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Pathology A - General Pathology > [A] 1.19 Hemostasis, shock > Flashcards

[A] 1.19 Hemostasis, shock Flashcards

1
Q

Haemostasis

A

Arrest of bleeding

  • Finely regulated physiological response
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2
Q

Purpose of physiological haemostasis

A
  • Respond to vascular damage → Prevent blood loss
  • Without affecting fluidity and flow of blood in normal, undamaged vasculature
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3
Q

Disruption of the balance of:

  • Endothelium
  • Platelets
  • Coagulation factors
A
  • Haemorrhage
  • Thrombosis
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4
Q

Give the steps of haemostasis

A
  1. Primary stage
  2. Secondary stage
  3. Thrombus dissolution
  4. Tissue repair at the damaged site
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5
Q

Haemostasis: Primary stage

A
  • Transient vasoconstriction
  • Platelet aggregation to form platelet plug
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6
Q

Haemostasis: Secondary stage

A
  • Coagulation to form a meshwork of fibrin
    • Intrinsic (XII activation)
    • Extrinsic (TF - VII activation)
      • Common pathway activation of X
      • Fibrin activation
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7
Q

Haemostasis: Thrombus dissolution

A
  • Thrombus retraction by plasmin
  • Fibrinolysis
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8
Q

List the disturbances of microcirculation

A
  • Prehaemostasis
  • Haemostasis
  • Posthaemostasis
  • Peristasis
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9
Q

Praehaemostasis

A

Blood flow slows down

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10
Q

Haemostasis of microcirculation

A
  • In terminal bed
  • Leakage
  • Reversible
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11
Q

Posthemostasis

A

Start of the blood flow

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12
Q

Peristasis

A

Slow bloodflow

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13
Q

What can induce haemostasis?

A
  • Cellular changes
  • Viscosity
  • Chemical factor
  • Rheological factors
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14
Q

Cellular changes inducing haemostasis

A
  • Stabile suspension - labile suspension
  • Thrombocytes, RBCs, WBCs
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15
Q

Viscosity changes inducing haemostasis

A
  • Plasma leakage
  • Higher density
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16
Q

Chemical factors inducing haemostasis

A
  • Intercellular bridges
  • Hypercoagulability
17
Q

Shock

A
  • General circulatory disturbance
  • Peripheral circulatory failure
    • Clinical term
    • Blood is in the terminal circulatory bed
18
Q

Mild shock

A

Can lead to collapse

  • Mild disorder for a short time
19
Q

Define shock

A

Cardiovascular collapse

  • The syndrome resulting from a disproportion between blood volume and volume of the circulatory system (1:6)
  • Profound circulatory failure resulting in life-threatening hypoperfusion of vital organs
20
Q

Give the types of shock

A
  • Cardiogenic
  • Hypovolaemic
  • Blood maldistribution
21
Q

Cardiogenic shock

A

Acute/chronic heart failure

22
Q

Hypovolaemic shock

A
  • Blood loss
    • Reduced circulating blood volume
  • Fluid loss
    • Secondary to vomiting, diarrhoea, burn
23
Q

Blood maldistribution shock

A
  • Neurogenic
    • Vasodilation - paralysis of the vasomotor centre
  • Anaphylactic - Type I hypersensitivity reaction
  • Septic (endotoxin)
24
Q

Septic shock: Causes

A
  • Gr- lipopolysaccharide
  • Gr+ fungi
  • Cytokines
  • Vasoactive mediators
25
Q

Give the steps of septic shock cause

A
  1. LPS blocks production of anticoagulant substances
  2. Activation of the complement cascade
  3. Activation of the intrinsic coagulation
  4. TNFα & IL-1 production by activated macrophages
  5. Promotion of extrinsic coagulation by TF expression
  6. PAF - Thrombocyte aggregation
26
Q

Give the phases of shock

A
  1. Non-progressive
  2. Progressive
  3. Irreversible
27
Q

Non-progressive phase of shock

A
  • Compensation
  • Baroreceptors
    • Sympathetic effect, epinephrine
      • ↑ Cardiac output, ↑ peripheral resistance (vasoconstriction)
    • ADH
    • Renin-angiotensin-aldosterone system
      • ACE-blockers
28
Q

Progressive phase of shock

A
  • Inadequate compensation
  • Anaerobic glycolysis in the cells (lack of O2)
  • Lactate, local hypoxia, ↑ CO2 → Arteriolar relaxation & dilation
29
Q

Irreversible phase of shock

A
  • Severe metabolic acidosis
  • Insufficient blood supply of the vital organs, DIC
30
Q

Shock: Pathological signs

A
  • Haemorrhages:
    • Under the serosal membranes
    • On mucous membranes
    • In some organs
  • Congestion in the abdominal organs
  • Acute dilation of the heart
  • Ischemia in the kidney

Pathology A - General Pathology (85 decks)

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