Exam 2 (Lecutre 11) - Blood Flow Alterations, Shock, Acute Inflammation Flashcards
What is shock?
Widespread hypoperfusion of cells and tissues due to inadequate effective circulating blood volume.
What are the mechanisms of shock?
1) Hypovolemic
- dehydrated/losing fluids
2) Cardiogenic
- heart is unable to fill/pump correctly
3) Maldistributive
- peripheral vasodilation
- anaphylactic: type I hypersensitivity; histamine
- septic: endotoxin, peptidoglycans, cytokines
- neurogenic: autonomic
Describe Hypovolemic Shock.
Loss of circulating fluid.
- Loss of fluid may be internal or external
- hemorrhage, burns, dehydration due to vomiting/diarrhea
- Initially there is peripheral vasoconstriction
- Later there is peripheral vasodilation
- loss of vasomotor tone
Describe Cardiogenic Shock.
Pump failure for any reason
- Arrhythmia
- Cardiac tamponade (cardiac sac filled with fluid and heart can’t
push against it)
Leads to decreased cardiac output
Describe Blood Maldistributive Shock (or distributive/pooling of blood in microvasculature). AKA: Venous pooling
Septic shock, anaphylactic shock, and neurogenic shock all fit here.
- Septic and Endotoxic Shock:
- Bacteremia or septicemia
- Leads to widespread endothelial damage
- Gram-negative: LPS
- Gram-positive: peptidoglycans, others
- Bacteremia or septicemia
- Anaphylactic Shock:
- Systemic Type 1 hypersensitivity
- IgE > mast cell degranulation > histamine release > systemic
vasodilation
- IgE > mast cell degranulation > histamine release > systemic
- Systemic Type 1 hypersensitivity
Describe Maldistributive Neurogenic Shock.
Blunt force trauma to spinal cord; fear; lightning strike; emotional stress.
Loss of sympathetic tone
- neural-induced vasodilation > peripheral vasodilation
- reduced blood pressure
- reduced venous return
What are the clinical findings of shock?
- Muddy cool mucus membranes
- Increased capillary refill time
- Cool skin
- Increased heart rate - weak, thready pulse
- Increased respiratory rate
- Hypotension
- Oliguria (not producing urine)
- Metabolic acidosis
What are the parts of the morphological diagnosis? Give some examples.
1) Organ and Process (+ exudate if inflammatory)
2) Distribution
3) Duration
4) +/- Severity (our examples will always be severe)
Examples:
- Lung: suppurative bronchopneumonia, cranioventral, acute, severe
- Liver: necrosuppurative hepatitis, multifocal, acute, severe
What is inflammation of an artery?
Arteritis
What is inflammation of the bladder?
Cystitis
What is inflammation of the brain?
Encephalitis
What is inflammation of the cecum?
Typhlitis
What is inflammation of the connective tissue?
Cellulitis
What is inflammation of the eye?
Ophthalmitis
What is inflammation of fat?
Steatitis
What is inflammation of the intestine?
Enteritis
What is inflammation of the kidney?
Nephritis
What is inflammation of a ligament?
Demitis
What is inflammation of the liver?
Hepatitis
What is inflammation of the lung?
Pneumonia
What is inflammation of a lymph node?
Lymphadenitis
What is inflammation of a muscle?
Myositis
What is inflammation of the myocardium?
Myocarditis
What is inflammation of a nerve?
Neuritis
What is inflammation of the pancreas?
Pancreatitis
What is inflammation of the pericardium?
Pericarditis
What is inflammation of the peritoneum?
Peritonitis
What is inflammation of the pleura?
Pleuritis
What is inflammation of the sinuses?
Sinusitis
What is inflammation of the skin?
Dermatitis
What is inflammation of the spleen?
Splenitis
What is inflammation of the stomach?
Gastritis
What is inflammation of the trachea?
Tracheitis
What is inflammation of the uterus?
Metritis
What is inflammation of a vein?
Phlebitis
List and describe the terms for a disease process.
1) -itis = inflammation (Ex: in kidney; nephritis)
2) -osis = degenerative or toxic (Ex: in kidney; nephrosis)
3) -opathy = generic “something wrong” (Ex: in kidney; nephropathy)
Describe the distribution terms.
1) Focal
- one area of a lesion
2) Multifocal
- multiple lesions but normal tissue in between lesions
3) Locally extensive
- one pole/lobe, etc affected by lesion
4) Diffuse
- lesion is found throughout
What are the different durations? How do we distinguish between each?
1) Peracute = minutes to hours
2) Acute = sudden edema/hemorrhage = < 48 hours
3) Subacute = > 48 hours but less than 1 week
4) Chronic = > 1 week; fibrous tissue involved
What are the five cardinal signs of inflammation?
1) Redness (due to active hyperemia and vasodilation)
2) Pain (increased vascular permeability)
3) Heat (due to active hyperemia and vasodilation)
4) Swelling (increased fluids/increased cells)
5) Loss of function
What types of exudates are associated with acute inflammation?
1) Serous
2) Fibrinous
3) Fibronecrotic
4) Mucoid or Catarrhal
5) Purulent or Suppurative
6) Eosinophilic
7) Hemorrhagic
8) Necrotizing
What types of exudates are associated with chronic inflammation?
1) Lymphocytic/Plasmacytic
2) Granulomatous
3) Pyogranulomatous
4) Fibrosing
5) Proliferative
