edema/congestion

Question 1

5 causes of edema

Answer 1

1. increased hydrostatic pressure
2. reduced plasma osmotic pressure
3. lymphatic obstruction
4. sodium and water retention
5. inflammation

Question 2

increased hydrostatic pressure can result from _____

Answer 2

impaired venous return (i.e. mechanical obstruction, CHF)

Question 3

reduced plasma osmotic pressure can result from _____ or _____

Answer 3

• reduced protein (albumin) synthesis (i.e. cirrhosis)

- increased loss of protein (i.e. nephrotic syndrome, some forms of gastroenteropathy)

Question 4

pulmonary edema impairs _____ (e.g. acute congestive heart failure)

Answer 4

gas exchange

Question 5

cerebral edema causes _____ and ____ of critical areas which decreases _____

Answer 5

compression; herniation; blood flow

Question 6

collection of fluid in body cavity or other space

Answer 6

effusion (transudate or exudate)

Question 7

local increase in intravascular blood volume (increased tissue blood volume)

Answer 7

hyperemia/congestion

Question 8

hyperemia is increased tissue blood volume secondary to _____ or _____; is considered ____

Answer 8

neurogenic mechanisms; inflammation

hyperemia = active vasodilation

Question 9

congestion is increased tissue blood volume secondary to ______

Answer 9

impaired venous return (passive)

Question 10

4 examples of congestion

Answer 10

1. acute pulmonary congestion (after acute MI)
2. chronic pulmonary congestion
3. chronic hepatic congestion
4. acute hepatic congestion

Question 11

chronic hepatic congestion produces gross appearance of _____ due to blood in the _____

Answer 11

nutmeg pattern; centrizonal sinusoids

Question 12

acute hepatic congestion can lead to ______ of _____

Answer 12

ischemic necrosis ; centrizonal hepatocytes (centrizonal necrosis)

Question 13

loss of blood secondary to vessel injury or physical disruption

Answer 13

hemorrhage

Question 14

types of internal hemorrhages

Answer 14

1. hematoma
2. petechiae
3. purpura
4. ecchymoses (bruise)
5. hemothorax, hemopericardium, hemarthrosis (joint), hemoperitoneum (hemorrhage into body spaces)

Question 15

hematoma is blood in ____

Answer 15

tissue (literally tumor of blood)

Question 16

petechiae are ____ or ____ hemorrhages ____ in size ; can be seen in mono

Answer 16

skin; mucous membrane; 1-2 mm

Question 17

purpura are ___ or ____ hemorrhages larger than ____ in size

Answer 17

skin; mucous membrane; 3-9 mm

Question 18

ecchymoses (bruise) is a focal ____ and ____ hemorrhage

Answer 18

skin; subcutaneous (greater than or equal to 1 cm)

Question 19

acute hemorrhage of > 20% of blood volume leads to ____

Answer 19

shock

Question 20

chronic blood loss leads to _____

Answer 20

iron deficiency anemia

Question 21

rapid arrest of blood loss at site of injury

Answer 21

hemostasis

Question 22

3 major components of hemostasis

Answer 22

1. endothelium
2. platelets
3. coagulation cascade

Question 23

antithrombotic properties of the endothelium act as a barrier from the _____; _____ inhibits platelet aggregation

Answer 23

extracellular matrix (ECM); prostacyclin (PGI2)

Question 24

_____ allow anti-thrombin III (AT-III) to inactivate ____, ___, and other factors

Answer 24

heparin-like molecules; thrombin; Xa

Question 25

____ binds to thrombin and this complex activates ____, an anticoagulent

Answer 25

thrombomodulin; protein C

Question 26

protein C inhibits clotting by cleaving and inactivating two procoagulents, factors ___ and ___ ; protein C needs a cofactor, _____, synthesized by endothelial cells

Answer 26

Va; VIIIa; protein S

Question 27

endothelial cells synthesize _____, a protease that cleaves ____ to ____

Answer 27

tissue plasminogen activator (tPA); plasminogen; plasmin (plasmin in turn cleaves fibrin to degrade thrombi)

Question 28

3 prothrombotic properties of endothelium

Answer 28

1. von Willebrand factor
2. tissue factor
3. inhibitors of plasminogen activity

Question 29

vWF is a cofactor for binding ____ to ____

Answer 29

platelets; collagen

Question 30

tissue factor (major in vivo regulator of _____) is secreted after exposure to _____ (referred to as endothelial activation) and initiates the ______

Answer 30

coagulation; cytokines; extrinsic clotting pathway

Question 31

inhibitors of plasminogen activity limit ____ and thereby favor ____

Answer 31

fibrinolysis (enzymatic breakdown of fibrin in blood clots); thrombosis

Question 32

3 phases to forming the platelet plug

Answer 32

1. adhesion
2. secretion
3. aggregation

Question 33

after vascular injury, platelets encounter _____ and ____

Answer 33

ECM constituents (collagen most important); adhesive glycoproteins (such as vWF)

Question 34

adhesion is mediated by ____ which bridges between collagen and a surface platelet receptor (gp lb)

Answer 34

vWF

Question 35

____ mediates platelet aggregation and ____ is required for the coagulation cascade

Answer 35

ADP; calcium

Question 36

aggregation is stimulated by ____ and ____

Answer 36

ADP; thromboxane A2

Question 37

____ derived from the coagulation cascade binds to a platelet surface receptor leading to more _____ (reversible) and ____ (irreversible)

Answer 37

aggregation; platelet contraction

Question 38

____ binds to the platelet surface receptor GP IIb-IIIa and the platelet plug becomes cemented by ____

Answer 38

fibrinogen; fibrin

Question 39

extrinsic system activated by _____

Answer 39

tissue factor (thromboplastin)

Question 40

intrinsic system activated by _____

Answer 40

factor XII (hageman factor)

Question 41

final products of both systems are ___ and ____

Answer 41

thrombin and fibrin

Question 42

control of excess coagulation is by _____ which inhibit activity of thrombin and other coagulation factors, and ____ which inactivate _____

Answer 42

antithrombins (AT-III); proteins C and S; factors Va and VIIIa

Question 43

fibrinolysis occurs through activation of ____ from ____ by _____

Answer 43

plasmin; plasminogen; tissue plasminogen activator (tPA)

Question 44

plasmin breaks down ____, resulting in _____

Answer 44

fibrin; fibrin split/degradation products