Ischemia
8 important questions on Ischemia
What are watershed zones?
Why do watershed zones influence ischemia
What is end-artery blood supply?
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Why do end artery blood supply influence ischemia
Arterial vs venous occlusion in ischemia
Venous: Congestion and edema precede and promote infarction
What are the outcomes of ischemia?
Sequelae: reperfusion injury and necrosis (infarction)
Sequence of events of ischemia
- Cell swelling, ER swelling, loss of microvilli
2. Unreparable damage to cell infrastructure = more mitochondrial dysfunction, production of ROS
- Cell membrane damage, organelles
3. Cell-wide systems breakdown = cytocavitary network or cytoskeleton
- Oncotic necrosis, apoptosis, changes in nucleus
Basically
Reversible -> Irreversible -> Cell death
What are the colours and profiles of infarctions
- Arterial: acute, no blood entering
2. Dark red +/- swollen
- Arterial: Damaged vessels within infarcted tissue -> blood backflow from surrounding vessels
- Venous: congestion, no blood leaving
3. Pale +/- swollen +/- red rim
- Cell swelling and necrosis force blood out of infarct, it is cleaned up by macrophages
- Red rim = hyperemia/hemorrhage/acute inflammation from adjacent parenchyma
4. Multicolored: RBC breakdown, inflammation, neovascularization
5. White + contracted: chronic = scar
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