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Pathology 3000 > Fluid and Hemodynamic Disorders - Final Exam > Flashcards

Fluid and Hemodynamic Disorders - Final Exam Flashcards

1
Q

Edema

A

Fluid in tissues

Localized or systemic

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2
Q

Capillary hydrostatic pressure

A

Pressure in capillary due to heart pumping and weight of blood

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3
Q

Capillary oncotic pressure

A

Pressure in capillary due to proteins present in fluids

Proteins in blood cannot cross normal capillary wall

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4
Q

Lymphatic system

A

A network of vessels separate from blood circulation that carry lymphatic fluid

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5
Q

Blood components (4)

A
  1. Water
  2. Electrolytes
  3. Cells
  4. Proteins
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6
Q

Electrolytes in blood

A

Na, K, Ca etc

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7
Q

Proteins in blood

A

Albumin, coagulation proteins etc

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8
Q

Albumin

A

Maintains oncotic pressure
Made by liver
Involved in transportation of: steroids, thyroid hormone, bilirubin, bile salts, fatty acids

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9
Q

Two main drivers of fluid movement across capillary wall

A
  1. Capillary hydrostatic pressure

2. Capillary oncotic pressure

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10
Q

Lymph fluid entering venous sytem***

A

Thoracic duct/right lymphatic duct

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11
Q

Arteriole

A

Site of filtration

Fluid leaves

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12
Q

Venule

A

Site of reabsorption

Fluid comes back

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13
Q

Pericyte

A

Vascular supportive cell

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14
Q

Components of normal capillary wall

A

Basement membrane

Endothelial cells

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15
Q

How can we tell if a vessel is a lymphatic vessel?

A

Only lymphatic fluid and lymphocytes

No RBC

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16
Q

Causes of localized edema (3)

A
  1. Ischemia - irreversible cell injury, causing release of chemical mediators
  2. Infection - chemical mediators released by WBC
  3. Lymphatic obstruction - obstruction or damage of small or large lymphatic vessels, usually by treatment for carcinoma
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17
Q

Endothelial cell retraction

A

Endothelial cells retract from each other in response to chemical mediators
Can be reversible

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18
Q

Endothelial cell injury

A

More severe damage results in endothelial cell necrosis and detatchment
Not reversible

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19
Q

Causes of localized edema- ischemia

A

Cell lysis, irreversible cell injury, causing release of chemical mediators
Causing cells to retract and capillary to become leaky

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20
Q

Causes of localized edema- infection

A

Neutrophils resppond to infection (ie. bacteria)

Neutrophils inside and outside of capillary release signals to make capillary leaky

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21
Q

Impetigo

A

Staphylococcus aureus invades and replicates in skin

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22
Q

Causes of localized edema- inflammation

A

ie. Crohn’s Disease

in ileum, causing dilution of lymphatic vessels

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23
Q

Causes of local edema- lymphatic obstruction

A

Obstruction of lymphatic vessels, fluid is not re-absorped and also forced out

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24
Q

Subcapsular sinus

A

Where afferent lymph vessel enters lymph node

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25
Q

Afferent lymphatic vessels

A

Bring lymphatic fluid to lymph node

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26
Q

Efferent lymphatic vessels

A

Take lymphatic fluid from lymph node

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27
Q

Example of localized edema - breast carcinoma therapy

A

Axillary lymph node dissection

Causes left arm edema

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28
Q

Lymph node dissection

A

Surgical identification and removal of lymph nodes for purposes of treatment and/or staging of tumor

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29
Q

Staging

A

A system of describing how advanced a tumor is in a patient

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30
Q

Axillary

A

Armpit

31
Q

Causes of systemic edema (3)

A
  1. Heart failure
  2. Kidney Disease
  3. Liver failure
32
Q

Heart failure causing systemic edema

A

Left heart failure causes edema in lungs
Right heart failure causes edema in legs
Increased hydrostatic pressure from impaired venous return
Heart is unable to pump enough blood to adequately perfuse tissues
Fluids will back up according to which ventricle is affected

33
Q

Kidney disease causing systemic edema

A

Loss of albumin in urine

Retention of sodium and water

34
Q

Liver failure causing systemic edema

A

Not enough albumin produced, decreasing oncotic pressure in capillaries

35
Q

Ascites

A

Caused by cirrhosis of liver

Accumulation of fluid in abdomen

36
Q

Cirrhosis

A

Fibrosis of liver

37
Q

Systemic edema

A

Fluid edema that is not localized

Refers to edema caused by heart failure, kidney disease or liver failure

38
Q

Systemic circulation

A

Blood circulation other than heart and lungs

39
Q

Left heart failure

A

Pressure increases in pulmonary veins

Hydrostatic pressure increases in pulmonary capillary bed and causes fluid to enter lungs

40
Q

Pulmonary edema

A

Fluid build up in lungs

Can be heard as crackles with stethoscope at base of lungs

41
Q

Right heart failure

A

Pressure increases in vena cavae

Hydrostatic pressure increases in systemic capillary bed and causes fluid to enter systemic (leg) tissues

42
Q

Pitting edema

A

In legs due to right heart failure

Pressing on skin will leave indentation

43
Q

Why does fluid accumulate at bottom of lungs and legs?

A

Subject to gravity

44
Q

Glomeruli

A

Part of kidney where blood filtration occurs

45
Q

Kidney disease

A

Damage to basement membrane in glomeruli
Albumin can cross and be released into urine
Low albumin causes fluid to enter into tissues (decreased oncotic pressure) causing systemic edema

46
Q

Liver failure (2)

A
  1. Liver not producing enough albumin

2. Liver not producing enough clotting factors

47
Q

Coagulation cascade

A

Proteins in blood that participate and regulate thrombus formation
Thrombin cleaves fibrinogen into fibrin - causes stabilization of coagulation plug

48
Q

Thrombus

A

Blood clot
Composed of platelets and fibrin
Entraps RBC and WBC
Forms are site of blood vessel injury

49
Q

Thrombo-embolus

A

A piece of thrombus has broken off and and travelled elsewhere in body

50
Q

Hypercoagulable state

A

A condition where the blood will clot very easily

51
Q

Atherosclerosis

A

Disease of the arteries
Fatty deposite and calcification in arterial wall
Hardening
Plaques are potential sites of thrombus formation

52
Q

Atrial fibrillation

A

Disease of the heart
Uncoordinated chaotic contraction of atrium causes areas of irregular blood flow
Thrombus can form at sites of poor blood flow, such as on surface of left atrial appendage - can break loose and embolize and cause infarction

53
Q

Hemostasis

A

Coagulation

Process of thrombus formation at site of blood vessel injury to make bleeding stop

54
Q

Three components that control thrombus formation

A
  1. Endothelial cells: damage causes platelets to adhere and form plugs
  2. Platelets: aggregate and form plug at site of injury
  3. Coagulation cascade: thrombin cleaves fibrinogen into fibrin, which stabilizes platelet plug
55
Q

Lamination

A

Layers form in thrombus due to blood flood

RBC get trapped

56
Q

Platelets

A

Produced by megakaryocytes in bone marrow

Released into blood until needed for thrombus formation

57
Q

Causes of pathological thrombi (3)

A
  1. Endothelial cell injury
  2. Poor blood flow
  3. Hyper-coagulable state
    These are all activating components of hemostasis system
58
Q

Causes of arterial thrombi (2)

A
  1. Atherosclerosis

2. Atrial fibrillation

59
Q

Potential thrombo-embolic consequences of arterial thrombi (3)

A
  1. Myocardial infarction
  2. Cerebral infarction
  3. Kidney infarction
60
Q

Causes of venous thrombi (4)

A
  1. Venous stasis
  2. Cancer
  3. Pregnancy
  4. Inherited thrombophilia
61
Q

Venous stasis

A

Poor blood flow, can cause venous thrombus
Can occur in any vein, but mainly legs
Immobilization is risk factor (air travel, surgery)

62
Q

Cancer

A

Causes hypercoagulable state
Can cause venous thrombus
Can release pro-coagulaent factors like cytokines and clotting system activators

63
Q

Inherited thrombophilia

A

Causes hypercoagulable state
Genetic abnormalities in coagulation proteins
Can cause venous thrombus

64
Q

Potential thrombo-embolic consequecnes of venous thrombi

A

Pulmonary emboli - venous thrombus breaks off from its origin and end up in lungs

65
Q

Pleural based infaction

A

Caused by small thromboembolus in branch of pulmonary artery

66
Q

Shock

A

Circulatory failure that results in poor tissue perfusion resulting in cellular hypoxia

67
Q

Three types of circulatory failures

A
  1. Cardiogenic shock (myocardial infarction)
  2. Hypovolemic shock (trauma, blood loss)
  3. Septic shock (systemic inflammatory response, usually infection)
68
Q

Cardiogenic shock (pump failure)

A

Myocardial infarction, ventricular rupture, pulmonary embolism
Tissues are not getting enough blood because heart is not pumping properly

69
Q

Hypovolemic shock (fluid loss)

A

Hemorrhage, vomiting/diarrhea

Tissues are not getting enough blood as there is not enough blood volume

70
Q

Septic shock (systemic imflammatory response)

A

Due to infection
Systemic vasodilation
Tissues are not getting enough blood because peripheral blood vessels are markedly dilated

71
Q

Complications of shock (2)

A
  1. Acute respiratory distress sydrome

2. Disseminated intravascular coagulation

72
Q

Acute respiratory distress syndrome

A

Damage to pulmonary capillary endothelium and alveolar epithelium causes edema to enter pulmonary alveoli
Damage is secondary to many things (aspiration, pancreatitis, smoke, toxic gas)

73
Q

Phases of acute respiratory distress syndrome

A

Acute: alveolar edema
Later: progression to hyaline membranes and thickened alveolar walls

74
Q

Disseminated intra-vascular coagulation

A

Complication of shock
Caused by excessive activation of coagulation and formation of thrombi in microvasculature of body
Causes consumption of coagulation factors and platelets causing bleeding in other parts of body

Pathology 3000 (14 decks)

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