Fluid & Hemodynamics Flashcards by Joan Ravalo

What kind of shock is this:
due to inadequate blood or plasma volume
hemorrhage, fluid loss (vomiting, diarrhea, burns, trauma) ?

Hypovolemic shock

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failure of myocardial pump owing to intrinsic myocardial damage, extrinsic pressure or obstruction of outflow

What kind of shock is this?

Cardiogenic shock

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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

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Identify: necrosis resulting from ischemia caused by obstruction of the blood supply

Infarction

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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

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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.

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Origin of pulmonary embolus

Deep venous thromboses (due to lack of mvmt at lower extremities)

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What is saddle embolus?

When the fragmented thrombi are large enough, it can occlude the main pulmonary artery and straddle the pulmonary artery bifurcation.

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What is paradoxical embolism?

When embolus passes through interatrial or interventricular defect and gain access to systemic circulation

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What is cor pulmonale?

occurs when emboli obstruct 60% or more of the pulmonary circulation

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What is a mural thrombus?

thrombus that adheres to one wall of a heart chamber or major artery

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What is Cerebral Infarction?

Arterial emboli @ Branches of carotid artery, esp middle cerebral artery

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What is fat and marrow embolus?

marrow or adipose tissue herniated into the vascular space due to fracture of long bones

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Arterial thrombus has alternate dark and light morphology. What do these areas represent?

Dark:platelets
Light:Lines of Zahn

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What is air embolism?

Circulating Gas bubbles that coalesce and obstruct vascular flow

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used to stain air embolism into lipid red

Sudan stain

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__ cc is required to have a clinical effect in pulmonary circulation

100

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What is decompression sickness?

special form of air embolism caused by sudden decrease in atmospheric pressure

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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.

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What is Caisson disease?

chronic form of decompression sickness; may lead to ischemic necrosis

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What causes amniotic fluid embolism?

tear in the placental membranes or rupture of uterine veins

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Identify: inappropriate activation of blood clotting in an uninjured vasculature, often causing interruption of blood flow

Thrombosis

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Virchow’s Triad: 3 Primary Influences In Thrombosis Formation
Enumerate!

Endothelial Injury
Alterations In Normal Blood Flow
Hypercoagulability

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endothelial injury may lead to thrombosis formation, why?

It can activate clotting factors.

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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

(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

C) Increase the inflow of clotting inhibitors Decrease dapat.

Turbulent blood flow most common in ___

Vessels that bifurcate (carotid artery, for example)

A | Hypercoagulation dapat

C D A B

A. | Once the activation of the clotting cascade occurs, fibrinolysis also occurs.

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)

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

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

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

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?

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

Fluid & Hemodynamics Flashcards

(151 cards)