Hemodynamic Disorders Flashcards by Abagayle Moody

____ delivers oxygen and nutrients to tissues and removes wastes

blood circulation

How well did you know this?

Not at all

Perfectly

The functions of circulation include:

Delivers oxygen & nutrients
Wastes are removed

How well did you know this?

Not at all

Perfectly

Blood clotting that prevents excess bleeding after blood vessel damage:

hemostasis

How well did you know this?

Not at all

Perfectly

Inappropriate clotting:

thrombosis

How well did you know this?

Not at all

Perfectly

migration of clots:

embolism

How well did you know this?

Not at all

Perfectly

active process, arteriolar dilation and increased blood inflow:

hyperemia

How well did you know this?

Not at all

Perfectly

Describe the color of blood associated with hyperemia:

Red color- due to oxygenated hemoglobin

How well did you know this?

Not at all

Perfectly

Passive process, impaired outflow of venous blood from a tissue:

congestion

How well did you know this?

Not at all

Perfectly

Describe the color of blood associated with congestion:

blue/red color (cyanosis)- deoxygenated hemoglobin

How well did you know this?

Not at all

Perfectly

Hyperemia is a ____ process

Congestion is a ____ process

Hyperemia- active
Congestion- passive

How well did you know this?

Not at all

Perfectly

What is seen in this image? Is the specimen from a living or dead individual?

Liver with chronic passive congestion and hemorrhagic necrosis- they dead

How well did you know this?

Not at all

Perfectly

_____% of body weight is water, ___ intracellular

60%; 2/3

How well did you know this?

Not at all

Perfectly

2/3 of the 60% water comprising our body weight is:

intracellular

How well did you know this?

Not at all

Perfectly

The remaining fluid of the body (not including the water) is comprised by mostly:

interstitial fluid

How well did you know this?

Not at all

Perfectly

around ___% blood plasma is found in the body

How well did you know this?

Not at all

Perfectly

accumulation of interstitial fluid in tissues

edema

How well did you know this?

Not at all

Perfectly

Edema is the accumulation of ___ in tissues

interstitial fluid

How well did you know this?

Not at all

Perfectly

extravascular fluid that collects in body cavities:

effusions

How well did you know this?

Not at all

Perfectly

Effusions are ___ that collects in body cavities

extravascular fluid

How well did you know this?

Not at all

Perfectly

Effusion in the pleural cavity:

hydrothorax

How well did you know this?

Not at all

Perfectly

Effusion in the pericardial cavity:

hydropericardium

How well did you know this?

Not at all

Perfectly

Effusion in the peritoneal cavity:

hydroperitoneum or ascites

How well did you know this?

Not at all

Perfectly

Severe generalized edema due to fluid retention in tissues and cavities:

Anasarca

How well did you know this?

Not at all

Perfectly

Causes of edema include: (5)

increased hydrostatic pressure
reduced plasma osmotic pressure (hypoproteinemia)
lymphatic obstruction
sodium retention
inflammation

How well did you know this?

Not at all

Perfectly

What may cause increased hydrostatic pressure that leads to edema? (2)

1. impaired venous return 2. arteriolar dilation

- CHF - Constrictive pericarditis - Ascites (liver cirrhosis) - Venous obstruction or compression - Thrombosis - External pressure (e.g. mass) - Lower extremity inactivity with prolonged dependency These are all examples of:

impaired venous return (leading to increased hydrostatic pressure which is a cause of edema)

- Heat - Neurohumoral dysregulation These are examples of:

components leading to arteriolar dilation (which leads to increased hydrostatic pressure which is a cause of edema)

- Protein-losing glomerulopathies (nephrotic syndrome) - Liver cirrhosis (ascites) - Malnutrition - Protein-losing gastroenteropathy These are all conditions leading to:

reduced plasma osmotic pressure (hypoproteinemia) (which is a cause of edema)

-Inflammatory - Neoplastic - Postsurgical - Postirradiation These are all conditions leading to:

lymphatic obstruction (which is a cause of edema)

- Excessive salt intake with renal insufficiency - Increased tubular reabsorption of sodium - Renal hypperfusion - Increase renin-angiotensin-aldosterone secretion These are all conditions leading to:

sodium retention (which is a cause of edema)

- Acute inflammation - Chronic inflammation - Angiogenesis These are all conditions leading to:

inflammation (which is a cause of edema)

What is responsible for dictating fluid movement between vascular and interstitial spaces?

- vascular hydrostatic pressure - colloid osmotic pressure (plasma proteins)

What causes colloid osmotic pressure?

plasma proteins

vascular hydrostatic pressure and colloid osmotic pressure (plasma proteins) dictate fluid movement between:

vascular and interstitial spaces

Arterial outflow is normally balanced by:

inflow at the venous end

____ is normally balanced by inflow at the venous end

arterial outflow

Arterial outflow is normally balanced by inflow at the venous end: Results in small net ____ --> drained by ___

outflow of fluid in interstitial space; lymphatics

Capillary hydrostatic and osmotic forces are normally balanced so their is little net movement of fluid into the:

interstitium

Capillary hydrostatic and osmotic forces are normally balanced so their is little net movement of fluid into the interstitium. However, increased hydrostatic pressure or diminished plasma osmotic pressure leads to:

extravascular fluid accumulation (edema)

Increased _____ or diminished ____ leads to extravascular fluid accumulation (edema)

hydrostatic pressure; plasma osmotic pressure

When extravascular fluid accumulates, tissue lymphatics drain much of the excess fluid back to the circulation by way of the ___. However, if the capacity for lymphatic drainage is exceeded, ____ results

thoracic duct; tissue edema

Usually caused by disorders that impair venous return:

increased hydrostatic pressure

Disorders that can cause impaired venous return: (2)

1. Deep venous thrombosis 2. Congestive heart failure

Increased hydrostatic pressure is usually caused by disorders that:

impair venous return

Reduced plasma albumin concentration will lead to:

reduced plasma osmotic pressure

Reduced plasma albumin concentration may result from:

loss in circulation or reduced synthesis

Nephrotic syndrome and severe liver disease are both causes for:

reduced plasma albumin concentration (which reduces plasma osmotic pressure)

Fill in the highlighted portions:

A: heart failure B: malnutrition C: decreased hepatic synthesis D: nephrotic syndrome E: renal failure F: edema

Fill in the highlighted portions:

Green: DECREASED plasma albumin Blue: DECREASED plasma osmotic pressure

Fill in the highlighted portions:

Green: INCREASED capillary hydrostatic pressure Blue: INCREASED renal blood flow Orange: activation of RNENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM Pink: retention of Na+ & H2O Purple: INCREASED blood volume

Pathways leading to _____ can result form heart failure, renal failure, or reduced plasma osmotic pressure

systemic edema

Compromises resorption of fluid from interstitial spaces --> edema:

lymphatic obstruction

What conditions can lead to lymphatic obstruction? (3)

1. inflammatory conditions 2. neoplastic conditions 3. congenital lymphedema

What does lymphatic obstruction compromise?

resorption of fluid from interstitial spaces (ultimately leading to edema)

Stage of lymphedema in which the lymphatic system experiences abnormal flow but no fluid build-up; (asymptomatic):

stage 1

Stage of lymphedema which is due to an accumulation of lymph fluid that may subside when elevated; (swelling):

stage 2

Stage of lymphedema categorized by permanent swelling that cannot be relived through elevation, accompanied by changes in the skin (fibrosis):

stage 3

Stage of lymphedema characterized by lymphostatic elephantiasis, or the deformation of a limb due to extensive swelling, skin thickening and scarring:

Stage 4

extravasation of blood from vessels:

hemorrhage

Defective clot formation, trauma, atherosclerosis, inflammatory, neoplastic condition, inherited/aquired defects are all causes of:

hemorrhage

Hemorrhage manifestations include: (4)

1. hematoma 2. ecchymoses 3. purpura 4. petechiae

Large collection of hemorrhage in a tissue:

hematoma

1-2cm subcutaneous hemorrhage (bruises):

ecchymoses

3-5mm hemorrhages:

purpura

1-2 mm minute hemorrhage:

petechiae

Often a consequence of thrombocytopenia or vitamin C deficiency:

petechiae

What can be seen in this image?

petechiae

Clot formation steps include: (4)

1. vasoconstriction 2. platelet plug formation 3. fibrin deposition 4. clot stabilization & resorption

____ are the primary regulations of hemostasis though changes in expression of procoagulaant or anticoagulation factors

endothelial cells

Endothelial cells are the primary regulators of hemostasis through changes in expression of ___ or ___ factors

procoagulant; anticoagulant

Disk-shaped, enucleate fragments of megakaryocytes:

platelets

Platelet adhesion is mediated by:

von willebrand factor

Congenital deficiency of receptors or molecules may lead to:

bleeding disorders

Functions as adhesion bridge between subednothelial collagen and glycoprotein Ib (Gp1b) platelet receptor

VWF

Platelet aggregation is accomplished by ____ binding to platelet ____ on different platelets

fibrinogen; GpIIb-IIIa

Deficiency due to Gp2b-3a complex:

Glanzmann thrombasthenia

Deficiency due to Gp1b:

Bernard-Soulier syndrome

Von willebrand factor deficiency:

Von Willebrand disease

A serious of amplifying enzymatic reactions that lead to the deposition of an insoluble fibrin clot:

coagulation cascade

The coagulation cascade is also known as:

secondary hemostasis

Coagulation cascade pathway that is spontaneous and occurs when there is internal injury to vascular endothelium

intrinsic pathway

Coagulation cascade pathway that is activated by external trauma:

extrinsic pathway

Contact activation due to a damaged surface occurs with what coagulation cascade pathway?

intrinsic pathway

Label the following steps of the coagulation cascade pathways:

1. Intrinsic pathways 2. Common pathway 3. Extrinsic pathway

The intrinsic pathway of the coagulation cascade is activated by:

contact activation - (damaged surface)

The extrinsic pathway of coagulation is activated by ____.

injury

Factors from the intrinsic pathway & factors from the extrinsic pathway that converge: What do they act on?

5A- They form the prothrombinase complex to act on prothrombin and convert it to thrombin

What is the ultimate result of the various pathways of the coagulation cascade?

clot formation

A coagulation cascade assay is:

an evaluation of coagulation function

___ evaluates the intrinsic pathway factors:

Partial prothrombin time (PTT)

PTT evaluates ___ pathway factors including: (8)

intrinsic; XII, XI, IX, VIII, X, V, Prothrombin (II), Fibrinogen (I)

___ evaluates the extrinsic pathway factors:

Prothrombin time (PT)

Prothrombin time evaluates the ___ pathway factors including: (5)

extrinsic; VII, X, V, Prothrombin (II), Fibrinogen (I)

Important for regulation of coagulation, and plays a key role in synthesis of factors II, VII, IX & X:

Vitamin K

Vitamin K plays a key role in the synthesis of factors:

II, VII, IX, X

Vitamin K helps synthesize protein ___ and ___. What are these proteins important for?

C and S; important for negative feedback regulation of clotting cascade

Vitamin K deficiency results in:

increased bruising & bleeding

Anticoagulant medication, antagonist for vitamin K:

Warfarin

Warfarin is a ___ medication that is an antagonist for ___ and functions to inhibit ___

anticoagulation; antagonist; clotting

List some foods rich in vitamin K: (10)

1. Kale 2. Brussel Sprouts 3. Brocoli 4. Asparagus 5. Cabbage 6. Green Snap Beans 7. Kiwi 8. Collard Greens 9. Turnip Greens 10. Spinach

MOST important coagulation factor:

Thrombin

Thrombin is responsible for the conversion of:

fibrinogen into cross-linked fibrin

Responsible for conversion of fibrinogen into fibrin:

Thrombin

What activates platelets?

Thrombin

The effects of thrombin can be described as:

Pro-inflammatory effects & Anti-coagulation effects

Thrombin displays anti-coagulation effects after encountering:

normal endothelium

Factors limiting coagulation include:

1. dilution of blood past the site of injury 2. negatively charged phospholipids required- activated platelets 3. Regulation by neighboring intact endothelium 4. Fibrionlytic cascade limits size of clot

Fibrinolytic cascade limits the size of the but ___ activation is essential for this.

plasmin

The ____ serves as a barrier to platelets resulting in lack of access to ___ & ___

endothelium; VWF & collagen

Release of nitric oxide, prostacyclin, and adenosine diphosphate by the endothelium result in:

barrier to platelets - coagulation limitation

The endothelium expresses factors that inactivate ___ resulting in ___

thrombin; anticoagulant effects

Synthesis of tissue plasminogen activator (tPA) is considered a _____ effect

fibrinolytic (busts up the clot I think)

Coronary artery disease, MI and chronic inflammation are a result of:

endothelial injury leading to thrombosis

Endothelial injury can cause:

Thrombosis

Physical injury, infectious agents, abnormal blood flow, inflammatory mediators, toxins=

chronic inflammation (may lead to thrombosis)

Abnormal blood flow promotes endothelial procoagulant activity leading to:

thrombosis

Abnormal blood flow can lead to stasis which allows:

platelets and leukocytes to associate with endothelial cells (leading to thrombosis)

Abnormal blood flow can lead to stasis which slows:

removal of activated clotting factors, and impedes inflow of clotting factor inhibitors (leading to thrombosis)

abnormally high tendency for blood to clot:

hypercoagulability

What is an important risk factor for venous thrombosis?

hypercoagulability

Hypercoagulability may be classified as:

Primary (genetic) or Secondary (acquired)

Hypercoagulability that is genetic in nature:

primary disorder

Hypercoagulability that is acquired:

secondary disorder

Virchow's triad in thrombosis:

1. endothelial injury 2. abnormal blood flow 3. hypercoagulability

What is the most important factor in thrombosis?

Endothelial integrity

Abnormalities of procoagulatants or anti-coagulants can tip the balance in favor of:

thrombosis

____ (____) can lead to hypercaogulability directly and also indirectly through endothelial dysfunction

Abnormal blood flow (stasis or turbulence)

Where can thrombi develop?

anywhere in the cardiovascular system

What type of thumb often occur at sites of injury?

arterial thrombi

What type of thrombi occur in heart chambers or aorta:

cardiac mural thrombi

What type of thumb occur often at sites of stasis?

venous thrombi

Observed both grossly and microscopically; differentiates antemortem clots from postmortem clots:

Lines of Zahn - is the beech dead or alive

Thrombi occurring in heart chambers or aortic lumen:

cardiac mural thrombi

Thrombi typically rich in platelets, often formed by endothelial injury:

arterial trhombi

Venous thrombi may also be called:

phlebothrombosis

Thrombi that contain high volumes of red blood cells:

Venous thrombi

____% of venous thrombi occur in the ___

90%; legs

Fate of thrombi includes: (4)

1. Propagation 2. Embolization 3. Dissolution 4. Organization and recanalization

What fate of thrombi are being described below? Clot enlarges

propagation

What fate of thrombi are being described below? clot dislodged and moved by circulatory system

embolization

What fate of thrombi are being described below? activations of fibrinolytic factors

dissolution

What fate of thrombi are being described below? older thrombi are reorganized to facilitate some function

organization & recanalization

Clot in the leg that is described as "local congestion and swelling from impaired blood flow:

Superficial vein clot

Give an example of a superficial vein:

varicose veins

Deep venous thrombosis occurs in larger veins called:

deep veins

What are two risks with deep venous thrombosis?

1. may be asymptomatic in 50% of patients 2. may embolism to lungs

What is major cause of arterial and cardiac thrombosis?

atherosclerosis

atherosclerosis results in ____ which leads to:

results in loss of endothelial integrity and abnormal blood flow; leads to MI & ischemia to organs (especially brain, kidneys, and spleen)

DIC:

disseminated intravascular coagulation

DIC- Disseminated Intravascular Coagulation can be described as:

widespread thrombosis & microcirculation

Disseminated Intravascular Coagulation (DIC) involves the consumption of:

platelets and clotting factors

DIC may occur from:

complications in obstetrics, injuries, cancer, and more

The net result from DIC:

excessive clotting and bleeding

May be a solid, liquid or gaseous mass, carried by the blood from its point of origin to a distant site:

embolism

Most common embolism:

pulmonary embolism

Most common embolism, mostly from upper deep leg veins proximal to popliteal fossa. They pass through the larger right heart vessels and lodge in the pulmonary artery or arterioles:

pulmonary embolism

Most pulmonary embolisms are small an then progressively become organized but larger ones can cause ____, and multiple emboli over time causes ____ and ____

sudden death; pulmonary hypertension & right ventricular failure

May arise from intracardiac mural thrombi (80%). Can embolism to lower extremities most frequently, CNS, intestines, kidney and spleen:

Systemic thromboembolism

Injury to bone marrow can cause release of fat globules into circulation but rarely show clinical manifestations. Less than 10% show pulmonary problems, neurologic problems, anemia, thrombocytopenia, and petechial rash:

Fat embolism

Severe post-birth complication with 80% mortality rate due to biochemical activation of coagulation system and immune system from entry of amniotic fluid into circulation system of mother:

Amniotic fluid embolism

Gas in circulation can come together to obstruct vascular flow- example decompression sickness in scuba divers

Air embolism

How does a pulmonary embolism form? (3)

1. embolus breaks off 2. embolus travels through vein to lung 3. embolus travels through heart and gets lodged in blood vessel of lungs

Area of ischemic necrosis caused by occlusion of vascular supply to the affected tissue:

infarction

Most infarctions are caused by:

arterial thrombosis or embolism

What are the most common complications of infarctions?

involvement of the heart and brain

Infarctions are classified based on:

color

Infarct that contains hemorrhage:

red infarct

A red infarct can be caused by:

- venous occlusion - loose tissue - tissue with dual circulation -previously congested tissue - reperfusion injury

Infarct that is an arterial occlusion in solid organs:

white infarct

A white infarct can occur in the:

heart, liver, or spleen

A state in which diminished cardiac output or reduced effective circulating blood volume impairs tissue perfusion and lead to cellular hypoxia:

shock

Prolonged shock leads to:

irrreversible tissue injury

Three types of shock include:

1. cardiac shock 2. hypovolemic shock 3. septic shock

Failure of myocardial pump resulting from intrinsic myocardial damage, extrinsic pressure, or obstruction to outflow resulting in shock:

cardiogenic shock

Inadequate blood or plasma volume resulting in shock:

hypovolemic shock

Peripheral vasodilation and pooling of blood; endothelial activation/injury; leukocyte-induced damage; disseminated intravascular coagulation; activation of cytokine cascades resulting in shock:

septic shock

- Myocardial infarction - Ventricular rupture - Arrhythmia - Cardiac tamponade - Pulmonary embolism These are all potential causes of:

cardiogenic shock

- Hemmorhage - Fluid loss (vomiting, diarrhea, burns, trauma) These are all potential causes of:

hypovolemic shock

- overwhelming microbial infections - gram-negative sepsis - gram-positive septicemia - fungal sepsis - superantigens (toxic shock syndrome) These are all potential causes of:

septic shock