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Cell Pathology > 2 - Haemodynamic disorders > Flashcards

2 - Haemodynamic disorders Flashcards

1
Q

What is oedema?

A

Abnormal increase in fluid in the interstitial space.

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2
Q

What are the causes of oedema?

A

Raised hydrostatic pressure,
Reduced osmotic pressure,
Disruption to the capillary bed

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3
Q

What are the 2 different types of oedema?

A

Localized (e.g. pulmonary oedema, cerebral oedema)

Generalized (affects subcutaneous tissues and serous cavities).

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4
Q

What is pulmonary oedema?

Causes and consequences

A

WHAT - The result of raised pulmonary capillary hydrostatic pressure due to pulmonary venous congestion.
CAUSE - left ventricular failure.
CONSEQUENCES - breathlessness and susceptibility to pneumonia.

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5
Q

What is cerebral oedema?
Where does it normally occur?
What pressure is raised?

A

WHAT - The result of breakdown of the normal capillary barrier.
WHERE - occurs in brain tissue surrounding lesions such as cerebral contusions, haemorrhages, infarcts, and tumours.
Cerebral oedema contributes to a rise in intracranial pressure which can be fatal.

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6
Q

What is generalised oedema?

A

WHAT - Generalized oedema causes pitting peripheral oedema, pleural effusions and ascites.
The pathogenesis of generalized oedema is complex and multifactorial.
A key factor is thought to be activation of the renin-angiotensinaldosterone system which stimulates renal sodium retention.

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7
Q

What are the 3 common causes of generalised oedema?

A

Left ventricular failure,
Hepatic failure
Nephrotic syndrome.

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8
Q

What is thrombosis?

A

Pathological clot formation in a blood vessel.

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9
Q

What is thrombosis caused by?

A

Caused by abnormal activation of the haemostatic system.

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10
Q

What are the 3 broad factors that predispose to thrombosis? What are they known as?

A
  • changes in the vessel wall
  • changes in blood flow
  • changes in blood coagulability
    (Virchow’s triad)
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11
Q

Where can thrombi form?

A

arteries
veins
heart

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12
Q

What is venous thrombosis related to?

Where do they commonly form?

A

Related to stasis of blood and an increase in blood coagulability.
Commonly form in deep leg veins (deep venous thrombosis).

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13
Q

What is arterial thrombosis related to?

A

Related to changes in the vessel wall due to unstable atherosclerotic plaques.

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14
Q

What is cardiac thrombosis related to?

A

Related to stasis of blood in a cardiac chamber, most commonly the left atrium in association with atrial fibrillation or the left ventricle in association with a myocardial infarct.

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15
Q

What can thrombi do?

A
  • Completely resolve

- Undergo organisation and recanalisation, in which case they may remain clinically silent.

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16
Q

When do thrombi become significant?

A

If they occlude a vessel or embolize.

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17
Q

What is an embolism?

A

An embolus is a detached mass within the circulatory system that is carried in the blood to a site distant from its point of origin.

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18
Q

What may happen to emboli in small vessels?

A

They can lodge in small vessels and block them off

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19
Q

What does thromboemboli mean?

A

Most emboli are fragment of dislodged thrombus

20
Q

What may Venous thromboemboli do?

A

Travel via the heart into the pulmonary arteries causing pulmonary embolism.

21
Q

What may Arterial thromboemboli do?

A

May impact in…

  • cerebral arteries (causing stroke)
  • the mesenteric arteries (causing small bowel infarction) - lower limbs (causing acute lower limb ischaemia)
22
Q

What are the 3 rare types of emboli?

A

Fat emboli,
Septic emboli,
Amniotic fluid emboli

23
Q

What is a Pulmonary embolism?

A

Occlusion of a pulmonary artery by embolic thrombus.

Very common and often underdiagnosed.

24
Q

What do Emboli lodging in a major pulmonary artery cause?

A

Instant death

25
Q

What do Emboli lodging in medium sized arteries cause?

A

Breathlessness

26
Q

What do Emboli lodging in small arteries cause?

A

breathlessness,
chest pain,
dizziness

27
Q

What is a haemorrhage?

A

Extravasation of blood due to vessel rupture.

Escape of blood from a ruptured vessel

28
Q

What may a haemorrhage be caused by?

A

Traumatic rupture

Intrinsic disease of the vessel

29
Q

Rupture of a major vessel causes acute haemorrhage. What are the risks? Give examples.

A

RISKS - Hypovolaemia, shock and death

EXAMPLES - ruptured abdominal aortic aneurysm or ruptured thoracic aortic dissection

30
Q

Where can small haemorrhages be fatal?

A

Brainstem

31
Q

Why can formation of a solid haematoma within the enclosed cranial cavity be fatal?

A

By causing a rise in intracranial pressure and tonsillar herniation.

32
Q

Chronic low grade haemorrhage may present with what?

A

Iron deficiency anaemia e.g. bleeding from a colonic carcinoma.

33
Q

What is shock?

A

A generalised failure of tissue perfusion.

34
Q

What is shock caused by?

A
  • Pump failure (e.g. acute myocardial infarction)

- Peripheral circulation failure (e.g. hypovolaemia, sepsis, anaphylaxis) leading to circulatory collapse.

35
Q

What would a patient with shock look like & what are their symptoms?

A

Looks grey and feels clammy. There is tachycardia and hypotension.

36
Q

What can untreated shock cause?

A

Ischaemia (inadequate blood supply) of the heart, lungs, gut, kidneys and brain.
Rapid treatment is necessary to prevent multiple organ failure and death.

37
Q

What is infarction?

A

Tissue necrosis due to ischaemia.

38
Q

What are infarcts caused by?

A

Obstruction of an artery, either by thrombosis overlying a complicated atherosclerotic plaque or a thromboembolus e.g. acute myocardial infarction (‘heart attack’) and cerebral infarction (‘stroke’).

39
Q

How do infarctions occur due to venous obstruction?

A

The tissue becomes massively suffused with blood and appears dark purple or black e.g. testicular torsion, sigmoid volvulus.

40
Q

How do infarcts heal?

A

By repair i.e. laying down of granulation tissue which is replaced by a fibrous scar.
Although structural integrity is maintained, there is permanent loss of functional tissue.

41
Q

What is atherosclerosis?

A

An inflammatory disease of large and medium sized arteries characterised by formation of lipid-rich plaques in the vessel wall.
Very common, particularly in developed countries.

42
Q

What are the risk factors for atherosclerosis?

A 
Older age, 
Male gender, 
Obesity, 
Diabetes mellitus, 
Hypertension,
Smoking
43
Q

What may endothelial injury lead to?

A

Inflammatory and fibroproliferative response culminating in atherosclerosis.

44
Q

What is atherogenesis?

A

The process of forming atheromas, plaques in the inner lining (the intima) of arteries.

45
Q

What is a common driver of atherogenesis?

A

Oxidised LDL

46
Q

What do stable plaques cause?

A

Cause symptoms of reversible ischaemia in the supplied organ e.g. angina pectoris, chronic lower limb ischaemia.

47
Q

What do unstable (vulnerable) plaques cause?

A

Cause acute ischaemic events due to thrombosis overlying them e.g. acute coronary syndromes and cerebral infarction.

Cell Pathology (5 decks)

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