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Clinical Pathology > Exam II-HemoDisorders > Flashcards

Exam II-HemoDisorders Flashcards

1
Q

What are the three types of shock? Give an example of each…

A

1.Cardiogenic Shock (pump failure of the heart) 2.Hypo-volemic Shock (loss of fluid from the circulation) 3.Septic Shock (gram negative bacteremia)

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2
Q

What is a freely movable, intravascular mass that is carried from one anatomic site to another by the blood.

A

Embolism

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3
Q

What are the 4 main forms of emboli?

A
  1. Thromboemboli 1a.Venous 1b.Arterial 1c.Paradoxical 2.Liquid Emboli 3.Gaseous Emboli 4.Small Particle 4a.cholesterol 4b.tumor 4c.bone marrow 4d.bullets 5.
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4
Q

Thromboemboli-these represent fragments of thrombi carried by venous or arterial ____. Infected thrombi give rise to _____ emboli.

A

blood…SEPTIC

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5
Q

Liquid Emboli- these include _____ emboli that occur after bone fracture, and ________ emboli caused by the entry of amniotic fluid into the uterine veins during delivery.

A

fat….amniotic fluid

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6
Q

Gaseous Emboli- an _____ embolism can be produced by injecting air into veins. air that is liberated under pressure, as in ___________ sickness is yet another form.

A

air…decompression

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7
Q

What are the 4 SUBFORMS of Solid Particle Emboli?? like ________ crystals can detach from atherosclerotic plaques, as well as from ______ cells, ________ emboli, or ______!!

A

cholesterol…tumor….bone marrow…BULLETS!!!

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8
Q

The clinical significance of emboli lies in the fact that all emboli can ______ blood vessels thus interrupting the blood supply to an organ.

A

occlude

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9
Q

_________, which accounts for MOST of the emboli in clinical practice, are classified on the basis of the vessels through which they are carried in the blood.

A

ThromboEmboli

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10
Q

PLEASE don’t get this wrong… _______ emboli originate in veins and are carried by the venous circulation that typically lodge in the _______ artery and its _______ branches, causing ______ embolism.

A

Venous…PULMONARY (for all three)

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11
Q

________ emboli are venous emboli that reach the arterial circulation through the foramen ovale or an interventricular septal defect that can cause symptoms similar to those of _______ emboli.

A

Paradoxical….arterial

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12
Q

Arterial emboli originate in the _____ atrium or ventricle, aorta, and the major arteries.

A

left

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13
Q

Arterial emboli are important causes of infarction resulting from the occlusion of ______ arteries.

A

peripheral

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14
Q

Interesting: Paradoxical emboli are _______ emboli that reach the arterial circulation through the _______ or an inter ventricular ______ defect that can cause symptoms similar to those of _______ emboli.

A

venous….foramen ovale….septal…..arterial

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15
Q

The MOST IMPORTANT COMPLICATION of venous emboli that typically originate in the deep veins of the ________ and are carried by venous blood to the _______, through the right atrium and ventricle and then into the ________.

A

lower extremities..vena cava…pulmonary artery

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16
Q

A massive thromboembolus may occlude the main _______ artery or its branches.

A

pulmonary

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17
Q

“________” are often lethal because they prevent the entry of blood into the lungs and cause acute anoxia.

A

“Saddle Emboli” (like a saddle on top of the pulmonary artery branches)

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18
Q

Pulmonary Artery Embolus: Smaller emboli lodge in the minor branches of the pulmonary vascular tree and cause pulmonary infarcts. These infarcts are _______ or _____-shaped, are subpleural, and can cause irritation of the ______, associated with sharp pleuritic pain, accentuated with _______.

A

triangular or wedge-shaped..pleura…inspiration

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19
Q

Are common causes of ischemia in various organs and most originate from the endocardium or from valvular thrombi.

A

ARTERIAL Embolism

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20
Q

ARTERIAL embolism: In cases of bacterial _________, the emboli may be infected.

A

endocarditis

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21
Q

Arterial Embolism: Other sources are thrombi from ulcerated atherosclerotic plaques of the _____ and its major branches.

A

aorta

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22
Q

Arterial emboli are ________ inside the vessels because arterial blood flows fast and disrupts them and so they tend to lodge in medium-sized and smaller arteries.

A

fragmented

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23
Q

The GREATEST RISK is associated with emboli of the _______ circulation, which typically lodge in the _________ artery and causes infarcts of the _________.

A

cerebral..middle cerebral..basal ganglia

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24
Q

Besides the basal ganglia of the brain, what are the 3 other common infarcts due to an arterial embolus?

A

1.Spleen (sharp subcostal pain) 2.Renal (hematuria) 3.Intestine(gangrene and necrosis of the bowel)

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25
Q

Septic Shock: Gram negative ________ shock resulting from the spread of bacteria from a severe localized infection into the blood stream (ie abscesses, pneumonia, or peritonitis)

A

ENDOTOXIC (lps)

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26
Q

Septic shock can also occur with gram ___ and _____ infections.

A

gram-positive….fungal infections

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27
Q

What is currently the MOST COMMON cause of death in ICU’s (>100,000/ year)?????

A

SEPTIC SHOCK!!!

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28
Q

What are the 6 Gram Negative Bacteria associated with septic shock?

A

Caused by endotoxin-producing gram- negative bacteria such as 1. E.coli, 2. Proteus, 3. Serratia, 4. Pseudomonas,5. K. pneumoniae, and the anaerobe 6. Bacteroides

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29
Q

LPS forms a complex with LPS binding protein in the serum. This complex binds to receptors on _____’s and tissue cells, causing release of _________ mediators (like _____).

A

WBC’s…inflammatory mediators (like TNF-alpha)

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30
Q

In the Nonprogressive stage of Shock: The cardiac failure and the resultant hypo- perfusion are initially compensated for by peripheral __________. This redirects blood to vital organs such as the brain and preserves their critical function.

A

vasoconstriction

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31
Q

In non progressive shock: central pooling of blood in the _______ organs and the ______ is accompanied by pallor of the skin, which also is ______.

A

abdominal…lungs….clammy

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32
Q

In NONprogressive shock: Vasoconstriction of the renal blood vessels results in renal hypoperfusion and a decreased _____. This activates the ________ for conservation of fluid, increasing the cardiac output and blood pressure. The early stage is _______ and treatable.

A

GFR….Renin-Angiotinsin System..REVERSIBLE

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33
Q

The Progressive shock: Characterized by tissue _________ and the onset of worsening circulatory and metabolic imbalances (______).

A

hypoperfusion…..acidosis

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34
Q

Progressive shock results in widespread tissue ______ and impairment of intracellular aerobic respiration by which anaerobic respiration follows, resulting in ________.

A

hypoxia…..lactic acidosis

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35
Q

Progressive Shock: This low pH _______ the arterioles and blood begins to ____ in the microcirculation, which worsens the cardiac output.

A

dilates….pool

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36
Q

Progressive Shock: Metabolic acidosis also has a ______ effect on the heart, further potentiating pump failure. Left ventricular insufficiency raises the intrapulmonary venous pressure, causing _______ of blood in the pulmonary circula- tion, and favors the formation of pulmonary edema and _____ (shock lungs).

A

depressive…stagnation…..ARDS

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37
Q

Progressive shock: In the lungs, the capillaries are congested and leaky owing to ______. The alveolar capillaries necrotize and slough off, and are covered and lined by ______ (hyaline membranes).

A

anoxia..fibrin

38
Q

Progressive Shock: Urinary output begins to fall, marking the transition between the _______ and ________ stage three. This is due to marked constriction of the renal ______ vessels reducing the GFR with decreased renal output.

A

reversible….non- reversible….cortical

39
Q

________ Shock: Sets in after the body has incurred cellular and tissue injury so severe that even if treatment is instituted, survival is not possible.

A

Irreversible Shock

40
Q

Irreversible Shock: The cellular injury is widespread, affecting all organs, the _____ being the MOST SERIOUS. The ________ exhibit necrosis, perforation, and peritonitis.

A

kidneys….intestines

41
Q

Irreversible Shock: The brain exhibits ischemic ________, confusion and coma.

A

encephalopathy

42
Q

Irreversable Shock: Typically, patients are in great distress or are _______.

A

unconscious

43
Q

What are the 4 main clinical, systemic signs of IRREVERSIBLE SHOCK?

A

1.hypotension 2.respiratory distress 3.acidosis 4.anuria.

44
Q

Irreversible Shock: Multiple organ failure is usually present and ____ is common.

A

DIC…Desseminated Intravascular Coagulation

45
Q

Pathology of Shock: On gross examination, the body is usually _______ (anasarca), and the body cavities contain fluid (______ and ______).

A

edematous…(effusions and ascites)

46
Q

Path of Shock: On internal examination, the organs appear congested and wet from ______, most prominent in the _____ (2-3 x’s normal wt).

A

edema…lungs

47
Q

Path of Shock: The ______ is congested and enlarged, with blood oozing from the cut surface.

A

liver

48
Q

Path of Shock: The _______ are dark due to pooling of blood in their vessels, and the walls are swollen from the edema.

A

intestines

49
Q

Path of Shock: The ______ are swollen with a pale cortex on cut surface, due to the constriction of the cortical blood vessels with cortical-tubular necrosis.

A

kidneys

50
Q

Path of Shock: The _____ is edematous with flattening of the gyri.

A

brain

51
Q

What are the 8 organs involved in septic shock?

A

1.Brain 2.Lungs 3.Heart 4.Liver 5.Spleen 6.Stomach 7.Kidney 8.Intestines

52
Q

What cells are these?? “The disintegration of RBC’s are taken up by the alveolar macrophages and the hemoglobin of the RBC is degraded into a brown pigment (hemosiderin), which accumulates in the lysosomes of macrophages.”

A

“Heart Failure Cells”

53
Q

What is another name for “heart failure cells”?

A

“Hemo-sid-erin-Laden Macrophages”

54
Q

Fat embolism syndrome appears __-__ days after the injury, and in its most severe form is characterized by ________ failure….In most instances, it is clinically ________.

A

1-3 days….RESPIRATORY…..inapparent

55
Q

Fat Embolism: Also characterized by _____ changes, ___________, and widespread ________.

A

mental….thrombocytopenia…. pete-chi-ae

56
Q

Fat Embolism: The lungs typically exhibit changes of _____ and microscopically show numerous fat globules within the microvasculature.

A

ARDS

57
Q

Fat Embolism: The lesions in the BRAIN include _____ edema, red petechiae and microinfarcts, with fat globules also seen in the microvasculature.

A

cerebral…pete-chi-ae

58
Q

Fat Embolism: Usually considered a direct result of ______, with fat entering ruptured capillaries at the site of the fracture.

A

TRAUMA

59
Q

Fat Emboli: The platelets adhere to the fat globules, causing __________.

A

thrombocytopenia

60
Q

Although this occurs in about 90% of patients with severe skeletal injuries, less than ____% of such patients have clinical findings.

A

10%

61
Q

What syndrome is this? The bacterial infection leads to massive hemorrhage into one or (usually) both ADRENAL GLANDS…What is a common clinical sign?

A

Waterhouse-Friderichsen Syndrome..GRAY petechial skin!

62
Q

______ or ______ infarcts are typical of arterial occlusion in SOLID ORGANS (heart, kidneys, etc).

A

White or Pale….

63
Q

White Infacrts are often rimmed by a thin _______ containing extravasated blood that was destined to reach the ischemic zone from surrounded anastomotic blood vessels.

A

red zone

64
Q

Red infarcts are typical of venous obstruction involving the ________ or ________. The _______ circulation may be interrupted as a result of twisting of the organ around its supporting structure.

A

venous….intestines or testes…freaking ouch

65
Q

Red infarcts are also typical of organs that have a dual blood supply, such as the _____ or ______.

A

liver…lungs

66
Q

Red Infarcts: Twisting of the ________ (volvulus) causes compression of the blood vessels in the mesentery.

A

sigmoid colon

67
Q

Red infarcts leads to a sudden onset of venous ______, local ischemia, and _______.

A

congestion…necrosis

68
Q

The fate of infarcts depends on factors such as their anatomic _____, the general ________ of the patient, and the body’s capacity to ______ the area of infarction.

A

site….circulation….repair

69
Q

INFARCTS caused by infected thrombi or emboli (septic infarcts) show signs of inflammation and may transform into an _______ that tends to heal poorly because of an inadequate blood supply to the infarcted area.

A

ABSCESS

70
Q

SEPTIC SHOCK: Gram-negative endotoxic shock resulting from the spread of bacteria from a severe localized infection into the blood stream (ie _______, pneumonia, or peritonitis)

A

ABSCESSES

71
Q

On the basis of gross features, thrombi are classified as either _____ thrombi, which are composed of tightly intermixed RBC’s and fibrin, or ______ thrombi, which show distinct layering of cellular elements and fibrin…the white layers in these thrombi are called the “Lines of ______”.

A

red….layered…“Lines of Zahn”

72
Q

Thrombi in small vessels tend to be ______.

A

red

73
Q

Thrombus TX: Most small thrombi are ______ with no consequences, but larger thrombi remain attached to the surface of the vessel wall or endocardium.

A

LYSED

74
Q

THROMBUS PREVENTION: Initially, the attachment of these larger thrombi is mediated by the actions of ______ molecules, such as _____.

A

adhesion….FIBRIN

75
Q

Thrombus Prevention: This process is called “_________”, and the inflammatory cells of this ________ tissue dissolve the thrombus, while the thrombus is replaced by collagen from the granulation tissue.

A

Organization…granulation

76
Q

Thrombus Prevention: Occlusive thrombi may also be ________, and the blood could flow again through the previously impassable lumen.

A

recanalized

77
Q

Amniotic Fluid Embolus: The classic findings are the presence of _________ cells shed from fetal skin, lanugo _____ and ____ from vernix caseosa within the mom’s pulmonary vasculature.

A

epithelial squamous, hair, & fat

78
Q

Other names for “Shock Lung Syndrome”

A

ARDS::AdultRespiratoryDistressSyndrome

79
Q

THANKS WIKI!!!An _______ is a subcutaneous purpura (extravasation of blood) larger than 1 centimeter or a hematoma, commonly called a bruise, though the terms are not interchangeable. Specifically, bruises are caused by trauma whereas __________, a type of purpura, are not necessarily caused by trauma. DR F: Larger, BLOTCHY bruises are termed _________.

A

ECCH-y-mo-sis, ecchymosis

80
Q

Blood released by internal hemorrhage may fill various body cavities and form ________.

A

hematomas

81
Q

Small hemorrhages into the skin and mucosa that are less than 1mm in diameter are called Petechiae, and those that measure 1mm. to 1cm. In diameter are termed _______.

A

Pete chi ae=less then 1mm…..Pur-pura=1mm-1cm

82
Q

Thank you Wiki!! A bruise (layman’s term), also called a _______ (medical term), is a type of hematoma of tissue in which capillaries and sometimes venules are damaged by trauma, allowing blood to seep, hemorrhage, or extravasate into the surrounding interstitial tissues.

A

contusion

83
Q

________ are usually encountered after cardiac resuscitation, a procedure in which fractures of the bones of the sternum, thorax and ribs are common.

A

BONE MARROW emboli

84
Q

True bone marrow emboli, complete with hematopoietic cells and fat, are often seen in the ______ at autopsy. Are there symptoms??

A

lungs…no symptoms

85
Q

Hypovolemic Shock: Venous: is usually traumatic in which the blood either flows out of the body, resulting in ________ and a marked reduction in blood volume (Hypovolemia)….OR any loss of _____ from the circulation.

A

exsanguination…fluid

86
Q

Hypovolemic Shock: Results from a loss of circulatory volume, attributed to massive ________ or to ______ loss related to a massive burn, vomiting, or diarrhea.

A

hemorrhage….water

87
Q

________ denotes an accumulation of blood in the peripheral circulation.

A

Hyperemeia

88
Q

________ results in the influx of blood into the capillaries.

A

Hyperemia

89
Q

_______ Hyperemia- is a consequence or dilatation of the arterioles and mediated by _____ signals that lead to the relaxation of arteriolar smooth muscle.

A

Active…neural

90
Q

_______ congestive hyperemia- or congestion is caused by an increased venous back _______ and most often occurs in a ______ form.

A

Passive..pressure…chronic

Clinical Pathology (5 decks)

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