Fluid and Hemodynamic Disorders, Thrombosis, and Shock

Question 1

Define edema

Answer 1

increased interstitial fluid

Question 2

Increased hydrostatic pressure, reduced plasma osmotic pressure, lymphatic obstruction, sodium retention, and inflammation are all causes of what?

Answer 2

edema

Question 3

Describe the effects on veins and arteries associated with increased hydrostatic pressure

Answer 3

veins: impaired venous return (can cause thrombus)
arteries: arteriolar dilation (causes heat and neurohumural dysregulation)

Question 4

What are the results of reduced plasma osmotic pressure?

Answer 4

protein-losing glomerulopahties
cirrhosis
malnutrition
protein-losing gastroenteropathy

Question 5

When sodium retention occurs, renin-angiotensin-aldosterone secretion ____

Answer 5

increases

Question 6

Activation of the renin-angiotensin system in association with sodium retention causes a ____ in blood volume

Answer 6

increase in blood volume = edema

Question 7

This is an active process; defined as arteriolar dilation that leads to increased blood flow and engorgement of vessels with oxygenated blood

Answer 7

hyperemia

Question 8

This is a passive process; defined as reduced outflow of blood which causes an increased volume of deoxygenated blood, increased pressure, and stasis

Answer 8

congestion

Question 9

Define hemorrhage

Answer 9

a release of blood into the extravascular space

Question 10

Hemorrhages have specific names depending on their size. For the following sizes, give the associated name.
1-2 mm
> 3 mm
> 1-2 cm

Answer 10

1-2 mm = petechiae
> 3 mm = purpura
> 1-2 cm = ecchymoses

Question 11

Factor 12 activates coagulation cascade to generate ____ which converts fibrinogen to fibrin to form a meshwork to stabilize the _____ ____

Answer 11

thrombin; platelet plug

Question 12

In regards to thrombosis, what is Virchow’s triad?

Answer 12

endothelial injury, abnormal blood flow, hypercoagulability

Question 13

Arterial thrombi typically occur at sites of ___ injury, while venous thrombi occur in sites of ____ and are almost always ___

Answer 13

endothelial; stasis; occlusive

Question 14

Thrombi on heart valves are “_____”

Answer 14

vegetations

Question 15

Thrombi are usually attached to their origin and tend to propagate towards the ____

Answer 15

heart

Question 16

The propagating tail of a thrombus may not be very firm and may fragment, causing ____

Answer 16

emboli

Question 17

This is a detached intravascular solid, semisolid, or gaseous mass carried by the blood to a site distant from the point of origin

Answer 17

emboli

Question 18

These emboli are usually from marrow of broken long bones. They are sometimes accompanied by a rash and can be seen in various organs, along with marrow elements, following CPR

Answer 18

fat emboli

Question 19

This type of embolism can be a consequence of decompression sickness from gas bubbling in tissues. The most common iatrogenic cause is introduction of > 100 cc air into a vessel during a procedure

Answer 19

air embolism

Question 20

This type of embolism is a grave but uncommon complication of labor. It has a 80% mortality rate and is caused by rupture of membranes and uterine vessels.

Answer 20

amniotic fluid embolism

Question 21

Definition: coagulation necrosis corresponding to a particular vascular distribution caused by either arterial or venous occlusion

Answer 21

infarct

Question 22

This type of infarct is generally venous, found in “loose” tissues/tissues with dual circulation (lung, liver, bowel), found in congested tissues, and can occur when flow is re-established to a site of previous occlusion and necrosis

Answer 22

red (hemorrhagic) infarct

Question 23

This type of infarct is generally arterial and found in more “solid” organs

Answer 23

white (occlusive) infarct

Question 24

This is formation of widespread microvascular thrombi after activation of coagulation cascade by tissue factor or a mimic.

Answer 24

Disseminated Intravascular Coagulation (DIC)

Question 25

In regards to DIC, the fibrinolytic system responds by degrading newly formed fibrin. This leads to what?

Answer 25

consumptive coagulopathy (defect in coagulation) and bleeding diathesis (susceptibility to bleeding)

Question 26

Which clinical symptoms of Thrombotic Thrombocytopenia Purport/Hemolytic Uremic syndrome overlap with DIC?

Answer 26

preeclampsia, HELLP, malignant hypertension, and vasculitis

Question 27

The difference between other syndromes dealing with coagulation, and DIC is the composition of the thrombi. explain

Answer 27

DIC: fibrin

other syndromes: platelets

Question 28

This represents circulatory collapse with resultant hypo-perfusion and decreased oxygenation of tissue.

Answer 28

shock

Question 29

What are the two causes of shock?

Answer 29

1. decreased cardiac output (hemorrhage, heart failure)

2. widespread peripheral vasodilation (sepsis, trauma)

Question 30

This type of shock is due to circulatory collapse resulting from the acute reduction in circulating blood volume

Answer 30

hypovolemic shock

Question 31

This type of shock is due to circulatory collapse resulting from pump failure of the left ventricle

Answer 31

cardiogenic shock

Question 32

This type of shock is most often associated with severe trauma and reactive peripheral vasodilation

Answer 32

neurogenic shock

Question 33

This type of shock is most often associated with gram-negative infections, and significant peripheral pooling of blood from peripheral vasodilation results in relative hypovolemia and impaired perfusion

Answer 33

septic shock

Question 34

A group of toxic molecules called _____ produce septic shock-like manifestations. The release of these molecules occurs in Toxic Shock Syndrome - s. aureus infection

Answer 34

superantigens

Question 35

Describe the irreversible stage of shock

Answer 35

organ damage and metabolic disturbances are so survive that survival is not possible

Question 36

Describe the morphologic manifestations associated with shock

Answer 36

kidney: acute tubular necrosis

liver/brain: necrosis

heart/liver: fatty change

colon: mucosal hemorrhages