudoclaudication, pain persists when standing and can necessitate sitting or changing position Page 421 ALU 201: Intermediate Medical Life Insurance Writing pulselessness, paralysis, paraesthesia, pain, and pallor. These signs can be applicable in more advanced disease but are not sensitive enough to make a diagnosis early in the disease process. Ankle-Brachial Index Test total mortality. Studies show that more severe disease, as evidenced by the lower ABI value, is Page 422 Exercise Treadmill Testing ABI in recovery. Segmental Limb Pressures Segmental Volume Plethysmography Ultrasonography system, especially when surgical intervention is contemplated. Magnetic resonance techniques are Angiography disease when surgical intervention is contemplated. Treatment cardiovascular and cerebrovascular di Page 423 ALU 201: Intermediate Medical Life Insurance Writing vascular and cardiovascular health. Exercise appears to reduce red blood cell aggregation, improve muscle metabolism, improve such as aspirin and dipyridamole, decrease claudication with ambulation and increase resting platelet aggregation, modestly increase walking distance. Cilostazol, a phosphodiesterase inhibitor, ® ) is approved in most studies. Interventions transluminal angioplasty (PTA), balloon angioplasty, and stenting, have resulted in a dramatic increase in these procedures in recent years. A landmark study, published in 1993, showed no 1. 2. pain at rest 3. tissue loss. allows PTA to be applied to more extensive disease segments. It can also be used in individuals who are poor surgical candidates. Page 424 aortoiliac occlusive disease is usually limited to a suboptimal angioplasty result and is not routinely outcome. vessel can result in distal embolization (2%), thrombotic occlusion (2%), and rarely, arterial rupture. initial surgery. 1. 2. male sex, relative risk 1.55 3. diabetes mellitus, relative risk 1.71 4. systemic hypertension, relative risk 1.51. Thromboangiitis obliterans, a vasculitis strongly linked to cigarette smoking, is characterized vessel and neural involvement. Angiography demonstrates smooth, tapered, segmental lesions. Page 425 ALU 201: Intermediate Medical Life Insurance Writing the vessel lumen. Abdominal Aortic Aneurysms and synthesis, providing a susceptible substrate on which atherosclerosis and hypertension could act to weaken the vessel wall. pressure. As aneurysms grow, they can impinge on adjacent structures such as a blood vessel Diagnosis Most abdominal aortic aneurysms are asymptomatic and can progress without symptoms. imaging based on aneurysm diameter. Page 426 AAA diameter (cm) 3.0 – 3.9 4.0 – 4.9 5.0 – 5.4 Surveillance interval 10 years 3 years 1 year 6 months may be either endovascular or open surgical repair. imaging surveillance. Underwriting AAA Thoracic Aneurysms 1. 2. 3. 4. ascending thoracic aneurysms aortic arch aneurysms descending aortic aneurysms thoracoabdominal aneurysms. as likely to occur in males. Thoracic aneurysms are commonly seen in atherosclerotic vessels, A strong association exists between thoracic aneurysms and bicuspid aortic valve and aortic Page 427 ALU 201: Intermediate Medical Life Insurance Writing a imaging procedures to diagnose thoracic aneurysms. modality choice depends on aneurysm location, ideally using the same technique (and center) in size. 1.0 cm per year in aneurysms less than 5.0 cm in diameter. Surgical intervention is also indicated Vasculitis vessel Takayasu arteritis Medium Small vessel vessel Polyarteritis nodosa (temporal) disease arteritis Eosinophilic granulomatosis with Variable vessel Behçet’s syndrome Cogan’s syndrome Single organ Primary central nervous system Associated with sarcoid, others Associated with tis membrane disease, Cryoglobulinemic vasculitis, IgA associated vasculitis) Page 428 Polyarteritis Nodosa The organ systems most involved are skin, peripheral nerves, gastrointestinal tract, and kidneys. and cyclophosphamide (Cytoxan® Kawasaki Syndrome Treatment is directed at preventing coronary artery aneurysms. Coronary artery aneurysms disease. Page 429 ALU 201: Intermediate Medical Life Insurance Writing Granulomatosis with polyangitis (GPA, Wegener’s Granulomatosis) relapse and develop active disease. Giant Cell Arteritis (Temporal Arteritis) the aorta, occurring almost exclusively in individuals older than 50 years. The disease incidence vertebral, ophthalmic, and posterior ciliary arteries. sharp or dull headaches, usually severe enough to prompt an evaluation. Typically, they notice Pulses are reduced or absent. Vision loss is a serious complication and can occur when the ophthalmic experience claudication with prolonged talking or chewing. Takayasu’s Arteritis (TA) This large vessel vasculitis classically involves the aortic arch and its main branches but can also Page 430 arteries would present with arm claudication, pulselessness, and discrepant blood pressures. Page 431