Circulatory Disturbances Flashcards
1
Q
Coagulation Factors
A
Plasma proteins produced by the liver
2
Q
The Circulatory System consists of
A
blood, a central pump, blood distribution and collection networks, and a system for exchange of nutrient and waste products between blood and extravascular tissue.
3
Q
Nitric Oxide when released from vascular endothelium has what effect
A
Relaxation and vasodilation
4
Q
Water distribution between plasma and interstitium is primarily determined by
A
Hydrostatic and Osmotic pressure differences between the two compartments
5
Q
Ground substance of ECM consists of
A
Glycoproteins (Fibronectin and Laminin), Glycosaminoglycans, Proteoglycans, etc
6
Q
Possible outcomes to thrombi
A
Lysis
Propagation
Embolization
Organization/ recanalization
7
Q
Describe the process of hematoma resolution
A
Hemoglobin (red/blue) enzymatically converted to bilirubin (blue/green) and eventually into hemosiderin (gold/brown)
8
Q
Condition
A
Subacute Hepatic Congestion
______________________
“Nutmeg Liver”
9
Q
Types of shock
A
Cardiogenic Shock
Hypovolemic Shock
Blood Maldistribution
10
Q
Embolus
A
Any detacehed intravascular mass which is carried by the blood to a site distal to the point of origin
11
Q
Pathomechanisms of Edema
A
- Increased blood hydrostatic pressure
- Decreased plasma colloid osmotic pressure
- Lymphatic obstruction
- Increased vascular permeability
12
Q
Clinical significance of edema
A
Tissue may become firm and distorted due to an increase in fibrous connective tissue after prolonged edema
13
Q
Epistaxis
A
Bleeding from the nose
14
Q
Plasma accounts for ______% of total water weight
A
5%
15
Q
Thrombosis
A
Formation or presence of a solid mass within the cardiovascular system
16
Q
Non inflammatory pulmonary edema can be the result of
A
Left Sided Congestive Heart Failure (CHF)
17
Q
Clinical significance of hemorrhage is determined by
A
location and severity
18
Q
Describe the histologic appearance of edema
A
- Clear or pale eosinophilic staining
- Dependent on inflammatory vs non-inflammatory
- Spaces distended
- Blood vessels filled with RBC
- Lymphatics dilated
- Collagen bundles separated
19
Q
Describe what happens during the vasoconstriction step of normal hemostasis
A
- Brief period of arteriolar vasoconstriction occurs mostly as a result of reflex neurogenic mechanism
- Augmented by local secretions of factors such as endothelin
20
Q
Example of what circulatory distrubance
A
Edema
21
Q
Condition
A
Ascites or Hydroperitoneum
22
Q
Suffusive Hemorrhage
A
Larger than ecchymosis and contiguous.
23
Q
Intracellular Fluid accounts for _________% of total water weight
A
40%
24
Q
Hydrothorax
A
Fluid in the thoracic cavity
25
Condition - Fibrin thrombi within glomerular capillaries
Disseminated Intravascular Coagulation (DIC)
26
Thromboplastin
Promotes blood coagulation
27
Epistaxis
28
Thrombomodulin
Has anticoagulent activity
29
Interstitial fluid accounts for \_\_\_\_\_\_\_\_% of total water weight
15%
30
Types of hyperemia
Physiological
Pathological
31
Ecchymosis
Larger than petechia (up to 1 or 2 cm) as seen in bruise (contusion) or small hematoma
32
Endothelin released from vascular endothelium has what effect
Vasoconstriction
33
Classification of hemorrhage
Ecchymosis
34
Common name for this disease
"Mulberry Heart Disease"
35
Petechia
Up to 1-2mm in size, especially found on skin, mucosal and serosal surfaces
36
Total body water is \_\_\_\_\_\_\_% of total body weight
65%
37
Pathogenesis of Gastric Volvulus (Torsion)
* Twisting of vessels obstructs gastric veins
* Severe venous congestion (acute, local)
* Ischemia (necrosis)
* Loss of endothelial integrity
* Hemorrhage
* Shock
* Death
38
Describe an arterial Infarct lesion
Initially hemorrhagic but become pale as the are of coagulation necrosis becomes eviden
39
Example of what circulatory disturbence
Edema
40
Hemostasis
Arrest bleeding by physiological properties of vasoconstriction and coagulation or by surgical means
41
Tissue Edema results from what in regards to starling pressures
Increased hydrostatic pressure
Decreased osmotic pressure
42
Hemorrhagic Diathesis
Increased tendency to hemorrhage from usually insignificant injuries
43
Submandibular Edema
"Bottle Jaw"
Commonly associated with sever GI parasitism and hypoproteinemia in sheep
44
Condition
Thrombotic Meningoencephalitis (TME)
45
Example of what circulatory disturbance?
Hemorrhage
46
Describe the gross appearance of edema
Wet
Gelatinous and heavy
Swollen organs
Fluid weeps from cut surfaces
May be yellow
47
What stain is being used? What does it stain?
HE-Stain
Brown pigment staining the cytoplasm of alveolar macrophages
48
Example of what circulatory disturbance
Edema
49
Causes of hemorrhage
Trauma
Sepsis, viremia, bacteremia, toxic conditions
Abdominal neoplasia may lead to hemoperitoneum
Coagulation abnormalities
50
Embolism
Pieces of a thrombus break off from the original mass and sail downstream to lodge at a distant site
51
Condition
Chronic Hepatic Congestion
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Nutmeg Liver
52
What happens at the conclusion of the coagulation cascade
Thrombin converts the soluble plasma protein fibrinogen into fibrin
53
This condition is usually the result of
Right sided congestive heart failure
54
Pro-coagulation factors secreted by endothelium
Thromboplastin
Platelet Activation Factor (PAF)
Von Willebrand Factor
55
Condition
Pericardial Effusion
56
Describe what happens during the primary hemostasis step of normal hemostasis
* Endothelial injury exposes highly thrombogenic subendothelial ECM allowing platetlets to adhere and be activated
* Activation of platelets results in a dramatic shape change and release of secretory granules lead to further platelet aggregation to form the primary hemostatic plug
* Secreted products recruit additional platelets
57
Difference betwen hemorrhage and hyperemia/congestion
Hemorrhage the blood is outside the vessel wall
Hyperemia/Congestion the blood is within the blood vessels
58
In which direction does hydrostatic pressure move fluid?
Moves fluid out of vasculature
59
Cardinal signs of inflammation
Reddening - Rubor
Edema - Tumor
Heat - Calor
Pain
Loss of Function
60
Describe the basic mechanism of normal hemostasis
1. Vasoconstriction
2. Primary hemostasis
3. Secondary hemostasis
4. Thrombus and antithrombotic events
61
Prostacylin
Causes vasodilation, inhibits platelet aggregation
62
Pathogenesis
Twisting of vessels obstructs gastric veins → severe venous congestion (acute,local, congestion) → ischemia (necrosis → loss of endothelial integrity → hemorrhage → shock → death
63
Hemoperitoneum
Blood in the peritoneal cavity
64
Causes of physical hyperemia
* Digestion
* Exercise
* Dissipation of heat
* Neurovascular - facial hyperemia (blushing)
65
Hemorrhage
Escape of blood from the blood vessels
66
Example of what circulatory disturbance?
Hemorrhage
67
Condition
Gastric Volvulus (Torsion)
68
Secretory granules secreted during primary hemostasis
ADP and TXA2
69
Agonal Hemorrhages
Petechiae and ecchymoses associated with terminal hypoxia
70
Increased blood hydrostatic pressure can be the result of
Generalized - Right sided CHF
Localized - Tightly bandaged limb resulting in venous occlusion
71
Condition
Pulmonary Edema
72
Example of what circulatory disturbance
Edema
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Inflammatory Edema
73
Classification of hemorrhage
Suffusive Hemorrhage
74
Extracellular Matrix is composed of
Structural molecules
Ground substance
75
Etiology
Histophilus somni infection
76
Key players in the regulation of homeostasis, as the balance between anti and prothombotic activities of endothelium determines whether thrombus formation propagation or dissolution occurs
Endothelial Cells
77
This condition is usually the result of what?
Heart failure and associated edema
78
Pathogenesis of septic shock
1. Endotoxin - producing gram negative bacilli
2. LPS and other microbial substances induce injury and activation of the vascular endothelium
3. Stimulate WBCs to release cytokines
4. Vasodilation and prothrombotic diathesis
79
Chronic pulmonary edema is most commonly associated with
Cardiac failure
80
Cardiogenic Shock
Failure of the heart to maintain normal cardiac output
81
Interstitium
Space between tissue compartments - microcirculation and the cells. Medium through which all metabolic products must pass between the micocirculation and the cells
82
Describe what happens in the thrombus and antithrombotic event step of normal hemostasis
* Polymerized fibrin and platelet aggregates form a solid permanent plug to prevent any additional hemorrhage
* Counter regulatory mechanisms and thrombomodulin are set into motion to limit the hemostatic plug to the site of injury
83
Classification of hemorrhage
Petechia
84
Acute Respiratory Distress Syndrome (ARDS)
Sudden, diffuse and direct - increase in vascular permeability.
High fatality rate
Pneumonia if animal survives
85
Tissue Plasminogen Activator (tPA)
Regulates fibrinolysis
86
Platelet Activating Factor (PAF)
Causes activation of platelets and neutrophils
87
Anti-coagulation factors secreted by endothelium
Prostacylin
Nitric Oxide
Tissue Plasminogen Activator (tPA)
Thrombomodulin
88
In which direction does osmotic pressure (of plasma protein) move fluid?
Moves fluid into the vasculature
89
Example of what circulatory disturbance?
Congestion
90
Role of vascular endothelium in hemostasis
* Anti-thrombotic and pro-fibrinolytic in normal state
* Pro-thrombotic and anti-fibrinolytic during injury
91
Hemorrhage by Rhexis
Due to a substantial rent or tear in the vascular wall (or heart)
92
Disseminated Intravascular Coagulation (DIC)
Systemic reaction in which there is generalized activation of the blood coagulation system
93
Anasarca
Generalized edema with profuse accumulation of fluid within the subcutaneous tissue
94
Hemoptysis
95
Example of what kind of embolism
Fat Embolism
96
This condition is caused by
Copper deficiency
97
Describe the fluid in inflammatory edema
Protein rich ( \> 30g/L)
Specific Gravity ( \> 1.025)
Total nucleated cells ( \< 7x109L)
Less than 7000 cells per uL
98
Pulmonary congestion is usually the result of
Heart failure - associated with edema
99
Example of what circulatory disturbance?
Congestion
100
Infarction
Localized area of ischemic necrosis in a tissue or organ caused by occlusion of either the arterial supply or the venous drainage
101
Example of what circulatory disturbance
Edema
102
Most water leakage occurs in capillaries or post-capillary venues because they have
Semi-permeable membrane wall that allows water to move more freely than proteins
103
Role of vascular endothelium in inflammation
* Regulate the traffic of inflammatory cells
* Produce pro-inflammatory cytokines
* Control angiogenesis and tissue repair
104
Starling Equation
Illustrates the role of hydrostatic and osmotic forces in the movement of fluid across capillary membranes
105
Nutmeg Liver
Appearance of the parenchyma with animal suffering from chronic hepatic congestion
106
Example of what circulatory disturbance
Infarction
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Arterial Infarct
107
Hypovolemic Shock
Fluid loss due to hemorrhage, vomiting, diarrhea
108
Clinical significance of edema dependent on
Extent
Location
Duration
109
Verminous Thrombosis
Thrombus formation in the cranial mesenteric artery of horses with Strongylus vulgaris infection
110
Fat Embolsim can be the result of
long bone fractures
111
Endothelin
Potent endothelium - derived vasoconstrictor
112
Describe what happens during the secondary hemostasis step of normal hemostasis
* Tissue factor is exposed at the site of injury
* Thrombin cleaves circulating fibrinogen into soluble fibrin creating a fibrin meshwork deposition
* Thrombin also induces further platelet recruitment and granule release
113
Example of what circulatory disturbance
Thrombosis
114
Hemopericardium leads to
Fatal Cardiac tamponade
115
Pathogenesis of thrombosis
1. Endothelial injury
2. Alteration in blood flow - turbulence or stasis
3. Hypercoagulability
1. Increase coagulation factors
2. Decrease coagulation inhibitors
116
Example of what circulatory disturbance
Congestion
117
Interstitium is composed of
Extracellular Matrix (ECM)
Supporting Cells
118
Example of what circulatory disturbance
Congestion
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Pulmonary congestion
119
Von Willebrand Factor
Promotes platelet adhesion and activation of blood coagulation
120
Condition
Hydrothorax
121
Pathogenesis of Nutmeg Liver
* Low grade chronic hypoxia
* Increased pressure of centralobular hepatocytes
* Atrophy
* Necrosis
122
Homeostasis
A tendency to stability in the normal body states
123
Heart Failure Cells
Hemosiderin - laden macrophages
Characteristic of left sided CHF
124
What is the stain being used? What does it stain?
Iron (Perl's) Stain
Hemosiderin-laden macrophages - "Heart Failure Cells"
125
Ascites (Hydroperitoneum)
Fluid (transudate) within the peritoneal cavity
126
Thrombus
Aggregate of platelets, fibrin and entrapped blood cells. Can result in occlusion of the vascular lumen and embolism. It is adhered to the vascular wall as opposite to blood clot
127
Shock - Cardiovascular Collapse
Final common pathway for a number of potentially lethal clinical events. Gives rise to systemic hypoperfusion.
128
Transcellular Fluid accounts for \_\_\_\_\_\_\_% of total water weight
5%
129
Edema
Abnormal accumulation of excess extracellular water in interstitial spaces or in body cavities
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Fluid is outside both vascular fluid compartment and cellular fluid compartment
130
Edema can be classified as
Inflammatory
Non-Inflammatory
131
Decreased plasma colloid osmotic pressure can be the result of
* Proteins not absorbed from diet
* Proteins not produced
* Protein loss
132
Hyperemia
Increase of arteriole mediated engorgement of the vascular bed - blood is oxygenated
133
Classification of hemorrhage
Paintbrush hemorrhage
134
Pathological form of hemostasis is
Thrombosis
135
Non-inflammatory Edema
Edema of CHF or liver failure, etc - refers to as a transudate
136
Hemoptysis
Coughing up of blood or blood-stained sputum from the lungs or airways
137
Classification of hemorrhage
Agonal Hemorrhages
138
Example of what circulatory disturbance
Thrombus
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Mural thrombus
139
Condition
Intestinal volvulus
140
Hemostasis
Arrest bleeding by physiological or surgical means
141
T/F: There are infectious causes of thromosis/ thromboembolism
True
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Bacterial valvular endocarditis
Thrombotic Meningioencephalitis
142
Example of circulatory disturbence
Edema
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Pitting Edema
143
Example of what circulatory disturbance
Congestion
144
Venous Infarcts
Intensely hemorrhagic as blood backs up into the affected tissue behind the obstruction
145
End results of shock
Hypotension
Impaired tissue perfusion
Cellular hypoxia
DIC and multi-organ system failure
146
Condition
Hepatic Congestion
147
Example of what circulatory distrubance
Thrombosis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Verminous thrombosis
148
Condition
Submandibular edema
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
"Bottle Jaw"
149
Chronic pulmonary edema causes
Alveolar walls to become thickened - fibrosis
Congestion, micro-hemorrhages and accumulation of heart failure cells
150
Condition
Pulmonary Edema
151
Thrombosis
Clot (thrombus) forms within a vessel which is not injured or only mildly injured
152
Histological appearance of what circulatory disorder
Edema
153
Pitting Edema
Pressure is applied to an area of edema a depression or dent results as excessive intersitial fluid is forced to adjacent areas
154
Example of what circulatory disturbance
Thrombosis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Saddle Thrombosis
155
Pericardial Effusion
"Mulberry Heart Disease"
Inflammatory edema
Fibrin strands and cloudy appearance of pericardial fluid
156
Inflammatory pulmonary edema can be the result of
Damage to pulmonary capillary endothelium
157
Shock caused by blood maldistribution can be due to
Anaphylactic - Type I Hypersensitivity
Neurogenic
Septic
158
Hemarthrosis
Blood within a joint space
159
Describe the fluid in non-inflammatory edema
"Protein Poor"
Low protein content ( \<30g/L)
Low specific gravity ( \< 1.025)
Low cellularity ( \< 1.5x109L)
Less than 1500 cells per uL
160
Congestion
Passive venous engorgement - blood is not oxygenated
161
Tissue Factor - Factor III-Thromboplastin
Membrane bound procoagulant glycoprotein synthesized by endothelium. Acts in conjunction with Factor VII as the major in vivo pathway to activate the coagulation cascade, eventually culminating in thrombin
162
Paint Brush Hemorrhage
Looks like if red paint was hastily applied with a paint brush - most common on mucosal and serosal surfaces
163
Condition
Colonic Torsion
164
Pathological hyperemia is usually caused by
Inflammation
165
Subactue to chronic hepatic congestion is usually the result of
Right Sided Heart Failure
166
Hemorrhage by Diapedesis
Hemorrhage due to a small defect in the vessel wall or RBCs passing through the vessel wall in cases of inflammation or congestion
167
Hemothorax
Blood in the thoracic cavity
168
Gingivitis and blood shot eyes are an example of what circulatory disturbance
Hyperemia
169
Iron (Perl's) Stain
Highlights hemosiderin - laden macrophages within alveoli
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Stains blue
170
Example of what circulatory disturbance
Congestion and Edema
171
Components necessary for normal hemostasis or thrombosis
Vascular wall
Platelets
Coagulation cascade
172
Substances released from vascular endothelium that modulate perfusion
NO
Endothelin
173
Nitric Oxide
Causes vasodilation, inhibits platelet adhesion and aggregation
174
Example of what circulatory disturbance?
Thrombosis
175
Example of what circulatory disturbance
Infarction
176
Structural molecules of the ECM include
Collagen, Reticulin and Elastic Fibers
177
Inflammatory Edema
Increased vascular permeability - refers to as an exudate
178
Condition
Dissecting aneurysm
179
Coagulation Cascade
Amplifying series of enzymatic conversions; each step proteolytically cleaves an inactive proenzyme into an activated enzyme, culminating in thrombin formation
