Gen Path. Exam 2 Section 3: Hemodynamic Disorders, Thromboembolism, and Shock Flashcards
Hemodynamic
flow of blood within organs and tissues; related to issues associated with blood flow
Hemostasis
appropriate clotting of blood without causing excessive clotting
Thrombosis
formation of a blood clot within a vessel
coagulation
used to describe physical change of blood at site of thrombosis; blood is transitioning from fluid to a semi-solid or gel-like state
Thrombus
“blood clot”; final product of thrombosis
Ex: Deep Vein Thromboses (DVT)
Factors that increase risk of Thrombus
obesity, immobility, family history, older age (>50), chronic inflam., pregnancy, smoking, dehydration, advanced cancer, trauma, surgery, diabetes, conditions causing hypercoagulable state
Embolus
unattached mass traveling through bloodstream (is the mass that causes an embolism)
Embolism
when embolus causes a blockage in blood flow
Thromboembolism
general term; combines thrombus & embolism; describes vascular blockage by piece of material that broke loose from a thrombus (clot); results in obstruction of blood (many times in venous flow)
Hematoma
localized collection of blood within body, outside of blood vessels; commonly due to trauma
Exs: Epidural Hematomas & Subdural Hematomas
Hemorrhage
“bleeding”; more precisely describes profuse amount of blood loss from ruptured blood vessel
Examples: postpartum hemorrhage, ass. with severe trauma (MVA or gunshot)
What are the most common hemodynamic disorders in the U.S. causing morbidity and mortility?
myocardial infarction (heart attack) cerebral infarction (stroke) pulmonary embolism (P.E.)
Hyperemia
increase in amount of blood within a tissue; and ACTIVE process that involves vasodilation to increase tissue blood volume; occurs at ARTERIOLES
Why does hyperemia occur?
as a vascular component of acute inflammation OR as a method to deliver more blood to body’s surface to regulate body temp.
–will engorge skeletal muscle tissue with increase blood when working out OR will engorge GI tract with blood to assist in digestion
Congestion
increase in amount of blood within a tissue; PASSIVE process from impaired VENOUS outflow; commonly manifest with cyanosis and transudate edema; more likely to experience hypoxia
Examples: Chronic Pulmonary Congestion & Congestive Hepatopathy
What two things can produce congestion?
Deep Vein Thrombosis (DVT) = produces congestion in isolated single region of body (lower leg, ankle)
Congestive Heart Failure (CHF) = produces systemic (body-wide) congestion –> in lunges and rest of body
Chronic Pulmonary Congestion
most likely results from CHF; causes pulmonary capillaries to engorge –> injures them –> and fibrotic changes in alveolar septa –> bleeding within lungs
- dyspnea (due to edema + congestion)
- “heart failure cells”
- hyrdothorax
hydrothorax
fluid (edema) accumulates in lungs within plural space (within pleural cavity)
“heart failure cells”
when macrophages become engorged with hemosiderin
- occurs in pulmonary alveolar macrophages due to injury that caused inflammation
Congestive Hepatopathy
“chronic passive liver congestion”; result from any condition inhibiting venous blood outflow form liver; manifests with “centrilobular necrosis” AND macrophages overloaded with hemosiderin
- “nutmeg liver”
Common Causes of Congestive Hepatopathy
cirrhosis (from alcohol liver disease, NEFLD, chronic inflam.)
liver cancer and metastasis cancer to liver
large blood clots within liver
Edema
= accumulation of excess interstitial fluid; common feature of tissue congestion
- Anasarca
- Hydrothorax
- Ascities
- Dependent Edema
Anasarca
accumulation of body-wide subcuatneous edema; commonly from–> liver failure, sever malnutrition, heart failure, kidney failure
Ascites
edema within peritoneal cavity; Occlusion of hepatic veins due to:
- cirrhosis
- cancer, blood clots, etc.
Dependent Edema
gravity-dependent; pulls edema to lowest point in body
- If can sit or stand: edema in lower legs or ankles
- If unable to sit: edema in soft tissues posterior to sacral region
Exudate vs Transudate
Exudate: protein-rich, inflammatory, no pitting, osmosis
Transudate: protein-poor, non-inflammatory, pitting, no osmosis
Two opposing forces that regulate movement of fluid form blood vessels to interstitium:
- Intravascular Hydrostatic Pressue
2. Osmotic Pressure of blood’s plasma
5 Contributing Factors to Edema
- Increased Hydrostatic Pressure
- Reduced Plasma Osmotic Pressure
- Lymphatic Obstruction
- Sodium and Water Retention
- Acute Inflammation
Increased Hydrostatic Pressure
most commonly due to obstructions in VENOUS drainage
- in isolated areas: commonly due to DVT
- body wide: commonly due to impaired venous drainage to heart (in CHF)
Congestive Heart Failure
progressively worsening condition (heart inadequately pumps blood–> blood congests in lungs–> then to rest of body’s veins –> therefore increase hydrostatic pressure –> transudate accumulate in tissues)
- DOES NOT provided adequate blood to kidneys–> activates RAAS (renin-angiotensin-aldosterone system)
Renin- Angiotensin- Aldosterone System (RAAS)
when kidney’s do not get enough blood; results in increased re-absorption of NA and therefore hold onto more water via osmosis–> increase body’s total blood volume–> adds additional workload to already failing heart
(creates positive feedback loop of increased edema)
Reduced Plasma Osmotic Pressure
causes anasarca; decrease in protein content of blood
- Hypoalbuminemia
Hypoalbuminemia
= low albumin in blood; used synonymous with low plasma protein levels
Caused by: Nephrotic Syndrome or Liver Disease
Nephrotic Syndrome
lose plasma proteins to external env. via urination; main mechanism is damage to glomeruli of kidney due to kidney damage (from diabetes, Lupus, or amyloidosis)
Liver Disease
lack of plasma protein synthesis; Protein Malnutrition–may inhibit liver’s ability to synthesize plasma proteins = “protein-energy malnutrition” or Kwashiorkor
Lymphatic Obstruction (related to edema)
results in accumulation of lymph within lymphatic systems = lymphedema
- Elephantiasis
- Breast Tumors
What are the most common reasons for Lymphedema?
- fibrosis form chronic inflammation
- local tissue distortion form trauma or surgery
- neoplastic obstruction form benign or malignant tumor
- (ionizing radiation, infection)
Elephantiasis (Filariasis)
result of lymphatic filariasis infection (a parasitic worm known as Wuchereria bancrofti); attacks inguinal lymphatic vessels and causes lymphatic fibrosis
- common infection in tropical areas and endemic to: Africa, Asia, and Pacific island nations
Breast Tumors (related to lymphatic obstruction)
create neoplastic invasion; benign or malignant–> may compress/invade axial lymph nodes or lymphatic vessels
Common Results:
- inverted nipple
- Peau d’orange (dimpling)
- possibly lymphedma of upper extremity that is drained by obstructed lymph nodes (could be after a mastectomy or radiation too)
Sodium and Water Retention (related to edema)
increase NaCl- (salt) --> increase water due to osmosis --> increase blood volume --> increase hydrostatic pressure Conditions That May Cause This: - excessive salt intake - acute renal failure - poststreeptococcal glomerulonephritis
Acute Inflammation (related to edema)
from increase vessel permeability due to: infection, injury, allergies, etc.; will be exudate edema
Hemorrhage
= “extravasation” or “bleeding” –> when blood moves from inside blood vessel and into external tissues or external env.
What is a hemorrhage frequently associated with?
- mechanical trauma, invasion of tumor, vascular injury, or loss of normal clotting capabilities (problems with hemostais)
- chronic tissue congestion –> hemorrage in capillaries
Hematoma
= when hemorrage results in blood within a tissue; “bruise”
Severity of a hemorrage involves what 3 things
- rate of blood loss
- total volume of blood lost
- site where hemorrhage is occuring (i.e. in cranium or thigh)
- Hypovolemic shock = lethal; occur w/ acute loss of >20% of total blood volume
Internal Hemorrhage
hematoma; macrophages capture iron and body reuses it for erythropoiesis
External Hemorrhage
blood lost to external env.; iron UNABLE to be reused; more likely to deplete iron stores–> result in iron-deficiency anemia (IDE)
Common causes of External Hemorrhage
- peptic ulcer disease
- colon polyps
- colorectal cancer
- heavy menstruation
Petechiae
very small areas of hemorrhage; ~1-2mm on skin, mucosa, or serosal surfaces
Common Causes: low platelets (thrombocytopenia), Vit. K deficiency, vessel fragility form Vit. C deficiency
Purpura
slightly larger hemorrage than petechiae; ~3-5mm
Common Causes: mechanical trauma, vasculitis, vessel fragility from Vit. C deficiency. Kaposi Sarcoma (AIDS)
Contusion vs Ecchymoses
contusion = result of trauma
ecchymoses = results of trivial trauma (MC due to patient taking Aspirin, Warfarin, or have Vitamin deficiency)
BOTH: bruises, > 1 cm, transition from:
reddish blue –> blue-green –> yellow brown
hemoglobin –> bilirubin –> hemosiderin
Hemostasis
adequately clotting blood Involves: 1. endothelial cells 2. platelets 3. coagulatin cascade
Primary Hemostasis
when platelets aggregate on vessel wall –> following endothelial damage; von Willebrand Factor (vWF) and collagen are exposed to elements of blood
- when platelets contact vWF–> they become “activated” and form initial “primary hemostatic plug”