Exam II-HemoDisorders Flashcards by Austin Shackelford

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

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

Embolism

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What are the 4 main forms of emboli?

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

blood…SEPTIC

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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.

fat….amniotic fluid

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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.

air…decompression

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

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

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

occlude

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_________, 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.

ThromboEmboli

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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.

Venous…PULMONARY (for all three)

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________ 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.

Paradoxical….arterial

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

left

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

peripheral

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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.

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

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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 ________.

lower extremities..vena cava…pulmonary artery

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

pulmonary

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

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

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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 _______.

triangular or wedge-shaped..pleura…inspiration

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

ARTERIAL Embolism

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

endocarditis

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

aorta

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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.

fragmented

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

cerebral..middle cerebral..basal ganglia

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

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

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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)

ENDOTOXIC (lps)

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

gram-positive....fungal infections

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

SEPTIC SHOCK!!!

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

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

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 _____).

WBC's...inflammatory mediators (like TNF-alpha)

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.

vasoconstriction

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

abdominal...lungs....clammy

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.

GFR....Renin-Angiotinsin System..REVERSIBLE

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

hypoperfusion.....acidosis

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

hypoxia.....lactic acidosis

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

dilates....pool

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).

depressive...stagnation.....ARDS

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).

anoxia..fibrin

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.

reversible....non- reversible....cortical

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

Irreversible Shock

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

kidneys....intestines

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

encephalopathy

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

unconscious

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

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

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

DIC...Desseminated Intravascular Coagulation

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

edematous...(effusions and ascites)

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

edema...lungs

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

liver

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

intestines

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.

kidneys

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

brain

What are the 8 organs involved in septic shock?

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

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."

"Heart Failure Cells"

What is another name for "heart failure cells"?

"Hemo-sid-erin-Laden Macrophages"

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

1-3 days....RESPIRATORY.....inapparent

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

mental....thrombocytopenia.... pete-chi-ae

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

ARDS

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

cerebral...pete-chi-ae

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

TRAUMA

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

thrombocytopenia

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

10%

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

Waterhouse-Friderichsen Syndrome..GRAY petechial skin!

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

White or Pale....

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

red zone

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.

venous....intestines or testes...freaking ouch

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

liver...lungs

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

sigmoid colon

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

congestion...necrosis

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.

site....circulation....repair

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.

ABSCESS

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)

ABSCESSES

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 ______”.

red....layered..."Lines of Zahn"

Thrombi in small vessels tend to be ______.

red

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

LYSED

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

adhesion....FIBRIN

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.

Organization...granulation

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

recanalized

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.

epithelial squamous, hair, & fat

Other names for "Shock Lung Syndrome"

ARDS::AdultRespiratoryDistressSyndrome

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 _________.

ECCH-y-mo-sis, ecchymosis

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

hematomas

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 _______.

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

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.

contusion

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

BONE MARROW emboli

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

lungs...no symptoms

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.

exsanguination...fluid

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

hemorrhage....water

________ denotes an accumulation of blood in the peripheral circulation.

Hyperemeia

________ results in the influx of blood into the capillaries.

Hyperemia

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

Active...neural

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

Passive..pressure...chronic