Hemodynamic Disorders 2

Question 1

Hyperemia vs congestion

Answer 1

Hyperemia is active increase in the volume of blood and is more red in color
Congestion is passive increase in volume of blood and is blue in color (deoxy) and is due to ↓ efflux (cardiac failure, venous obstruction)

Question 2

Hemosiderin laden macrophages in the lungs are pathonumonic for _______

Answer 2

Chronic heart failure

Question 3

Hallmark features of chronic pulmonary congestion

Answer 3

• Hemosiderin laden macrophages in the alveoli

- septal fibrosis

Question 4

Features of acute liver congestion

Answer 4

• degeneration of central hepatocytes due to distention of central vein and sinusoids

Question 5

Nutmeg liver is due to acute/chronic liver congestion

Answer 5

Chronic

Question 6

____________ from the coagulation cascade is required to convert fibrinogen to fibrin

Answer 6

Thrombin

Question 7

Define what disseminated intramuscular coagulation (DIC) is

Answer 7

Widespread small thrombi in the microcirculation throughout the body accompanied by simultaneous bleeding
Not primary disease but rather it is a end point of another disease

Question 8

What conditions can cause DIC?

Answer 8

Diffuse endothelial injury: gram negative sepsis, viral (ricketssiae), type 2,3, SLE

Release of htomboplastic agents in circulation that activate coagulation cascade:

• amniotic Fluid embolism
• snake bite
• promyelocytic leukemia
• extensive tissue necrosis, burns
• mucin, proteolytic enzymes from carcinoma

Question 9

In endotoxins causing DIC, the activated monocytes relasese _________ and _______ that act on endothelial cells and ↑ the expression of _______ and ↓ the expression of _______

Answer 9

IL-1; TNF α;

Tissue factor; thromnbomodulin

Question 10

Injured endothelial cells induce platelet aggregation and activation of the __________ pathway by exposure of collagen

Answer 10

Intrinsic

Question 11

Effects of DIC

Answer 11

• ↓ tissue perfusion: shock, lactic acidosis, microinfarcts
• bleeding : consumptive coagulopathy (body utilizes most of the platelets and coagulation factors for clots so when there is injury there is no more of them so then get bleeding)

Question 12

What breakdown products of stabilized fibrin are used to diagnose DIC?

Answer 12

FDP and D-Dimers

Question 13

Management of DIC

Answer 13

Heparin to prevent formation of thrombi

Replace platelets and plasma

Question 14

Why would you give someone with DIC heparin?

Answer 14

To prevent formation of thrombi

Question 15

Shock is a clinical state characterized by _______________ associated with reduction in effective cardiac output or ↓ circulating blood volume

Answer 15

↓ in perfusion in tissues

Question 16

Causes of shock:

Answer 16

• carcinogenic: pump failure such as intrinsic MI, ventricular arrhythmias, cardiac tamponade, or pulmonary embolism (outflow obstruction)
• hypovolemic: loss of blood volume due to hemorrhage, fluid loss due to burns, vomiting, diarrhea or trauma (↓ preload)
• septic due to systemic microbial infection
• distributive (imbalance between compartments) has two types: neurogenic and anaphylactic

Question 17

Give examples of neurogenic causes of shock

Answer 17

• fainting: temporary loss of vascular tone → pooling of poling → ↓ Venous Return → ↓ CO → faint
• anesthetic: loss of sympathetic vascular tone, peripheral pooling of blood
• spinal cord injury

Question 18

Septic, neurogenic and anaphylactic causes of shock affects ___________ (think about physiology and the equation)

Answer 18

Mainly affects the vasculature: causes vasodilation which then will ↓ SVR
→ peripheral pooling of blood → ↓ circulation blood → ↓ venous return → shock
MAP = CO x SVR

CO = HR x SV

Question 19

Anaphylactic shock is due to __________ which causes __________

Answer 19

IgE;

Systemic vasodilation which causes ↑ permeability → ↓ tissue perfusion