Circulatory Disturbances (Ex2)

Question 1

What are the roles of Vascular Endothelium in hemostasis?

Answer 1

• anti-thrombotic and pro-fibrinolytic when normal

- pro-thrombotic and anti-fibrinolytic during injury

Question 2

What are the roles of Vascular Endothelium in inflammation?

Answer 2

• regulates the traffic of inflammatory cells
• produces pro-inflammatory cytokines
• controls angiogenesis and tissue repair

Question 3

What are the pathomechanisms of Edema?

Answer 3

• increased blood hydrostatic pressure
• decreased plasma colloidal osmotic pressure
• lymphatic obstruction
• increased vascular permeability

Question 4

Type of fluid in Inflammatory Edema

Answer 4

Exudate - protein rich

Question 5

Type of fluid in Non-inflammatory Edema

Answer 5

Transudate - protein poor

Question 6

Gross appearance of Edema

Answer 6

• wet
• gelatinous and heavy
• swollen organs
• fluid weeps from cut surfaces
• may be yellow

Question 7

Histological appearance of Edema

Answer 7

• clear/pale eosinophilic staining
• spaces are distended
• blood vessels may be filled with RBCs
• lymphatics are dilated
• collagen bundles separated

Question 8

What is Pitting Edema?

Answer 8

When pressure is applied to an area of edema, a depression or dent results as excessive fluid is forced to adjacent areas

Question 9

What is Anasarca?

Answer 9

generalized edema with profuse accumulation of fluid within the subcutaneous tissue

Question 10

What are the usual causes of Pulmonary non-inflammatory and inflammatory edema?

Answer 10

Non: left-sided congestive heart failure
Inflam: damage to pulmonary capillary endothelium

Question 11

What happens in chronic pulmonary edema?

Answer 11

• commonly associated with cardiac failure
• alveolar walls become thickened, may lead to fibrosis
• congestion, microhemorrhages, and accumulation of heart failure cells

Question 12

What is Hyperemia?

Answer 12

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

Question 13

What is Congestion?

Answer 13

• passive, venous engorgement caused by decreased outflow of blood
• blood is not oxygenated
• tissues dark red to blue

Question 14

What are examples of Physiological Hyperemia?

Answer 14

• increase blood flow to GI tract during digestion
• increase blood flow to muscles during exercise
• increase blood flow to skin to dissipate heat
• involuntary increased blood flow to the face

Question 15

What is Pathological Hyperemia?

Answer 15

• caused by underlying pathological process, usually inflammation
• arteriolar dilatation secondary to inflammation
• reddening

Question 16

What is the cause of “Nutmeg Liver”?

Answer 16

• subacute to chronic hepatic congestion

- low-grade hypoxia and increased pressure of hepatocytes, leading to atrophy and necrosis

Question 17

What is hemorrhage by rhexis?

Answer 17

due to a substantial rent or tear in the vascular wall

Question 18

What is hemorrhage by diapedesis?

Answer 18

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

Question 19

What is hemorrhagic diathesis?

Answer 19

increased tendency to hemorrhage from usually insignificant injuries

Question 20

What is Hemoptysis?

Answer 20

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

Question 21

What is Epistaxis?

Answer 21

bleeding from the nose

Question 22

What are agonal hemorrhages?

Answer 22

petechiae and ecchymoses associated with terminal hypoxia

- results from slaughter

Question 23

What is suffusive hemorrhage?

Answer 23

larger than ecchymosis and contiguous

Question 24

What is an organizing hematoma?

Answer 24

a central mass of fibrin and RBCs surrounded by supportive vascular connective tissue
- will eventually be phagocytosed

Question 25

Explain the resolution of hematoma (colors)

Answer 25

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

Question 26

What are the components necessary for normal hemostasis or thrombosis to occur?

Answer 26

• vascular wall (endothelium)
• platelets
• coagulation cascade

Question 27

Describe normal Hemostasis

Answer 27

• after initial injury, a brief period of arteriolar constriction occurs (augmented by endothelin)
• platelets adhere and activate
• activated platelets change shape (round to flat) and release secretory granules attracting more platelets and form hemostatic plug (primary)
• tissue factor leads to activation of coagulation cascade, culminating in thrombin
• thrombin cleaves fibrinogen to fibrin
• fibrin and platelets form permanent plug

Question 28

What is a thrombus?

Answer 28

• aggregate of platelets, fibrin, and entrapped blood cells
• can result in occlusion of the vascular lumen ad embolism
• is adhered to the vascular wall (opposite of blood clot)

Question 29

What is the pathogenesis of thrombosis?

Answer 29

• endothelial injury
• alterations in blood flow
• hypercoagulability (increase in coagulation factors)

Question 30

What is an embolism?

What is an embolus?

Answer 30

Embolism: process of pieces of a thrombus breaking off the mass and lodging at distant sites
Embolus: the mass that breaks off

Question 31

What is Disseminated Intravascular Coagulation?

Answer 31

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

Question 32

What is infarction?

Answer 32

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