Hemodynamic disorders Flashcards
1
Q
- increased fluid in the interstitial tissue spaces and body cavities
A
edema
2
Q
the abnormal accumulation of fluid in the pleural cavity
A
hydrothorax
3
Q
or ascites in the peritoneal cavity
A
hydroperitonium
4
Q
pericardial sac
A
hydropericardium
5
Q
scrotal sac
A
hydrocele
6
Q
is severe and generalized edema with profound subcutaneous tissue swelling
A
anasarca
7
Q
low protein content and specific gravity of less than 1.012
A
noninflammatory edema or transdute
8
Q
in the arterial end drives fluid from the lumen of blood vessel into the interstitial space
A
normal hydrostatic pressure
9
Q
absorbs back the fluid in the venous end of capillary
A
plasma colloid osmotic pressure
10
Q
small amount of extra fluid in the interstitial space is absorbed by the ___ brought to the thoracic duct then to the left subclavian vein to the blood circulation.
A
lymphatic
11
Q
any disturbance in the hydrostatic pressure, osmotic pressure and obstruction of the lymphatic flow will promote ___
A
edema
12
Q
result from impaired venous outflow
A
local increases
13
Q
localized edema of the lower extremity involved
A
deep vein thrombosis in lower extremities
14
Q
example is a mass causing pressure on lymphatics
A
external pressure
15
Q
- Generalized increases causing systemic edema
- most common
A
congestive heart failure
16
Q
Reduced plasma osmotic pressure
A
hypoproteinemia
17
Q
decreased cardiac output
A
constrictive pericarditis
18
Q
increased permeability of glomerulus of kidney resulting to escape of proteins to the urine
A
nephrotic syndrome
19
Q
proteins in urine
A
proteinuria
20
Q
decreased protein synthesis
A
liver cirrhosis
21
Q
decreased protein intake
A
malnutrition
22
Q
results from excessive loss or reduced synthesis of albumin
A
Hypoalbuminemia
23
Q
most commonly encountered in subcutaneous tissues, lungs and brain
A
edema
24
Q
- dependant parts: legs, sacrum
- loose connective tissue matrix: periorbital edema
A
subcutaneous edema
25
- occurs in the following clinical conditions: left ventricular failure, renal failure, adult respiratory distress syndrome, pulmonary infections, hypersensitivity reactions
- lungs 2 – 3x their normal weight; on sectioning reveals a frothy fluid (mixture of air and fluid)
- microscopic examination shows alveolar spaces filled with fluid
pulmonary edema
26
- localized : abscess, neoplasms or tumors
- generalized: encephalititis, hypertensive crisis, obstruction to brain’s venous outflow
- local or generalized: trauma
- grossly swollen, narrowing of the sulci and flattening of the gyri
- dreaded complications: brain herniation
brain edema
27
- an active process resulting from increased tissue blood flow because of arteriolar dilatation
- affected tissue is red because of engorgement with blood
- Ex. Skeletal muscle during exercise sites of acute inflammation
hyperemia
28
a passive process resulting from impaired outflow from tissue
- closely related to development of edema
- Ex. Cardiac failure, venous obstruction
congestion
29
blue-red color congestion
cyanosis
30
– alveolar capillaries engorged with blood
- intra-alveolar hemorrhage
acute pulmonary congestion
31
– numerous heart failure cells in the alveolar spaces (or hemosiderin-laden macrophages)
Chronic pulmonary congestion
32
- central vein and sinusoids are distended with blood
Acute hepatic congestion
33
– central regions of hepatic lobules are grossly red-brown against the surrounding zones of uncongested tan liver (nutmeg liver)
Chronic passive congestion of liver
34
- extravasation of blood because of vessel rupture
hemorrhage
35
- hemorrhage may be external or enclosed with a tissue, the accumulation is ___
- (Ex. bruise)
hematoma
36
minute 1 – 2 mm hemorrhage into skin, mucous membranes or serosal surfaces are called ___
petechiae
37
petechiae is associated with
increased intravascular pressure to rupture to decreased platelet count and clotting factor defects
38
decreased platelet count
thrombocytopenia
39
slightly larger hemorrhages (> 3 mm) are called
purpura
40
- larger (> 1- 2 cm) subcutaneous hematomas are called
- typical after trauma and degraded erythrocytes that are phagocytosed by macrophages is responsible for color change
ecchymoses
41
red to blue
hemoglobin
42
blue to green
biliverdin, bilirubin
43
gold to brown
hemosiderin
44
larger accumulations of blood in body cavities
- hemothorax, hemopericardium, hemoperitoneum, hemarthrosis (joint cavity)
- hemocele (scrotal sac)
45
Clinical significance of hemorrhage
- depends on: volume and rate of blood loss
site
iron loss
46
Process of thrombus (clot) formation
1. Vascular wall (endothelium)
2. platelets
3. coagulation cascade
47
coagulation cascade
injury to endothelium to platelet adhesion and aggregation at site of endothelial injury to activation of coagulation cascade
48
series of conversions of inactive proenzymes to activated enzymes to thrombin to fibrinogen to fibrin (clot)
coagulation cascade
49
3 types of anticoagulants
- antithrombins
- proteins C and S
- plasmin
50
- inhibit activity of thrombin,
- Ex.antithrombin III
antithrombins
51
inactive factors Va and VIIIa
proteins C and S
52
breaks down fibrin
plasmin
53
3 main factors predispose to thrombus formation
Virchow’s triad
- endothelial injury
- alterations in normal blood flow
- hypercoagulability of blood
54
as in trauma or inflammation
endothelial injury
55
stasis and turbulence
alterations in normal blood flow
56
concentration of fibrinogen
hypercoagulability of blood
57
- can occur at any place in the circulatory system: cardiac chambers, heart valves, arteries, veins, capillaries
- has point of attachment to the vessel wall
- composed of platelets, fibrin, degenerating leukocytes, and entrapped RBC
thrombosis
58
thrombosis are arranged in a laminated pattern called ___ which are produced by alternating pale layers of platelets admixed with some fibrin and darker layers of more RBC.
lines of Zahn
59
usually occlusive
arterial thrombi
60
most common sites in descending order of thrombosis
coronary, cerebral, femoral arteries
61
- most occlusive thrombosis
- most commonly affects the veins of lower extremities (90%)
venous thrombosis or phlebothrombosis
62
accumulate more platelets and fibrin to enlarge to vessel obstruction
propagation
63
thrombi may dislodge or fragment to carried to the other sites
embolization
64
thrombi may be removed by fibrinolysis
dissolution
65
ingrowth of granulation tissue from vessel wall
organization
66
development of new vascular channels, restablishing blood flow
recanalization
67
clinical importance of fate of thrombus
1. cause obstruction of arteries and veins
2. sources of emboli
68
– a detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin
- 99% represent some part of a disloged thrombus
- rare forms of emboli include droplets of fats, bubbles of air or nitrogen, tumor fragments, bits of bone marrow
emobolus
69
disloged thrombus
thromboembolism
70
- more than 95% originate from deep, vein thrombi of lower extremities
- most are clinically silent but if massive any may cause sudden death
pulmonary thromboembolism
71
- fat globules in the circulation after fractures of long bones
Fat embolism
72
- gas bubbles within circulation may be due to chest wall injuries or during obstetric procedures
- when air is breathed at high pressure (deep sea), increased amounts of gas (nitrogen) become dissolved in blood and tissues, if divers ascend too rapidly the nitrogen expands in the tissues and bubbles out of solution in the blood to form gas emboli.
air embolism
73
- decompression sickness
- occurs when individuals are exposed to sudden changes in atmospheric pressure
ex. Scuba or deep sea divers
Caisson disease
74
- In the lungs, edema, hemorrhages & focal atelectasis or emphysema may appear leading to respiratory distress.
- Treatment: requires placing the individual in a compression chamber barometric pressure may be raised, thus forcing gas bubbles back into solution. Subsequent slow decompression permits gradual resorptoin & exhalation of gases so that obstructive bubbles, do not reform.
chokes
75
- a more chronic form of decompression sickness
- persistence of gas emboli in skeletal system leads to multiple foci of ischemic necrosis.
- the more common sites are: heads of femur, tibia & humeri.
caisson disease
76
– a grave but uncommon (1:50,000 deliveries) complications of labor & the immediate postpartum period caused by infusion of amniotic fluid or fetal tissue into the maternal circulation via a tear in the placental membranes or rupture of uterine veins.
- The onset is char. By sudden severe dysprea, cyanosis & hypotensive shock affected by seizures & coma. If survive the initial crisis, pulmonary edema & DIC (in ½ the pts.) owing to release of thrombogenic substances from amniotic fluid.
- Classic findings: presence in pulm, microcirc. Of squamous cells shed from fetal skin, lanugo hair, fat from vernix caseosa & mucin from fetal R.T., GIT, there is also pulm. edema, changes of DAD & systemic fibrin thrombi indicative of DIC.
amniotic fluid embolism
77
Where are thrombi formed?
A. Arterial or Cardiac thrombi usu. Begin at a site of endothelial injury, turbulence in vessel bifurcation (e.g. atherosclerotic plaque)
B. Venous thrombi occur in sites of stasis.
78
What is characteristics of all thromboses?
An area of attachment to the underlying vessel or heart wall, freq. firmest at the point of origin.
79
How do these thrombi propagate?
A. Arterial thrombi tend to grow in a retrograde direction from the point of attachment.
B. Venous thrombi extend in the direction of blood flow (e.g., toward the heart)
80
- Thrombi formed in the heart or aorta may have grossly & microscopically apparent laminations. These are produced by alternating pale layers of platelets admixed w/ some fibrin & darker layers containing more red cells
- Significance: they imply thrombosis at a site of blood flow.
lines of zahn
81
At autopsy, postmortem clots maybe confused for ___
venous thrombi
82
- Are gelatinous with a dark red dependent portion where red cells have settled by gravity & a yellow chicken fat supernatant resembling melted & clotted chicken fat.
- Are usu. Not attached to the underlying wall.
postmortem clots
83
- formed in a relatively static environment, tend to contain more enmeshed erythrocytes.
- are firmer.
- almost always, have a point of attachment.
- on transection reveal vague strands of pale gray fibrin.
venous thrombi (red thrombi or stasis thrombi)
84
usu. Adhere to the wall of cardiac chambers or the aorta & are termed Mural thrombi. Precursors of Cardiac Mural thrombi: Abn. Myoc contraction (Arrhythmias, Dilated CMP, or MI). Precursors of Aotic thrombus: Ulcerated atherosclerotic plaque, aneurysmal dilation.
Arterial thrombi
85
- an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage in a particular tissue.
- 99% result from arterial occlusion
infarction
86
Types of infarcts
- red (hemorrhagic) infarct
- white (anemic) infarct
- septic infarctions
87
ovarian torsion
with venous occlusions
88
lungs
in loose tissues
89
in the lungs and small intestine
in tissues with dual circulations
90
occur with arterial occlusions or in solid organs (heart, liver, spleen, kidneys)
white (anemic) infarct
91
when embolization occurs by fragmentation of a bacterial vegetation from a heart valve or when microorganisms seed an area of necrotic tissue; infarct is converted into an abscess
septic infarctions
92
tend to be wedge-shaped, with occluded vessel at apex and the periphery of the organ forming the base
Infarcts
93
- Final common pathway for a number of clinical conditions like severe hemorrhages, extensive trauma or burns, large myocardial infarction, massive pulmonary embolism or microbial sepsis
- Constitutes systemic hypoperfusion owing to reduction either in cardiac output or in the effective circulating blood volume; the end results are hypotension, followed by impaired tissue perfusion and cellular hypoxia.
shock or cardiovascular collapse
94
3 Major types of shock:
cardiogenic
hypovolemic
septic
95
- myocardial infarction, rupture of the heart, arrythmias, cardiac tamponade, oulmonary emoblism
- failture of myocardial pumo due to intrinsic myocardial damage or extrinsic pressure obstruction of flow
Cardiogenic
96
- Hemorrhage, Fluid loss
- Inadequate blood or plasma, volume
Hypovolemic
97
- Overwhelming bacterial inf: with gram (-) or gram (+) septicemia, fungal sepsis
- Peripheral vasodilation and pooling, pooling of blood: endothelial injury; activation of cytokine cascade
septic
98
Less common types of shock
Neurogenic Shock
Anaphylactic Shock
99
shock:
occurs in anesthetic accident or spinal cord injury
neurogenic shock
100
shock:
allergy
Anaphylactic Shock
101
cellular and tissue changes induced by shock are those of ___; characterized by failure of multiple organ systems
hypoxic injury
102
Clinical manifestations are the same regardless of the cause:
Hypotension
weak rapid pulse
tachypnea
cool, clammy, pale or cyanotic skin
103
congestive heart failure to
decreased cardiac output to
decreased arterial blood volume to
decreased renal perfusion to
triggers renin, angiotensin, aldosterone axis will cause
sodium & water retention by kidneys and will temporarily increase intravascular volume to
if failing heart cannot increase cardiac output
extra fluid results in increased venous pressure to
increased transudation to
EDEMA
systemic edema
104
elephantiasis
inflammatory - filariasis
105
due to scarring of lymphatic channels
postsurgical and post irradiation
