Edema/Congestion/Hemostasis

Question 1

Edema definition

Answer 1

Increased fluid within interstitial tissues

Question 2

Anasarca

Answer 2

Generalized and usually severe increase in fluid

Question 3

What is the pathophysiology/causes of Edema?

Answer 3

Increase in hydrostatic pressure and/or decrease in venous return
Reduced plasma osmotic pressure - when stuff leaks out, fluid wants to leave vessels and go to the tissues
Lymphatic obstruction - struggle to return liquid so it goes out to the tissues
Na and H20 retention - if Na stays in the tissues, water will follow it
Inflammation - increased vascular permeability

Question 4

What is a complication from pulmonary edema?

Answer 4

Impairs gas exhange

Question 5

What is a complication from cerebral edema?

Answer 5

Compression and herniation of critical areas

Decreases blood flow

Question 6

Effusion definition

Answer 6

Collection of fluid in body cavity or other space

Question 7

Hyperemia definition

Answer 7

Increased tissue blood volume secondary to neurogenic mechanisms or inflammation (Active)

Question 8

Congestion definition

Answer 8

Increased tissue blood volume secondary to impaired venous return (passive)
Often accompanied by edema

Question 9

Hemorrhage definition

Answer 9

Loss of blood secondary to vessel injury or physical disruption

Question 10

What are the different types of Hemorrhage?

Answer 10

External - bleeding, can be serious or minor

Internal

Question 11

What are the different types of Internal Hemorrhage

Answer 11

Hematoma
Ecchymosis
Purpura
Petechia
Hemorrhage into body spaces

Question 12

Hematoma

Answer 12

Large mass (tumor) of blood

Question 13

Ecchymosis

Answer 13

≥ 1cm
Flat area of disruption
“Bruise”

Question 14

Purpura

Answer 14

0.3-0.9 cm

Question 15

Petechia

Answer 15

1-2 mm
Small, pinpoint
Often there are multiple
Can be indication of greater bleeding/blood issues

Question 16

How do you name hemorrhage into a body space?

Answer 16

‘Hemo’ + the area

ie. Hemothorax, Hemopericardium, etc

Question 17

Acute hemorrhage

Answer 17

Shock

Lose more than 20% of you blood volume (this is variable depending on the patient)

Question 18

Chronic hemorrhage

Answer 18

More common than acute shock

Anemia is an example

Question 19

Hemostasis definition

Answer 19

Rapid arrest of blood loss at site of injury

Question 20

What are the 3 major components of Hemostasis?

Answer 20

Endothelium
Platelets
Coagulation cascade

Question 21

How does the endothelium partake in hemostasis?

Answer 21

Has both anticoagulant and procoagulant properties

Question 22

What are the 3 phases to forming the platelet plug?

Answer 22

Adhesion
Secretion
Aggregation

Question 23

Adhesion

Answer 23

Mediated by von Willebrand Factor - which bridges between collagen and a surface platelet receptor (glycoprotein Ib)

Question 24

Secretion

Answer 24

Release of contents from both types of granules
Platelets secrete ADP and Ca
ADP mediates platelet aggregation
Ca is required for the coagulation cascade
There is surface expression of a phospholipid complex, which is a binding site for Ca and coagulation factors

Question 25

Aggregation

Answer 25

Simulated by ADP and Thromboxane A2
Thrombin derived from the coagulation cascade binds to a platelet surface receptor leading to more aggregation and platelet contraction
Fibrinogen binds to the plate let surface receptor GP IIb-IIIa and the platelet plug becomes cemented by fibrin

Question 26

Coagulation Cascade

Answer 26

A series of enzymatic conversions of inactive proenzymes to active enzymes
The binding of calcium, active enzyme cofactor, and substrate (the proenzyme) occurs at the phospholipid complex on platelet membranes
Extrinsic system is activated by TF
Intrinsic system is activated by factor XII (Hageman factor)
Final products of both the intrinsic and extrinsic systems are thrombin and fibrin

Question 27

Antithrombins

Answer 27

Control excess coagulation by inibiting the activity of thrombin (and other coagulation factors), and proteins C and S, which inactivate factors Va and VIIIa

Question 28

Fibrinolysis

Answer 28

Occurs by the activation of plasmin from plasminogen by tissue plasminogen activator (t-PA)
Plasmin breaks down fibrin, resulting in fibrin split/degredation products