CH 4 part. 1

Question 1

What is edema?

Answer 1

Accumulation of fluid in the interstitial (body cavities) due to increased hydrostatic and decreased oncotic pressures.

Question 2

Anasarca

Answer 2

system malfunction (liver failure, renal failure, right side heart failure) that induces general systemic edema.

Question 3

Types of edematous fluid collection

Answer 3

Hydro - thorax, pericardium, peritoneum (ascites)

Question 4

parasitic filariasis

Answer 4

parasitic worm that causes fibrosis of inguinal lymphatics and lymph nodes causing elephantitis

Question 5

complication of upper extremity edema?

Answer 5

breast cancer removal. exacerbate UE edema due to physical removal of lymphatics (decrease drainage and increase edema)

Question 6

Increased hydrostatic pressure due to?

Answer 6

mainly impaired venous return

Question 7

Reduced oncotic pressure due to?

Answer 7

sever liver disease and malnutrition

Question 8

Sodium and water retention due to?

Answer 8

renal failure (which can be caused by congestive heart failure).

Question 9

Causes of lymphedema?

Answer 9

Chronic inflammation, invasive tumors, physical removal, radiation,

Question 10

Sub Q edema

Answer 10

dependent edema (due to gravity), and Pitting edema

Question 11

Edema secondary to renal dysfunction

Answer 11

Periorbital edema. affects Loose CT

Question 12

Sub Q (soft tissue) edema importance signals?

Answer 12

signals underlying cardiac, renal diseases. affects wound healing and clearance

Question 13

Pulmonary edema

Answer 13

seen with Left ventricular failure. pink, frothy fliud (extravasated RBC)

Question 14

Brain edema (general)

Answer 14

brain swollen with narrow sulci and distended gyri. compression against skull.

Question 15

Brain edema (severe)

Answer 15

brain substance herniation through the foramen magnum. compression of vasculature (ischemia)

Question 16

Hyperemia

Answer 16

active process. arteriolar dilation (increase blood flow- oxygenated blood) inflammation and exercise.

Question 17

congestion

Answer 17

passive process. reduced outflow of blood (cardiac failure)

Question 18

local congestion

Answer 18

venous obstruction (cyanosis, stasis)

Question 19

chronic congestion

Answer 19

chronic hypoxia (ischemia and scar), capillary rupture (hemorrhage foci)

Question 20

Telltale sign of chronic congestion- capillary rupture?

Answer 20

hemosiderin-laden macrophages

Question 21

Acute pulmonary congestion

Answer 21

engorged alveolar capillaries -> alveolar septal edema -> intra-alveolar hemorrhage

Question 22

chronic pulmonary congestion

Answer 22

septa thick and fibrotic (no edema), hemosiderin-laden macrophages (HF cells)

Question 23

Acute hepatic congestion

Answer 23

distension of central vein and sinusoids. potential centrilobar ischemia (distal end)

Question 24

chronic passive hepatic congestion

Answer 24

centrilobar are red-brown color due to cell death and located around uncongested tan liver (nutmeg liver)

Question 25

Hepatic microscopic examination- overveiw

Answer 25

Centrilobar hemorrhage, hemosiderin-laden macrophages, and variable degeneration of hepatocytes

Question 26

What is a hemorrhage?

Answer 26

extravasation of blood to extravascular space

Question 27

external hemorrhage?

Answer 27

hematoma

Question 28

Petechiae hemorrhage

Answer 28

small 1-2mm in skin, mucous, serosal. Associated with: increased intravasc pressure, low platelet (thrombocytopenia), and defective platelet function (uremia)

Question 29

Purpura

Answer 29

> 3mm hemorrhage. Associated to trauma, vasculitis, amyloidosis, and indication for petechiae

Question 30

ecchymoses

Answer 30

sub Q hematoma (bruise). change of color due to Hemoglobin (red/blue) -> bilirubin (green/blue) -> hemosiderin (yellow/brown)

Question 31

Normal Hemostasis

Answer 31

tightly regulated. form clots, keep blood fluid

Question 32

Thrombosis

Answer 32

blood clot formation

Question 33

components of hemostasis/thrombosis

Answer 33

vascular wall, platelets, coagulation cascade

Question 34

arteriolar vasoconstriction

Answer 34

immediate vasoconstriction to site of injury

Question 35

Primary hemostasis

Answer 35

formation of platelet plug. vWF and collagen promote platelet adherence and activation (shape change and degranulation)

Question 36

Secondary hemostasis

Answer 36

deposition of fibrin. Tissue factor coag cascade- thrombin generation - fibrin meshwork.

Question 37

Clot stabilization and resorption

Answer 37

tissue plasminogen activator (t-PA) to limit clotting and resorb clot.

Question 38

endothelial cells

Answer 38

anticoagulation. when activated- procoagulation.

Question 39

Endothelial antiplatelet

Answer 39

prevent platelet adherence to collagen (vWF) due to NO and PGI2

Question 40

Endothelial antiplatelet ADP

Answer 40

degrades ADP, therefore inhibits aggregation of platelets

Question 41

Endothelium anticoagulant

Answer 41

thrombomodulin binds to thrombin to convert to anticoagulant. Activating protein C to inhibit factor 5a and 8a.

Question 42

Endothelium anticoagulant heparin-like

Answer 42

endothelium surface bind and activate antithrombin 3 (indirect activation)

Question 43

endothelium anticoagulant tissue factor path

Answer 43

cell surface protein that inactivates factors: 7a and 10a

Question 44

endothelium fibrinolytic effect

Answer 44

tissue plasminogen activator (t-PA) cleaves plasminogen to plasmin which cleaves fibrin and degrades thrombi

Question 45

platelets attaché to what on endothelial surface

Answer 45

vWF (collagen)

Question 46

procoagulant effects of endothelial cells

Answer 46

synthesize tissue factor. activate factors 9 and 10

Question 47

antifibrinolytic effects

Answer 47

activated endothelial cells secrete inhibitors of plasminogen activator (PAI)

Question 48

Bernard- Soulier syndrome

Answer 48

deficiency of GpIb (no platelet binding to vWF)

Question 49

Glanzmann thrombasthenia

Answer 49

deficiency of GpIIb-IIIa (no platelet-fibrinogen-platelet binding)

Question 50

von Williebrand disease

Answer 50

deficiency of vWF

Question 51

platelet alpha granules

Answer 51

P-selectin for adherence to collagen

Question 52

Platelet delta (dense) granules

Answer 52

contain ADP (platelet aggregation), ATP, calcium (for coagulation cascade), histamine.

Question 53

platelet activation

Answer 53

negatively charged phospholipids on their surface bind to calcium