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RUSVM Pathology I > Circulatory Disturbances > Flashcards

Circulatory Disturbances Flashcards

1
Q

Coagulation Factors

A

Plasma proteins produced by the liver

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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.

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3
Q

Nitric Oxide when released from vascular endothelium has what effect

A

Relaxation and vasodilation

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4
Q

Water distribution between plasma and interstitium is primarily determined by

A

Hydrostatic and Osmotic pressure differences between the two compartments

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5
Q

Ground substance of ECM consists of

A

Glycoproteins (Fibronectin and Laminin), Glycosaminoglycans, Proteoglycans, etc

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6
Q

Possible outcomes to thrombi

A

Lysis

Propagation

Embolization

Organization/ recanalization

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7
Q

Describe the process of hematoma resolution

A

Hemoglobin (red/blue) enzymatically converted to bilirubin (blue/green) and eventually into hemosiderin (gold/brown)

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8
Q

Condition

A

Subacute Hepatic Congestion

______________________

“Nutmeg Liver”

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9
Q

Types of shock

A

Cardiogenic Shock

Hypovolemic Shock

Blood Maldistribution

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10
Q

Embolus

A

Any detacehed intravascular mass which is carried by the blood to a site distal to the point of origin

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11
Q

Pathomechanisms of Edema

A
  • Increased blood hydrostatic pressure
  • Decreased plasma colloid osmotic pressure
  • Lymphatic obstruction
  • Increased vascular permeability
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12
Q

Clinical significance of edema

A

Tissue may become firm and distorted due to an increase in fibrous connective tissue after prolonged edema

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13
Q

Epistaxis

A

Bleeding from the nose

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14
Q

Plasma accounts for ______% of total water weight

A

5%

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15
Q

Thrombosis

A

Formation or presence of a solid mass within the cardiovascular system

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16
Q

Non inflammatory pulmonary edema can be the result of

A

Left Sided Congestive Heart Failure (CHF)

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17
Q

Clinical significance of hemorrhage is determined by

A

location and severity

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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
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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
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20
Q

Example of what circulatory distrubance

A

Edema

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21
Q

Condition

A

Ascites or Hydroperitoneum

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22
Q

Suffusive Hemorrhage

A

Larger than ecchymosis and contiguous.

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23
Q

Intracellular Fluid accounts for _________% of total water weight

A

40%

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24
Q

Hydrothorax

A

Fluid in the thoracic cavity

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25
Q

Condition - Fibrin thrombi within glomerular capillaries

A

Disseminated Intravascular Coagulation (DIC)

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26
Q

Thromboplastin

A

Promotes blood coagulation

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27
Q
A

Epistaxis

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28
Q

Thrombomodulin

A

Has anticoagulent activity

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29
Q

Interstitial fluid accounts for ________% of total water weight

A

15%

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30
Q

Types of hyperemia

A

Physiological

Pathological

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31
Q

Ecchymosis

A

Larger than petechia (up to 1 or 2 cm) as seen in bruise (contusion) or small hematoma

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32
Q

Endothelin released from vascular endothelium has what effect

A

Vasoconstriction

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33
Q

Classification of hemorrhage

A

Ecchymosis

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34
Q

Common name for this disease

A

“Mulberry Heart Disease”

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35
Q

Petechia

A

Up to 1-2mm in size, especially found on skin, mucosal and serosal surfaces

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36
Q

Total body water is _______% of total body weight

A

65%

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37
Q

Pathogenesis of Gastric Volvulus (Torsion)

A
  • Twisting of vessels obstructs gastric veins
  • Severe venous congestion (acute, local)
  • Ischemia (necrosis)
  • Loss of endothelial integrity
  • Hemorrhage
  • Shock
  • Death
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38
Q

Describe an arterial Infarct lesion

A

Initially hemorrhagic but become pale as the are of coagulation necrosis becomes eviden

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39
Q

Example of what circulatory disturbence

A

Edema

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40
Q

Hemostasis

A

Arrest bleeding by physiological properties of vasoconstriction and coagulation or by surgical means

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41
Q

Tissue Edema results from what in regards to starling pressures

A

Increased hydrostatic pressure

Decreased osmotic pressure

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42
Q

Hemorrhagic Diathesis

A

Increased tendency to hemorrhage from usually insignificant injuries

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43
Q

Submandibular Edema

A

“Bottle Jaw”

Commonly associated with sever GI parasitism and hypoproteinemia in sheep

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44
Q

Condition

A

Thrombotic Meningoencephalitis (TME)

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45
Q

Example of what circulatory disturbance?

A

Hemorrhage

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46
Q

Describe the gross appearance of edema

A

Wet

Gelatinous and heavy

Swollen organs

Fluid weeps from cut surfaces

May be yellow

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47
Q

What stain is being used? What does it stain?

A

HE-Stain

Brown pigment staining the cytoplasm of alveolar macrophages

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48
Q

Example of what circulatory disturbance

A

Edema

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49
Q

Causes of hemorrhage

A

Trauma

Sepsis, viremia, bacteremia, toxic conditions

Abdominal neoplasia may lead to hemoperitoneum

Coagulation abnormalities

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50
Q

Embolism

A

Pieces of a thrombus break off from the original mass and sail downstream to lodge at a distant site

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51
Q

Condition

A

Chronic Hepatic Congestion

_______________________

Nutmeg Liver

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52
Q

What happens at the conclusion of the coagulation cascade

A

Thrombin converts the soluble plasma protein fibrinogen into fibrin

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53
Q

This condition is usually the result of

A

Right sided congestive heart failure

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54
Q

Pro-coagulation factors secreted by endothelium

A

Thromboplastin

Platelet Activation Factor (PAF)

Von Willebrand Factor

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55
Q

Condition

A

Pericardial Effusion

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56
Q

Describe what happens during the primary hemostasis step of normal hemostasis

A
  • 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
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57
Q

Difference betwen hemorrhage and hyperemia/congestion

A

Hemorrhage the blood is outside the vessel wall

Hyperemia/Congestion the blood is within the blood vessels

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58
Q

In which direction does hydrostatic pressure move fluid?

A

Moves fluid out of vasculature

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59
Q

Cardinal signs of inflammation

A

Reddening - Rubor

Edema - Tumor

Heat - Calor

Pain

Loss of Function

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60
Q

Describe the basic mechanism of normal hemostasis

A
  1. Vasoconstriction
  2. Primary hemostasis
  3. Secondary hemostasis
  4. Thrombus and antithrombotic events
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61
Q

Prostacylin

A

Causes vasodilation, inhibits platelet aggregation

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62
Q

Pathogenesis

A

Twisting of vessels obstructs gastric veins → severe venous congestion (acute,local, congestion) → ischemia (necrosis → loss of endothelial integrity → hemorrhage → shock → death

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63
Q

Hemoperitoneum

A

Blood in the peritoneal cavity

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64
Q

Causes of physical hyperemia

A
  • Digestion
  • Exercise
  • Dissipation of heat
  • Neurovascular - facial hyperemia (blushing)
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65
Q

Hemorrhage

A

Escape of blood from the blood vessels

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66
Q

Example of what circulatory disturbance?

A

Hemorrhage

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67
Q

Condition

A

Gastric Volvulus (Torsion)

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68
Q

Secretory granules secreted during primary hemostasis

A

ADP and TXA2

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69
Q

Agonal Hemorrhages

A

Petechiae and ecchymoses associated with terminal hypoxia

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70
Q

Increased blood hydrostatic pressure can be the result of

A

Generalized - Right sided CHF

Localized - Tightly bandaged limb resulting in venous occlusion

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71
Q

Condition

A

Pulmonary Edema

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72
Q

Example of what circulatory disturbance

A

Edema

________________

Inflammatory Edema

73
Q

Classification of hemorrhage

A

Suffusive Hemorrhage

74
Q

Extracellular Matrix is composed of

A

Structural molecules

Ground substance

75
Q

Etiology

A

Histophilus somni infection

76
Q

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

A

Endothelial Cells

77
Q

This condition is usually the result of what?

A

Heart failure and associated edema

78
Q

Pathogenesis of septic shock

A
  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
Q

Chronic pulmonary edema is most commonly associated with

A

Cardiac failure

80
Q

Cardiogenic Shock

A

Failure of the heart to maintain normal cardiac output

81
Q

Interstitium

A

Space between tissue compartments - microcirculation and the cells. Medium through which all metabolic products must pass between the micocirculation and the cells

82
Q

Describe what happens in the thrombus and antithrombotic event step of normal hemostasis

A
  • 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
Q

Classification of hemorrhage

A

Petechia

84
Q

Acute Respiratory Distress Syndrome (ARDS)

A

Sudden, diffuse and direct - increase in vascular permeability.

High fatality rate

Pneumonia if animal survives

85
Q

Tissue Plasminogen Activator (tPA)

A

Regulates fibrinolysis

86
Q

Platelet Activating Factor (PAF)

A

Causes activation of platelets and neutrophils

87
Q

Anti-coagulation factors secreted by endothelium

A

Prostacylin

Nitric Oxide

Tissue Plasminogen Activator (tPA)

Thrombomodulin

88
Q

In which direction does osmotic pressure (of plasma protein) move fluid?

A

Moves fluid into the vasculature

89
Q

Example of what circulatory disturbance?

A

Congestion

90
Q

Role of vascular endothelium in hemostasis

A
  • Anti-thrombotic and pro-fibrinolytic in normal state
  • Pro-thrombotic and anti-fibrinolytic during injury
91
Q

Hemorrhage by Rhexis

A

Due to a substantial rent or tear in the vascular wall (or heart)

92
Q

Disseminated Intravascular Coagulation (DIC)

A

Systemic reaction in which there is generalized activation of the blood coagulation system

93
Q

Anasarca

A

Generalized edema with profuse accumulation of fluid within the subcutaneous tissue

94
Q
A

Hemoptysis

95
Q

Example of what kind of embolism

A

Fat Embolism

96
Q

This condition is caused by

A

Copper deficiency

97
Q

Describe the fluid in inflammatory edema

A

Protein rich ( > 30g/L)

Specific Gravity ( > 1.025)

Total nucleated cells ( < 7x109L)

Less than 7000 cells per uL

98
Q

Pulmonary congestion is usually the result of

A

Heart failure - associated with edema

99
Q

Example of what circulatory disturbance?

A

Congestion

100
Q

Infarction

A

Localized area of ischemic necrosis in a tissue or organ caused by occlusion of either the arterial supply or the venous drainage

101
Q

Example of what circulatory disturbance

A

Edema

102
Q

Most water leakage occurs in capillaries or post-capillary venues because they have

A

Semi-permeable membrane wall that allows water to move more freely than proteins

103
Q

Role of vascular endothelium in inflammation

A
  • Regulate the traffic of inflammatory cells
  • Produce pro-inflammatory cytokines
  • Control angiogenesis and tissue repair
104
Q

Starling Equation

A

Illustrates the role of hydrostatic and osmotic forces in the movement of fluid across capillary membranes

105
Q

Nutmeg Liver

A

Appearance of the parenchyma with animal suffering from chronic hepatic congestion

106
Q

Example of what circulatory disturbance

A

Infarction

_____________________

Arterial Infarct

107
Q

Hypovolemic Shock

A

Fluid loss due to hemorrhage, vomiting, diarrhea

108
Q

Clinical significance of edema dependent on

A

Extent

Location

Duration

109
Q

Verminous Thrombosis

A

Thrombus formation in the cranial mesenteric artery of horses with Strongylus vulgaris infection

110
Q

Fat Embolsim can be the result of

A

long bone fractures

111
Q

Endothelin

A

Potent endothelium - derived vasoconstrictor

112
Q

Describe what happens during the secondary hemostasis step of normal hemostasis

A
  • 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
Q

Example of what circulatory disturbance

A

Thrombosis

114
Q

Hemopericardium leads to

A

Fatal Cardiac tamponade

115
Q

Pathogenesis of thrombosis

A
  1. Endothelial injury
  2. Alteration in blood flow - turbulence or stasis
  3. Hypercoagulability
    1. Increase coagulation factors
    2. Decrease coagulation inhibitors
116
Q

Example of what circulatory disturbance

A

Congestion

117
Q

Interstitium is composed of

A

Extracellular Matrix (ECM)

Supporting Cells

118
Q

Example of what circulatory disturbance

A

Congestion

_________________

Pulmonary congestion

119
Q

Von Willebrand Factor

A

Promotes platelet adhesion and activation of blood coagulation

120
Q

Condition

A

Hydrothorax

121
Q

Pathogenesis of Nutmeg Liver

A
  • Low grade chronic hypoxia
  • Increased pressure of centralobular hepatocytes
  • Atrophy
  • Necrosis
122
Q

Homeostasis

A

A tendency to stability in the normal body states

123
Q

Heart Failure Cells

A

Hemosiderin - laden macrophages

Characteristic of left sided CHF

124
Q

What is the stain being used? What does it stain?

A

Iron (Perl’s) Stain

Hemosiderin-laden macrophages - “Heart Failure Cells”

125
Q

Ascites (Hydroperitoneum)

A

Fluid (transudate) within the peritoneal cavity

126
Q

Thrombus

A

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
Q

Shock - Cardiovascular Collapse

A

Final common pathway for a number of potentially lethal clinical events. Gives rise to systemic hypoperfusion.

128
Q

Transcellular Fluid accounts for _______% of total water weight

A

5%

129
Q

Edema

A

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
Q

Edema can be classified as

A

Inflammatory

Non-Inflammatory

131
Q

Decreased plasma colloid osmotic pressure can be the result of

A
  • Proteins not absorbed from diet
  • Proteins not produced
  • Protein loss
132
Q

Hyperemia

A

Increase of arteriole mediated engorgement of the vascular bed - blood is oxygenated

133
Q

Classification of hemorrhage

A

Paintbrush hemorrhage

134
Q

Pathological form of hemostasis is

A

Thrombosis

135
Q

Non-inflammatory Edema

A

Edema of CHF or liver failure, etc - refers to as a transudate

136
Q

Hemoptysis

A

Coughing up of blood or blood-stained sputum from the lungs or airways

137
Q

Classification of hemorrhage

A

Agonal Hemorrhages

138
Q

Example of what circulatory disturbance

A

Thrombus

_______________________

Mural thrombus

139
Q

Condition

A

Intestinal volvulus

140
Q

Hemostasis

A

Arrest bleeding by physiological or surgical means

141
Q

T/F: There are infectious causes of thromosis/ thromboembolism

A

True

______________________

Bacterial valvular endocarditis

Thrombotic Meningioencephalitis

142
Q

Example of circulatory disturbence

A

Edema

___________________

Pitting Edema

143
Q

Example of what circulatory disturbance

A

Congestion

144
Q

Venous Infarcts

A

Intensely hemorrhagic as blood backs up into the affected tissue behind the obstruction

145
Q

End results of shock

A

Hypotension

Impaired tissue perfusion

Cellular hypoxia

DIC and multi-organ system failure

146
Q

Condition

A

Hepatic Congestion

147
Q

Example of what circulatory distrubance

A

Thrombosis

_______________________

Verminous thrombosis

148
Q

Condition

A

Submandibular edema

_______________________

“Bottle Jaw”

149
Q

Chronic pulmonary edema causes

A

Alveolar walls to become thickened - fibrosis

Congestion, micro-hemorrhages and accumulation of heart failure cells

150
Q

Condition

A

Pulmonary Edema

151
Q

Thrombosis

A

Clot (thrombus) forms within a vessel which is not injured or only mildly injured

152
Q

Histological appearance of what circulatory disorder

A

Edema

153
Q

Pitting Edema

A

Pressure is applied to an area of edema a depression or dent results as excessive intersitial fluid is forced to adjacent areas

154
Q

Example of what circulatory disturbance

A

Thrombosis

___________________

Saddle Thrombosis

155
Q

Pericardial Effusion

A

“Mulberry Heart Disease”

Inflammatory edema

Fibrin strands and cloudy appearance of pericardial fluid

156
Q

Inflammatory pulmonary edema can be the result of

A

Damage to pulmonary capillary endothelium

157
Q

Shock caused by blood maldistribution can be due to

A

Anaphylactic - Type I Hypersensitivity

Neurogenic

Septic

158
Q

Hemarthrosis

A

Blood within a joint space

159
Q

Describe the fluid in non-inflammatory edema

A

“Protein Poor”

Low protein content ( <30g/L)

Low specific gravity ( < 1.025)

Low cellularity ( < 1.5x109L)

Less than 1500 cells per uL

160
Q

Congestion

A

Passive venous engorgement - blood is not oxygenated

161
Q

Tissue Factor - Factor III-Thromboplastin

A

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
Q

Paint Brush Hemorrhage

A

Looks like if red paint was hastily applied with a paint brush - most common on mucosal and serosal surfaces

163
Q

Condition

A

Colonic Torsion

164
Q

Pathological hyperemia is usually caused by

A

Inflammation

165
Q

Subactue to chronic hepatic congestion is usually the result of

A

Right Sided Heart Failure

166
Q

Hemorrhage by Diapedesis

A

Hemorrhage due to a small defect in the vessel wall or RBCs passing through the vessel wall in cases of inflammation or congestion

167
Q

Hemothorax

A

Blood in the thoracic cavity

168
Q

Gingivitis and blood shot eyes are an example of what circulatory disturbance

A

Hyperemia

169
Q

Iron (Perl’s) Stain

A

Highlights hemosiderin - laden macrophages within alveoli

_____________________

Stains blue

170
Q

Example of what circulatory disturbance

A

Congestion and Edema

171
Q

Components necessary for normal hemostasis or thrombosis

A

Vascular wall

Platelets

Coagulation cascade

172
Q

Substances released from vascular endothelium that modulate perfusion

A

NO

Endothelin

173
Q

Nitric Oxide

A

Causes vasodilation, inhibits platelet adhesion and aggregation

174
Q

Example of what circulatory disturbance?

A

Thrombosis

175
Q

Example of what circulatory disturbance

A

Infarction

176
Q

Structural molecules of the ECM include

A

Collagen, Reticulin and Elastic Fibers

177
Q

Inflammatory Edema

A

Increased vascular permeability - refers to as an exudate

178
Q

Condition

A

Dissecting aneurysm

179
Q

Coagulation Cascade

A

Amplifying series of enzymatic conversions; each step proteolytically cleaves an inactive proenzyme into an activated enzyme, culminating in thrombin formation

RUSVM Pathology I (18 decks)

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