Fluid & Hemodynamics Flashcards
What kind of shock is this:
due to inadequate blood or plasma volume
hemorrhage, fluid loss (vomiting, diarrhea, burns, trauma) ?
Hypovolemic shock
failure of myocardial pump owing to intrinsic myocardial damage, extrinsic pressure or obstruction of outflow
What kind of shock is this?
Cardiogenic shock
peripheral vasodilation and pooling of blood; endothelial activation /injury;
AND
- “Kahit pump ka ng pump ng fluid sa katawan ng tao, you’re just losing the fluid into the different parts of the body, but not in the vessel.”
What kind of shock is this?
Septic shock
Identify: necrosis resulting from ischemia caused by obstruction of the blood supply
Infarction
White infarcts/anemic infarcts: occur in heart, spleen, kidney. How does it come about?
Only one artery supplies the organ, once the blood supply is cut, the cells will die; no activation (via blood) of enzymes responsible for liquefaction of the organ
How do red/hemorrhagic infarcts cause pathologic condition?
there is more than one vessel that supplies the area –> activation of enzymes will occur. But supply is decreased probably because of hypotension/lack of blood.
Origin of pulmonary embolus
Deep venous thromboses (due to lack of mvmt at lower extremities)
What is saddle embolus?
When the fragmented thrombi are large enough, it can occlude the main pulmonary artery and straddle the pulmonary artery bifurcation.
What is paradoxical embolism?
When embolus passes through interatrial or interventricular defect and gain access to systemic circulation
What is cor pulmonale?
occurs when emboli obstruct 60% or more of the pulmonary circulation
What is a mural thrombus?
thrombus that adheres to one wall of a heart chamber or major artery
What is Cerebral Infarction?
Arterial emboli @ Branches of carotid artery, esp middle cerebral artery
What is fat and marrow embolus?
marrow or adipose tissue herniated into the vascular space due to fracture of long bones
Arterial thrombus has alternate dark and light morphology. What do these areas represent?
Dark:platelets
Light:Lines of Zahn
What is air embolism?
Circulating Gas bubbles that coalesce and obstruct vascular flow
used to stain air embolism into lipid red
Sudan stain
__ cc is required to have a clinical effect in pulmonary circulation
100
What is decompression sickness?
special form of air embolism caused by sudden decrease in atmospheric pressure
Explain the pathophysio of Decompression Sickness
Air breathed at high pressure causes increasing amount of gas (particularly nitrogen) to be dissolved in blood and tissues. If the diver then ascends (depressurizes) too rapidly, the nitrogen comes out of solution in the tissues and the blood.
What is Caisson disease?
chronic form of decompression sickness; may lead to ischemic necrosis
What causes amniotic fluid embolism?
tear in the placental membranes or rupture of uterine veins
Identify: inappropriate activation of blood clotting in an uninjured vasculature, often causing interruption of blood flow
Thrombosis
Virchow’s Triad: 3 Primary Influences In Thrombosis Formation
Enumerate!
Endothelial Injury
Alterations In Normal Blood Flow
Hypercoagulability
endothelial injury may lead to thrombosis formation, why?
It can activate clotting factors.
Consequences of Endothelial Injury include all except:
A)Exposes subendothelial ECM and tissue factor
B)adhesion of platelets
C) increase of prostaglandins
D) none of the above
C) increase of prostaglandins
Depletion dapat
Possible consequences of turbulent blood flow include all except
A) Increasing platelet-endothelium contact –>increases chances of platelet activation
B) prevent dilution of activated clotting factors by flowing blood
C) Increase the inflow of clotting inhibitors
D) Atherosclerosis, atrial fibrillation
C) Increase the inflow of clotting inhibitors
Decrease dapat.
Turbulent blood flow most common in ___
Vessels that bifurcate (carotid artery, for example)
IDENTIFY
Embolus
IDENTIFY
(1)usually arise from a mural thrombus (2) can travel to a wide variety of sites 3) in general, outcome is tissue infarction
Arterial embolus
False about arterial embolus:
A) normal: thrombi in the left heart chamber settle in the lungs; B)paradoxical: thrombi in the right heart chamber settle in a hole in the heart affecting circulation
C)both are false
D)both are true
(A)
Imbes na left, right dapat
False about thrombophilia
A. Also called hypocoagulation
B.disruption of balance bet coagulation & anti-coagulation
C. May be caused by gene mutations (Factor V Leiden), anticoagulant deficiencies
D. May also be caused by oral contraceptives, hyperestrogenic state of pregnancy, malignancies and autoimmune diseases
A
Hypercoagulation dapat
Sequence the steps of thrombus fate
A. Dissolution by fibrinolytic activity
B. Organization and Recanalization, reestablishing flow by ingrowth of endothelial cells, smooth muscle cells, and fibroblasts to create vascular channels
C. Propagation causing complete vessel obstruction
D. Embolization to other sites in the vasculature
C D A B
False about fibrinolysis
A.Thrombus formation and thrombus dissolution occursin chronologic order. B. Concurrent with thrombogenesis and modulates coagulation
C.Restores blood flow in vessels occluded by thrombus and facilitates healing after inflammation and injury
D. None of the above
A.
Once the activation of the clotting cascade occurs, fibrinolysis also occurs.
False about arterial thrombi
A. formed in areas of less active blood flow
B. when mature, demonstrate the alternate dark gray layers of platelets (and RBCs) interspersed with lighter layers of fibrin
C. eventually liquefy and disappear or are organized with fibrous tissue formation
D. None of the above
A. formed in areas of less active blood flow
Less –> more
It can be determined if a clot is pre-mortem or postmortem based on the ___
Lines of Zahn (lighter layers of fibrin at thrombus)
Identify
Venous thrombi
Thrombophlebitis. What is it?
inflammation of veins with thrombus formation (when you stay very long in bed)
False about superficial leg veins’ thrombosis
A)usually in varicose saphenous veins B)causes local congestion and pain
C) embolize often
D) local edema and impaired venous drainage, i.e. skin infections, varicose ulcers
C) embolize often
Rarely dapat
False about venous thrombosis at deep leg veins
A.in larger veins above the knee (popliteal, femoral and iliac)
B.may cause pain and edema
C.cannot be asymptomatic
D.Prone to develop pulmonary emboli
C. Cannot be asymptomatic
May be Asymptomatic in 50% of patients
Deep venous thromboses may occur in all except
A) Advanced age, bed rest, or immobilization
B)Congestive heart failure
C)trauma, surgery and burns
D)puerperal and postpartum states
E)none of the above
E)none of the above
False about Migratory Thrombophlebitis
A. Also called Rousseau Syndrome
B. Commonly seen in patients with pancreatic cancer
C. Both are false
A. Also called Rousseau Syndrome
Trousseau dapat
False about Disseminated Intravascular Coagulation
A)Both the procoagulant and the anticoagulant are activated at the same time but are not balanced.
B) Separate illness
C)causing activation of clotting cascade.
D)Widespread fibrin microthrombi in the microcirculation.
E)occur most likely at eye, mucosa
B) Separate illness
It is an effect of illness, like cancer/sepsis
What is Consumption Coagulopathy?
Platelets & coagulation factors consumed
False about postmortem clots
A)attached to vessel wall
B)two-layered appearance:
C)Currant jelly appearance – red cell-rich layer
D)Chicken fat appearance – cell-poor upper layer
A)attached to vessel wall
Hindi siya attached sa vessel wall.
refers to blood extravasation following vessel rupture, defects in platelets or coagulation factors
Identify
Hemorrhage
capillary bleeding can occur with chronic congestion, true or false?
True
conditions or abnormalities that may increase tendency/risk of having hemorrhage from insignificant injuries
Identify
Hemorrhagic diatheses
Enumerate the 3 types of superficial hemorrhages. How are they classified?
Petechiae
Purpura
Ecchymosis
(According to size)
Arrange accdg to increasing size: purpura, petechiae, ecchymosis?
Petechiae, purpura, ecchymosis
In which diseases can you see petechiae?
Dengue hemorrhagic fever, platelet disorders
In which diseases can you see purpura?
Autoimmune disorders
True or false: ecchymosis may be seen in patients with hemophilia
True
localized blood volume increase in capillaries and small vessels
Identify
Hyperemia
Differentiate active fr passive hyperemia
Active Hyperemia (Hyperemia) - results from localized arterial dilatation Passive Hyperemia (Congestion) -resulting from obstructed venous return or increased pressure form CHF
congestion and distention of alveolar capillaries leading to capillary rupture and passage of RBCs into the alveoli; usually due to left heart failure
Identify
Chronic passive congestion of the lungs
Another name for heart failure cells
intraalveolar hemosiderin-laden macrophages
Location of heart-failure cells
Lungs
due to combination of dilated, congested central veins and the surrounding brownish-yellow liver cells
Nutmeg Liver
Nutmeg liver’s main cause
Right heart failure
defined simply as the process by which blood clots form at sites of vascular injury
Hemostasis
Sequence the steps of hemostasis A)Formation of platelet plug B)Deposition of fibrin C)Arteriolar vasoconstriction D)Clot stabilization and resorption
C A B D
Hemorrhagic disorders are characterized by __
characterized by excessive bleeding, hemostatic mechanisms are either blunted or insufficient to prevent abnormal blood loss
Thrombotic disorders are characterized by __
blood clots (thrombi) form within intact blood vessels or within the chambers of the heart
False about transudate
A)non-inflammatory edema fluid
B)high filtration rate but no inflammation; intact vessel wall
C)low protein content, specific gravity of
D)results from dec. intravascular hydrostatic or osmotic pressure
Increased
False about exudate
A)edema fluid from increased vascular permeability as a result of inflammation B)always occurs in an inflammatory setting
C)damage in vessel wall results to exit of protein
D)low protein content, specific gravity
D)low protein content, specific gravity
What is anasarca?
generalized edema
What are effusions?
excess fluids in body cavities
All are causes of edema except A)Increased Hydrostatic Pressure B)Decreased Capillary Permeability C)Decreased Oncotic Pressure D)Increased Sodium Retention E)Blockage of Lymphatics
B)Decreased Capillary Permeability
Increased dapat
True or false: Edema caused by increased hydrostatic pressure is manifested by Congestive Heart Failure.
True
Identify
Peripheral edema
Pulmonary edema
True or false. One can only have either pulmonary edema or peripheral edema.
False. Because as the left sided failure increases, the fluid also back clogs into the right ventricle. If it worsens, it also back clogs into the peripheral system
physiology of inflammation depends on the status of the blood vessel, true or false?
True
Oncotic pressure refers to the __ content of the plasma
Protein
How does decreased oncotic pressure increase possibility of edema?
The fluid is not maintained within the vessel, but is flushed out because there is no oncotic pressure pulling the water towards the lumen. What you only have is the hydrostatic pressure transmitted from the heart, which pushes the fluid away from the lumen.
How does increased sodium retention lead to edema?
Excessive salt intake with renal insufficiency impaired venous repair or arterial dilation –> Increased water retention, aldosterone secretion and hydrostatic pressure
Differentiate hemorrhagic infarct from ischemic infarct
Ischemic infarct has clotting
Identify: necrosis resulting from ischemia caused by obstruction of the blood supply
Infarction
White infarcts/anemic infarcts: occur in heart, spleen, kidney. How does it come about?
Only one artery supplies the organ, once the blood supply is cut, the cells will die. The area stays white because there will be no activation (via blood) of enzymes responsible for liquefaction of the organ
How do red/hemorrhagic infarcts cause pathologic condition?
there is more than one vessel that supplies the area, and so activation of enzymes will occur. But supply is decreased probably because of hypotension/lack of blood.
IDENTIFY
Embolus
False about Pulmonary Embolus
(1) Originate from deep venous thromboses (DVTs)
(2) least common form of thromboembolic disease
(3) important cause of sudden death, usually occurring in immobilized post-operative patients and those with CHF
(4) immobilization leads to venous thrombosis in lower extremities (usually deep vein thrombosis)
(2) least common form of thromboembolic disease
Most dapat
What is saddle embolus?
fragmented thrombi from DVT are carried eventually into the pulmonary arterial vasculature. When the fragmented thrombi are large enough, it can occlude the main pulmonary artery and straddle the pulmonary artery bifurcation.
What is paradoxical embolism?
When embolus passes through interatrial or interventricular defect and gain access to systemic circulation
What is cor pulmonale?
occurs when emboli obstruct 60% or more of the pulmonary circulation
What is a mural thrombus?
thrombus that adheres to one wall of a heart chamber or major artery
IDENTIFY
(1)usually arise from a mural thrombus (2) can travel to a wide variety of sites 3) in general, outcome is tissue infarction
Arterial embolus
False about arterial embolus:
A) normal: thrombi in the left heart chamber settle in the lungs; B)paradoxical: thrombi in the right heart chamber settle in a hole in the heart affecting circulation
C)both are false
D)both are true
(A)
Imbes na left, right dapat
What is Cerebral Infarction?
Arterial emboli @ Branches of carotid artery, esp middle cerebral artery
IDENTIFY
(1) Fractures of long bones (rarely in setting of tissue trauma and burns) rupture vascular sinusoids in the marrow or small venules, allowing marrow or adipose tissue to herniate into the vascular space and travel to the lung (2) lodge in lungs, brain, kidneys and other organs
Fat and Marrow embolus
Identify
symptomatic fat embolism characterized by pulmonary insufficiency, neurologic symptoms, anemia, and thrombocytopenia
Fat embolism syndrome
Identify
Gas bubbles within the circulation can coalesce to form frothy masses that obstruct vascular flow and cause distal ischemic injury
Air embolism
used to stain air embolism into lipid red
Sudan stain
__ cc is required to have a clinical effect in pulmonary circulation
100
What is decompression sickness?
special form of air embolism caused by sudden decrease in atmospheric pressure
Explain the pathophysio of Decompression Sickness
6) Air breathed at high pressure causes increasing amount of gas (particularly nitrogen) to be dissolved in blood and tissues. If the diver then ascends (depressurizes) too rapidly, the nitrogen comes out of solution in the tissues and the blood.
What is Caisson disease?
chronic form of decompression sickness; may lead to ischemic necrosis
IDENTIFY
(1) Caused by the infusion of amniotic fluid or fetal tissue into the maternal circulation via a tear in the placental membranes or rupture of uterine veins
(2) can activate the coagulation process and components of innate immunity
Amniotic fluid embolism
Identify: inappropriate activation of blood clotting in an uninjured vasculature, often causing interruption of blood flow
Thrombosis
Virchow’s Triad: 3 Primary Influences In Thrombosis Formation
Enumerate!
Endothelial Injury
Alterations In Normal Blood Flow
Hypercoagulability
endothelial injury may lead to thrombosis formation, why?
It can activate clotting factors.
Consequences of Endothelial Injury include all except:
A)Exposes subendothelial ECM and tissue factor
B)adhesion of platelets
C) increase of prostaglandins
D) none of the above
C) increase of prostaglandins
Depletion dapat
Possible consequences of turbulent blood flow include all except
A) Increasing platelet-endothelium contact –>increases chances of platelet activation
B) prevent dilution of activated clotting factors by flowing blood
C) Increase the inflow of clotting inhibitors
D) Atherosclerosis, atrial fibrillation
C) Increase the inflow of clotting inhibitors
Decrease dapat.
Turbulent blood flow most common in ___
Vessels that bifurcate (carotid artery, for example)
False about thrombophilia
A. Also called hypocoagulation
B.disruption of balance bet coagulation & anti-coagulation
C. May be caused by gene mutations (Factor V Leiden), anticoagulant deficiencies
D. May also be caused by oral contraceptives, hyperestrogenic state of pregnancy, malignancies and autoimmune diseases
A
Hypercoagulation dapat
Sequence the steps of thrombus fate
A. Dissolution by fibrinolytic activity
B. Organization and Recanalization, reestablishing flow by ingrowth of endothelial cells, smooth muscle cells, and fibroblasts to create vascular channels
C. Propagation causing complete vessel obstruction
D. Embolization to other sites in the vasculature
C D A B
False about fibrinolysis
A.Thrombus formation and thrombus dissolution occursin chronologic order. B. Concurrent with thrombogenesis and modulates coagulation
C.Restores blood flow in vessels occluded by thrombus and facilitates healing after inflammation and injury
D. None of the above
A.
Once the activation of the clotting cascade occurs, fibrinolysis also occurs.
False about arterial thrombi
A. formed in areas of less active blood flow
B. when mature, demonstrate the alternate dark gray layers of platelets (and RBCs) interspersed with lighter layers of fibrin
C. eventually liquefy and disappear or are organized with fibrous tissue formation
D. None of the above
A. formed in areas of less active blood flow
Less –> more
It can be determined if a clot is pre-mortem or postmortem based on the ___
Lines of Zahn (lighter layers of fibrin at thrombus)
Identify
Venous thrombi
Thrombophlebitis. What is it?
inflammation of veins with thrombus formation (when you stay very long in bed)
False about superficial leg veins’ thrombosis
A)usually in varicose saphenous veins B)causes local congestion and pain
C) embolize often
D) local edema and impaired venous drainage, i.e. skin infections, varicose ulcers
C) embolize often
Rarely dapat
False about venous thrombosis at deep leg veins
A.in larger veins above the knee (popliteal, femoral and iliac)
B.may cause pain and edema
C.cannot be asymptomatic
D.Prone to develop pulmonary emboli
C. Cannot be asymptomatic
May be Asymptomatic in 50% of patients
Deep venous thromboses may occur in all except
A) Advanced age, bed rest, or immobilization
B)Congestive heart failure
C)trauma, surgery and burns
D)puerperal and postpartum states
E)none of the above
E)none of the above
False about Migratory Thrombophlebitis
A. Also called Rousseau Syndrome
B. Commonly seen in patients with pancreatic cancer
C. Both are false
A. Also called Rousseau Syndrome
Trousseau dapat
False about Disseminated Intravascular Coagulation
A)Both the procoagulant and the anticoagulant are activated at the same time but are not balanced.
B) Separate illness
C)causing activation of clotting cascade.
D)Widespread fibrin microthrombi in the microcirculation.
E)occur most likely at eye, mucosa
B) Separate illness
It is an effect of illness, like cancer/sepsis
What is Consumption Coagulopathy?
Platelets & coagulation factors consumed
False about postmortem clots
A)attached to vessel wall
B)two-layered appearance:
C)Currant jelly appearance – red cell-rich layer
D)Chicken fat appearance – cell-poor upper layer
A)attached to vessel wall
Hindi siya attached sa vessel wall.
refers to blood extravasation following vessel rupture, defects in platelets or coagulation factors
Identify
Hemorrhage
capillary bleeding can occur with chronic congestion, true or false?
True
conditions or abnormalities that may increase tendency/risk of having hemorrhage from insignificant injuries
Identify
Hemorrhagic diatheses
Enumerate the 3 types of superficial hemorrhages. How are they classified?
Petechiae
Purpura
Ecchymosis
(According to size)
Arrange accdg to increasing size: purpura, petechiae, ecchymosis?
Petechiae, purpura, ecchymosis
In which diseases can you see petechiae?
Dengue hemorrhagic fever, platelet disorders
In which diseases can you see purpura?
Autoimmune disorders
True or false: ecchymosis may be seen in patients with hemophilia
True
localized blood volume increase in capillaries and small vessels
Identify
Hyperemia
Differentiate active fr passive hyperemia
Active Hyperemia (Hyperemia) - results from localized arterial dilatation Passive Hyperemia (Congestion) -resulting from obstructed venous return or increased pressure form CHF
congestion and distention of alveolar capillaries leading to capillary rupture and passage of RBCs into the alveoli; usually due to left heart failure
Identify
Chronic passive congestion of the lungs
Another name for heart failure cells
intraalveolar hemosiderin-laden macrophages
Location of heart-failure cells
Lungs
due to combination of dilated, congested central veins and the surrounding brownish-yellow liver cells
Nutmeg Liver
Nutmeg liver’s main cause
Right heart failure
defined simply as the process by which blood clots form at sites of vascular injury
Hemostasis
Sequence the steps of hemostasis A)Formation of platelet plug B)Deposition of fibrin C)Arteriolar vasoconstriction D)Clot stabilization and resorption
C A B D
Hemorrhagic disorders are characterized by __
characterized by excessive bleeding, hemostatic mechanisms are either blunted or insufficient to prevent abnormal blood loss
Thrombotic disorders are characterized by __
blood clots (thrombi) form within intact blood vessels or within the chambers of the heart
False about transudate
A)non-inflammatory edema fluid
B)high filtration rate but no inflammation; intact vessel wall
C)low protein content, specific gravity of
D)results from dec. intravascular hydrostatic or osmotic pressure
Increased
False about exudate
A)edema fluid from increased vascular permeability as a result of inflammation B)always occurs in an inflammatory setting
C)damage in vessel wall results to exit of protein
D)low protein content, specific gravity
D)low protein content, specific gravity
What is anasarca?
generalized edema
What are effusions?
excess fluids in body cavities
All are causes of edema except A)Increased Hydrostatic Pressure B)Decreased Capillary Permeability C)Decreased Oncotic Pressure D)Increased Sodium Retention E)Blockage of Lymphatics
B)Decreased Capillary Permeability
Increased dapat
True or false: Edema caused by increased hydrostatic pressure is manifested by Congestive Heart Failure.
True
Identify
Peripheral edema
Pulmonary edema
True or false. One can only have either pulmonary edema or peripheral edema.
False. Because as the left sided failure increases, the fluid also back clogs into the right ventricle. If it worsens, it also back clogs into the peripheral system
physiology of inflammation depends on the status of the blood vessel, true or false?
True
Oncotic pressure refers to the __ content of the plasma
Protein
How does decreased oncotic pressure increase possibility of edema?
The fluid is not maintained within the vessel, but is flushed out because there is no oncotic pressure pulling the water towards the lumen. What you only have is the hydrostatic pressure transmitted from the heart, which pushes the fluid away from the lumen.
How does increased sodium retention lead to edema?
Excessive salt intake with renal insufficiency impaired venous repair or arterial dilation –> Increased water retention, aldosterone secretion and hydrostatic pressure
Differentiate hemorrhagic infarct from ischemic infarct
Ischemic infarct has clotting
