Circulation

Question 1

What is Virschow’s Triad?

Answer 1

1. vessel injury
2. coagulability increase
3. decrease in blood flow

Question 2

Difference between hemostasis and thrombosis?

Answer 2

hemostatis: normal, clotting to stop bleeding of wounds
thrombosis: pathologic intravascular coagulation

Question 3

what are some causes of endothelial insult that can lead to thrombosis?

Answer 3

loss of endothelial cells, inflammation, plaques, hypertension, bacterial endotoxins

Question 4

was is ventricular mural thrombosis?

Answer 4

caused by injury to endocardium; decreased blood flow

Question 5

what is phlebothrombosis?

Answer 5

thrombosis in veins caused by stasis (primarily) and aggravated by hyper coagulability.

Question 6

what is the difference between phlebothrombosis and thrombophlebitis?

Answer 6

phelbothrombosis: thrombosis in uninflammed veins
thrombophlebitis: thrombosis in inflammed veins

Question 7

What is the result of thromboses in microcirculation? what is this called?

Answer 7

Disseminated Intravascular Coagulation caused by diffuse thrombi throughout circulation. Slow circulation and consume platelets and activate fibrolytic mechanisms&raquo_space; bleeding disorders.

Question 8

distinction between thrombi and emboli:

Answer 8

thrombi attached to vessel wall; if they become detached, = emboli

Question 9

what is an embolus:

Answer 9

mass (liquid or gas) that travels in vessels

Question 10

pulmonary emboli originate primarily from the:

Answer 10

deep veins of legs

Question 11

what is the clinical outcome of emboli in large arteries or micro emboli in >60% of the pulmonary circulation?

Answer 11

sudden death or right heart failure; cardiogenic shock

Question 12

Thromboemboli in systemic circulation primarily originate from ____ and terminate typically in ____

Answer 12

left heart; lower extremities

Question 13

what are the causes of fat embolism:

Answer 13

fractures of long bones with fatty bone marrow; trauma of fat tissue; burns

Question 14

What is Caisson disease:

Answer 14

chronic decompression sickness

Question 15

How do amniotic fluid emboli occur:

Answer 15

tear in placenta or uterine veins&raquo_space; fetal material or masses in maternal circulation. allergic rxn&raquo_space; coagulation

Question 16

What are the five types of shock?

Answer 16

Cardiogenic, hypovolemic, septic, neurogenic, anaphylactic

Question 17

What is the pathology of shock?

Answer 17

widespread thrombi; multiple ischemic foci, hemorrhage

Question 18

1) Define the process of thrombosis

Answer 18

coagula form within intravascular system. Pathogenic – result of minor endothelial injury causing obstruction to blood flow or in absence of injury

Question 19

2) Understand the difference between thrombosis and hemostasis

Answer 19

thrmobosis - pathogenic

hemostasis - normal physiologic response to seal injured vessels

Question 20

3) Review the causes of thrombosis forming Virchow’s triad

Answer 20

Endothelial injury + abnormal blood flow + hyper =coagulation

Question 21

4) Discuss the most encountered cases of thrombosis

Answer 21

hypertension, plaques, inflammation, trauma/ surgery, bacterial toxins, cigarrette smoke, homocystineuria,

Question 22

5) Define the outcomes of thrombosis

Answer 22

lysis, organization in epithelium, embolism to lungs, embolism to heart

Question 23

6) Define the process of embolism and its clinical outcomes

Answer 23

something, usually a droplet of fat or cholesterol or a piece of thrombus, traveling in vascular system away from its origin

Question 24

7) Discuss the types of embolism encountered in the clinic (thromboembolism, cholesterol
embolism, decompression sickness, fat embolism, amniotic embolism, foreign bodies) their
causes and their clinical outcomes

Answer 24

Different origins: piece of thrombus breaks away, droplet of fad, oxygen or nitrogen bubbles in decompression sickness, piece of plaque breaks away (cholesterol). Outcomes: infarction (if >60% of small arteries contain emboli or if large artery contains emboli), cardiogenic shock (if large artery contains emboli), hemorrhage if lodged in pulmonary system due to bronchiole circulation, pneumonia in case of sepsis, pulmonary hypertension + right heart failure if multiple emboli over time, wedge shaped infarction in left heart failure
air embolis: the bends, the chokes (air bubbles in muscles/lung edema + hemorrhages).

Question 25

8) Define shock as a cardiovascular disorder

Answer 25

decreased perfusion due to decreased circulating blood volume or decreased cardiac output. Vasodilation in effort to maintain adequate perfusion increased total volume, making problem worse. heart can’t keep up.

Question 26

9) Discuss the three progressive phases of shock pathogenesis

Answer 26

compensated: vital organs are adequately perfused due to compensatory response
Reversible: metabolic and circulatory imbalances are worse but can be still be corrected with treatment
Irrevesrible: even w/treatment, multiple organ failure due to hypo perfusion

Question 27

10) Name the types of shock encountered in the clinic and discuss the causes

Answer 27

Cardiogenic: inadequate cardiac output
Hypovolemic: inadeuqtae circulating volume
Septic: due to gram-negative endotoxin