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Cell Pathology 2 (Pathology) > Hem III and IV/Shock, Embolus, Necrosis > Flashcards

Hem III and IV/Shock, Embolus, Necrosis Flashcards

1
Q

What are the 3 main types of shock?

A

Cardiogenic shock, hypovolemic shock, and septic shock

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2
Q

What are the four main events in septic shock?

A

Vascular event (vasodilation, increased permeability)
Thrombotic (microvascular thrombosis, DIC)
Immunosuppressive (counter regulatory measure)
Metabolic (insulin resistance)

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3
Q

What produces the procoagulant state that can lead to thrombotic events in septic shock?

A

Endotoxins from the bacteria produce the procoagulant state

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4
Q

What causes adrenal insufficiency during shock?

A

Waterhouse-Friderichsen syndrome; it is adrenal hemorrhage and necrosis caused by DIC or endotoxin production from bacteria

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5
Q

What is disseminated intravascular coagulation (DIC)?

A

Concurrent microvascular thrombosis and fibrinolysis that occurs due to the procoagulant effects (from endotoxins of bacteria) and cytokines (TNF and IL-1) induce endothelial cells to make tissue factor leading to coagulation

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6
Q

What is the best screening test for DIC?

A

Elevated fibrin split products especially D-dimer

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7
Q

What is ARDS?

A

Adult respiratory distress syndrome. Combination of decreased cardiac output, vascular permeability and endothelial injury in the lungs.

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8
Q

What is the end result of septic shock (and what leads to mortality)?

A

End-organ damage

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9
Q

What are the 3 stages of shock?

A
  1. Nonprogressive phase where vital organ perfusion is maintained via reflex mechanisms
  2. Progressive stage where tissues are hypoperfused and acidosis sets in
  3. Irreversible stage where pronounced cell death is present
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10
Q

What is SIRS?

A

Systemic inflammatory response syndrome: nonspecific clinical response to either infection or noninfectious inflammatory process

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11
Q

What is bacteremia?

A

A blood infection without systemic response

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12
Q

What is acute tubular necrosis?

A

End-organ damage of the kidney, often due to shock

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13
Q

What is heparin-induced thrombocytopenia?

A

Platelet destruction due to heparin therapy; thrombosis results from destroyed platelets activating other platelets

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14
Q

How does fibrinolysis occur?

A

Tissue plasminogen activator converts plasminogen to plasmin, and plasmin cleaves fibrin and serum fibrinogen and blocks platelet aggregation

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15
Q

Why does cirrhosis of the liver lead to a disorder of fibrinolysis and plasmin overactivity?

A

Cirrhosis of the liver results in reduced production of alpha2-antiplasmin and thus overactivity of plasmin

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16
Q

What is the clinical laboratory difference between DIC and a disorder of fibrinolysis?

A

DIC has elevated D-dimers; in disorders of fibrinolysis, fibrin thrombi are not present thus D-dimers do not form

17
Q

What is hyperemia compared with congestion? What is a classic case of congestion?

A

Hyperemia is an active process where tissues are engorged with blood due to arteriole dilation. Congestion is a passive process when blood flowing out of the tissue is reduced, so it backs up in the organ (example is nutmeg liver)

18
Q

What are the 5 general causes of edema?

A
  1. Increase in hydrostatic pressure
  2. decreased plasma osmotic pressure
  3. sodium retention
  4. inflammation
  5. lymphatic obstruction
19
Q

Compare and contrast exudate and transudate?

A

Exudate is protein rich and is a result of inflammatory edema; transudate is protein poor and a result of increased hydrostatic pressure or decreased osmotic pressure

20
Q

What are vegetations in the heart?

A

Thrombi that are present on heart valves.

21
Q

What are the four fates of a thrombus?

A

Dissolution
Propagation
Embolization
Organization

22
Q

What is a fat embolism generally caused by? What is it characterized by?

A

Most commonly from long bone fractures; characterized by dyspnea and petechiae on skin overlying chest.

23
Q

What is an air embolism generally caused by?

A

Air into an intravenous infusion or sudden change in atmospheric pressure (eg decompression sickness or bends due to scuba diving)

24
Q

What causes an amniotic fluid embolism? What does the patient present with?

A

Enters maternal circulation during labor or delivery

25
Q

In an amniotic fluid embolus, what is the embolus characterized by?

A

Squamous cells and keratin debris from the fetal skin in the embolus

26
Q

What is a paradoxical embolus, and what is an example?

A

Occurs when an embolus travels from venous to arterial circulation through a defect in the heart (eg patent foramen ovale). EX: DVT that leads to a CNS arterial embolus and stroke

27
Q

Where are you most likely to see white (pale) infarcts, and where are you most likely to see red infarcts?

A

Pale infarcts are likely to be seen in solid organs with end-arterial circulation. Red infarcts are typical with venous occlusion, dual or anastomosing blood supply, or with reperfusion injury

28
Q

Why are most pulmonary embolism events clinically silent?

A
  1. lung has a dual blood supply via pulmonary and bronchial arteries
  2. embolus is usually small and self resolves
29
Q

What is a saddleback embolus?

A

An embolus that blocks both left and right pulmonary arteries; sudden death occurs

30
Q

What is coagulative necrosis?

A

Necrotic tissue that remains firm and keeps its architecture; area of infarcted tissue is wedge shaped .

31
Q

What is liquefactive necrosis, and where are you most likely to see it?

A

It is necrotic tissue where the tissue is digested and liquefied (due to lysis of cells and protein); characteristic of brain infarcts, abscesses, and pancreatitis

32
Q

What is gangrenous necrosis, and where is it characteristic of?

A

Is coagulative necrosis that resembles mummified tissue (can be dry or liquefactive, called wet gangrene); typical of distal extremities

33
Q

What is caseous necrosis, and what infection is it usually seen with?

A

Cottage cheese, soft necrotic tissue; typical of tuberculosis infection

34
Q

What is saponification (fat necrosis)?

A

Formation of chalky white soap material when fat is digested and the deposition of calcium occurs; often occurs due to trauma of the fat

35
Q

Is saponification (fat necrosis) an example of dystrophic or metastatic calcification and why?

A

It is an example of dystrophic calcification because there are normal serum calcium levels. Metastatic calcification occurs when there is high serum calcium due to a different underlying problem

36
Q

What is fibrinoid necrosis?

A

Necrotic damage to the blood vessel walls; autoimmune reactions when vasculitis occurs (as well as malignant hypertension)

Cell Pathology 2 (Pathology) (9 decks)

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