Edema/Congestion/Hemostasis Flashcards
what is Edema
increase fluid within interstitial tissue
generally, what causes an edema
Increased Hydrostatic pressure
Decreased venous return
in the body what causes an edema
Reduced plasma osmotic pressure
Lymphatic obstructure
Sodium and water retention
Inflammation
what is a generalized edema
Anasarca
Hydrops
how does Inflammatio lead to an edema
Vasodilation and increased permiability due to more blood being present
what causes vasodilation
NO
Protoglycans
Histamine
what would causes an increase in hydrostatic pressure to cause an edema
Impaired venous return for mechanical obstruction or congestive heart pressure
what would cause reduced plasma osmotic pressure to lead to an edema
reduced protein (albumin) synth Increased loss of protein (nephrotic syndrome, gastroenteropathy)
what would cause lymphatic obstrucutre to lead to a edema
Fibrosis
Parasites
cancer
Compression
what would cause a Na and Water retension to lead to an edema
Acute impairment of renal function
decreased renal perfusion with release of renin
what would lead to inflammation to cause an edema
Increased vascular permeability
necrosis
angiogensis
Pulmonary edema does what to gas exchage
Impairs gas exchange
what causes pulpmonary edema
Acute congestive heart failure
what does a cerebral edema leads to
Causes compression and herniation of critical areas
decreases blood flow
what is plasma osmotic pressure
The pulling of water into the blood vessels due to solutes being present
where is balance normally found to stop edema
Between hydrostatic and osmotic presssure
- prefers to leave capillary slowly and taken up by lymph
what is effusion
Collection of fluid in body cavity or other space
where might effusion occure
Pleural
Pericardial
Peritoneal (ascites)
Joint space (synovial)
a buldge in the abdominal cavity due to effusion
Ascites
what does effusion in the joint space lead to
Limited movement
what is transudate effusion
Transudate is fluid pushed through the capillary due to high pressure within the capillary
what is exudate effusion
Exudate is fluid that leaks around the cells of the capillaries caused by inflammation.
what is Hyperemia
increased tissue blood volume secondary to neurogenic mechanisms or inflammation
is hyperemia active or passive
active
what is congestion
Increased tissue blood volume secondary to impaired venous return
is Congestion active or passive
Passive
is Hyperemia and congestion both associated with increase in blood flow
No, only hyperemia is an increase blood flow
Congestion is due to increased volume from a blockage(less outflow)
color of congestion and hyperemia
Hyperemia: red
Congestion: blue (low O2)
what often accompanies congestion
Edema
examples of congestion
Acute pulmonary congestion
Chronic pulmonary congestion with hemosiderin
Chronic hepatic congestion
Acute hepatic congestion
what causes chronic pulmonary congesion with meosiderin
Laden Macrophages
what does chronic hepatic congestion lead to
Gross appearance of nutmeg pattern due to blood in the centrizonal sinusoids
what does Acute peatic congestion lead to
Ischemic necrosis of centrizonal hepatocytes (centrizonal necrosis)
what is a hemorrhage
Loss of blood secondary to vessel injury or physical disruption
- blood no longer in the vessel
is a hemorrhage internal or external
Can be both
what is an external hemorrhgae
Bleeding
what is an internal hemorrhage
Bleeding inside of connective tissue
types of Internal hemorrhages based on size
Hematoma
Petechiae
Purpura
Ecchymoses
what is a hematoma
large
blood in tissue as a tumor of blood
what is petechiae
Skin or muscous membrane hemorrhage that are 1-2mm in size
size of petechiae
1-2mm in size
what is purpura
Skin or muccous membrane hemorrhages larger than 3-9mm
what is Ecchymoses
Focal skin and subcutaneous hemorrhages larger than 1 cm
what are the types of hemmorhages into body spaces
Hemothorax
Hemopericardium
Hemarthrosis
hemoperitoneum
When does a hemorrhage cause shock
A loss of blood graeter than 20%
what type of hemorrhage causes shock
Acute hemorrhages
what does Chronic hemorrhages cause
Anemia
what is hemostasis
The rapid arrest of blood loss at the site of an injury
is the problem with hemmorhages into body spaces the loss of blood alone
No, can compress other organs
what are the 3 componenets of Hemostasis
Endothelium
Platelets
Coagulation cascade
what aspects of the endothelium is used for hemostasis
Antithrombotic properties
Anticoagulent properties
Prothrombotic properties
what are the antithrombotic properties of Endothelium to cause Hemostasis
- Barrier from the extracellular matrix ECM
- prostacyclin (PGI2) inhibiting platelet aggregation
action of heparin-like molecules from the endothelium to serve as an anticoagulant
Heparin-like molecules allow antithrombin III (AT III) to inactivate thrombin, Xa and other factors
action of thrombomodulin in endothelium
serves as an anticoagulant to bind to thrombin and activate protein C
roll of PRotein S in ANticoagulant in endothelium
Protein S is synth by Endothelium
- serves as a cofactor needed for full protein C function, inactivation of Va and VIIIa)
what synthesizes Tissue Plasminogen activator
Endothelium
What does the endothelium do to encourange anticoagulation in hemostasis
creates Heparin-like molecules
Thrombomodulin
Synth Protein S
Synth tissue plasminogen activator
what are the parts of the prothrombotic properties of endothelium
Von Wellebrand factor
Tissue Factor
inhibitors of plasminogen activity
what is the Von Wilebrand factor from endothelium roll
A cofactor for binding platelets to collagen
when is tissue factor secreted by endothelium
After exposure to cytokines(aka endothelial activation)
what does tissue factor initiate
The extrinsic clotting pathway
what are the phases to forming a platelet plug
Adhesion
Secretion
Aggregation
how does adhesion of platelets occur
Von Willebrand factor bridges between collagen and a surface platelet receptor (glycoprotein Ib)
What is secretion in platelet plug formation
Release of contents from both types of granules
- ADP and Ca
surface expression of a phospholipid complex
What mediates platelet aggregation
ADP
what is the roll of Ca in platelet plug formation
coagulation cascade
why do phospholipid complexes express themeslves during platelet plug formation
serves as a binding site for Ca and Coagulation factors
what is the Coagulation cascade biochemically
a series of enzymait conversions of inactive proenzymes to activated enzymes
what occures at the phospholipid complex on platlet membrane during the coagulation cascade
Binding of Ca
Active enzyme cofactor and substrate (proenzyme)
what is the roll of tissue factor (Thromboplastin) in the coagulation cascade
activates the extrinsic system
what is the roll of Factor XII (hageman factor) in the coagulation cascade
Activates the intrinsic system
what are the final products of the extrinsic and intrinsic systems
Thrombin (extrinsic)
Fibrin (Intrinsic)
what controlls excesss coagulation
Antithrombins (Including AT III)
and protein C and S
what is the action of antithrombins
Inhibit activity of thrombin and other coagulation factor
what is the action of protein C and S
inactivate Factors Va and VIIIa
why does Fibrinolysis occures
By the activation of plasmin from plasminogen by tissue plasminogen activator (t-PA)
what does plasmin do when activated
breaks down fibrin, resulting in fibrin split/degradation products
what is responsible for inhibiting clots
Antithrombin
Thrombomodulin
