Ch 4: Hemodynamic Disorders Flashcards
define hemostasis
blood clotting at the site of an injury
define edema
accumulation of fluids in the tissues
define effusions
accumulation of fluids in cavities
what are the two main conditions that cause an increase in hydrostatic pressure and therefore edema
deep vein thrombosis
congestive heart failure
define peau d-orange breast cancer
blockage of subareolar lymphatics due to cancer
causes the breast to appear like an orange
what are the three most common sites for edema
subcutaneous tissues
lungs
brain
what is non-pitting (dependent) edema
accumulation of protein rich fluid
what is pitting edema
accumulation of protein poor fluid
what are interlobular septal markings in a lung indicative of
edemic change
likely excess fluid in the lymphatics that present with severe pulmonary edema
define hydrothorax
effusion in pleural cavity
define hemothorax
effusion in pleaural cavity containing blood
define hydropericardium or pericardial effusion
effusion in pericardium
define hemopericardium
effusion into the pericardium containing blood
define hydroperitoneum
effusion into the peritoneal cavity (ascites)
define hemoperitoneum
effusion into the peritoneal cavity containing blood
what is hyperemia
arteriolar dilation causes increased blood flow
tissue appears red due to engorgement of oxygenated blood (erythema)
what is congestion
impaired outflow of venous blood from tissue
tissue spreads a blue-red color (cyanosis) due to deoxygenated hemoglobin
what is “nutmeg liver”
chronic passive congestion of the liver
shows central congestion with hemorrhagic necrosis
what are the three required things for each step in the coagulation cascade
enzyme
substrate
cofactor
what is Coumadin used as
anticoagulant
what is vitamin K used as
cofactor
disorders of primary hemostasis affect what
platelets
what is affected in disorders of secondary hemostasis
clotting factors
what are the two vWF deficiency disorders
von Willebrand disease
Bernard-soulier syndrome
what are three factors that affect platelet adhesion
platelet changes shape from disc to spike
platelet releases granular contents
platelet aggregate
mutations in which clotting factor lead to hemophilia A
clotting factor 8
what does the prothrombin time (PT) test do
coagulation test that assess factors 2, 5, 7, 10, and fibrinogen
what does the partial thromboplastin time (PTT) test do
coagulation test that assess factors 2, 5, 8, 9, 10, 11, 12, and fibrinogen
define hematoma
extravasated blood creates palpable mass of blood
what is henoch-schonlein purpura
deposition of circulating immune complexes within vessels
small blood vessels in your body become inflamed and bleed
what is factor 5 leiden
most common inherited hypercoagulability disorder
protein C resistance and mutation in single nucleotide
what is prothrombin gene mutation
second most common inherited hypercoagulative disorder
elevated prothrombin levels due to G nucleotide substitution for A
increases risk of venous emboli
what is heparin-induced thrombocytopenia (HIT) syndrome
adverse drug reaction caused by emergence of antibodies that activate platelets
unfractionated heparin is given
PF4 is released and binds to the heparin
this complex causes release of IgG which then binds to this complex
new complex binds to Fc receptor and platelet which causes it to be removed
what is anti-phospholipid antibody syndrome
immune system mistakenly attacks proteins in the blood
what are lines of Zahn
grossly apparent laminations of thrombi
caused by platelet and fibrin layers alternating with darker red-cell rich layers
what are arterial (white) thrombi
usually occlusive
caused by endothelial injury which leads to platelet activation
clot is under endothelial cells
clot has lots of fibrin and platelets
what are venous (red) thrombi
not usually occlusive (completely blocking the vessel)
form long cast that is prone to give rise to emboli
have more enmeshed (tangled) red cells
usually occur in lower extremities
what’s the main difference between a post and pre-mortem thrombus
a pre-mortem thrombus will be tightly adherent to the vessel wall
what is a mural thrombus
a thrombus that occurs in the heart chambers or in the aortic lumen
in heart: caused by abnormal heart contraction or heart injury
in aorta: caused by atherosclerotic plaques and dilation
what are vegetations
thrombi on heart valves
what is infective endocarditis
bacterial or fungal bloodborne infections cause valve damage
leads to development of large thrombotic masses
vegetations (thrombi on heart valves) are surrounded by bacteria and platelet/fibrin layers
what is nonbacterial thrombotic endocarditis
sterile vegetations that develop on noninfected valves in hypercoagulable states
what is propagation of a thrombus
when an older thrombus enlarges through the accumulation of additional platelets and fibrin
bigger size increases chances for vascular occlusion or embolization
what is embolization of a thrombus
part of all of the thrombus is dislodged and transported elewhere in the vasculature
what is dissolution/resolution of a thrombi
newly formed thrombi activates fibrinolytic factors that cause it to rapdily shrink and breakdown
older thrombi are more resistant to dissolving
what is recanalization of a thrombus
the body makes channels within the thrombus to reestablish the continuity of the original lumen
what are three endovascular interventions
clot busting drugs
angioplasty
inferior vena cava filter
what is disseminated intravascular coagulation (DIC)
widespread thrombosis within the microcirculation that may be of sudden or insidious onset
platelets and coagulation proteins are consumed which leads to excessive clotting and bleeding that may co-exsist
define embolus
detached intravascular mass carried by the blood from its point of origin to a distant site
what are solid thrombi made of
cholesterol, atherosclerotic debris, or tumor
what are liquid thrombi made of
fat droplets or bone marrow
what are gaseous thrombi made of
air/nitrogen
what does systemic embolization lead to
ischemic necrosis of downstream tissues
what does pulmonary embolization lead to
hypoxia, hypotension, and right sided heart failure
what is a pulmonary thromboembolism
pulmonary embolus that originates from a deep vein thrombus and travels through the right side of the heart before arresting in the lungs
kills about 100,000 people each year in the US
what is a saddle embolus
embolic occlusion at the bifurcation of the main pulmonary artery
what is a fat embolus
fat thrombus caused by injury, fractures, or resuscitation
typically presents with restlessness and trouble breathing
what is an amniotic fluid embolism
a rupture of the amniotic membrane causes amniotic fluid to get into the maternal circulation
leads to shock and neurologic defects
80% mortality rate
what is an air embolism
gas bubbles within the circulation
ex. during laparoscopic procedures or scuba divers
what is decompression illness
caused by intra or extravascular bubbles that are formed as a result of reduction in environmental pressure
what is caisson disease
persistence of gas emboli in the skeletal system
leads to ischemic necrosis
typically found in the femoral heads, tibia, and humeri
what is infarction
area of ischemic necrosis caused by occlusion of the vascular supply to the affect tissue
typically occurs in the heart or brain
what is a red (hemorrhagic) infarct
caused by a venous occlusion
blood collects in infarcted zone
ex. testicular torsion
what is a white (anemic) infarct
arterial occlusion in solid organs with end-arterial circulations (heart, spleen, and kidney)
what is the typical shape and location of an infarct
wedge shaped with the occluded vessels being at the apex and the organ periphery
what causes cardiogenic shock
low cardiac output as a result of myocardial pump failure
what causes septic shock
triggered by microbial infections and is associated with severe systemic inflammatory response (SIRS)
