Hemodynamic Disorders Flashcards
Movement of fluid into/out of tissues is dependent on the ________ pressure on the arterial end and the _______ _______ _______ pressure on the venous end of the capillary.
hydrostatic pressure on arterial end
plasma colloid oncotic pressure on venous end
Fluid that remains in the tissues is drained by the ________ system.
lymphatic
The dude that first said that the passage of fluid through the capillary wall is dependent on the balance between hydrostatic pressure and osmotic pressure was named _______.
Starling
Define edema.
Increased fluid in interstitial spaces.
What is anasarca?
Severe systemic edema.
Edema in a body cavity is called _______.
ascites
Protein-poor edema is called ________ and protein-rich edema is called ________.
transudate is protein poor
exudate is protein rich
Can edema be either inflammatory or non-inflammatory in origin?
Yeah
Name the five general causes of edema.
- Increased hydrostatic pressure.
- Decreased colloid osmotic pressure.
- Lymphatic obstruction.
- Primary renal sodium retention with associated H2O retention.
- Increased vascular permeability.
Name one disease that causes a generalized increase in hydrostatic pressure and one disease that results in a regional increase in hydrostatic pressure.
Generalized: congestive heart failure
Regional: DVT
Hyperemia and congestion both cause __________, _________, and __________.
vasodilation, increased volume, and increased pressure
How can kidney disease result in a decrease in colloid osmotic pressure?
Proteinuria - loss of serum proteins lowers osmotic pressure.
What is hyperemia?
Increased inflow and engorgement of oxygenated blood, which causes erythema.
What is congestion?
Decreased outflow of blood, capillary bed swells with deoxygenated blood, called cyanosis.
Hemorrhagic centrilobar necrosis (aka nutmeg liver) was an example of what type of phenomenon as presented in lecture?
Congestion
The extravasation of blood from vessels into the extravascular space is called a _______.
hemorrhage
What is hemorrhagic diathesis?
Increased susceptibility to bleeding, often due to hypocoagulability.
What is a hematoma?
Localized hemorrhage that is confined in an organ or tissue.
___________ is characterized by 1-2mm hemorrhages on skin, mucous membranes, or serosal surfaces.
Petechiae
Name the four possible causes of petechiae/purpura. Note that purpura (3mm spots or larger) would also require additional trauma, vasculitis, or increased vascular fragility.
- Increased local intravascular pressure
- Low platelet count (thrombocytopenia)
- Defective platelet function (uremia)
- Loss in vascular wall support (vitamin C deficiency)
What is the fancy word for bruises?
Ecchymoses
The blue-green color of a bruise is due to ________ and the gold-brown color is due to ________.
Blue-green caused by bilirubin, gold-brown caused by hemosiderin.
A hemorrhage into a body cavity is called a _________.
hemothorax
What are the three components of thrombosis?
- Endothelium
- Platelets
- Coagulation cascade
Name the four events of primary hemostasis that occur following vascular injury.
- Vasocontriction (quick)
- Exposure of thrombogenic substances: ECM, vWF
- Platelet activation, adherence and aggregation
- Formation of a primary hemostatic plug
Name the six events of secondary hemostasis that occur following vascular injury.
- Release of tissue factors (factor III/thromboplastin from endothelial cells) and phospholipids (from platelets).
- Coagulation cascade generates thrombin.
- Thrombin converts fibrinogen to fibrin.
- Fibrin meshwork consolidates the primary plug.
- Secondary hemostatic plug is formed from the polymerized fibrin, platelet aggregates, RBCs, and WBCs.
- Counter-regulatory mechanisms limit the plug to the local injury site.
In platelet aggregation, injury to endothelial cells exposes __________, which binds to ___________ receptors on platelets. This allows platelets to stick to the subendothelium. Next, platelets stick to each other with their ___________ receptors, using ________ as cross-bridges between platelets.
Injury exposes von Willebrand Factor on the subendothelium which binds to glycoprotein 1b receptors on platelets. Platelets stick to each other using GpIIb-IIIa receptors with fibrinogen serving as the cross-bridge.
Bernard-Soulier Syndrome is a congenital disease of __________.
clotting
Glanzmann Thrombasthenia is a congenital disease of __________.
clotting
What are thrombin’s five roles in hemostasis and cellular activation?
- Stimulates PDGF release
- Activates endothelial cells
- Aggregates platelets
- Activates lymphocytes
- Increases endothelial-neutrophil adhesion
What is Virchow’s Triad in thrombosis?
- Endothelial injury
- Abnormal blood flow
- Hypercoagulability
In maintaining hemostasis, the _________ of the endothelium is the most important factor, especially in the heart and arteries.
integrity
Does the endothelium need to be denuded or physically injured to contribute to the development of thrombosis?
Nope
Turbulent blood flow is important in the development of ________ and _______ thrombosis.
arterial and cardiac
Stasis is important in the development of ________ thrombi.
venous
What are the two types of hypercoagulability?
Primary (genetic) and secondary (ex. prolonged bedrest, MI, cancer, Afib, heparin-induced thrombocytopenia).
In which direction do thrombi grow?
Towards the heart
What are Lines of Zahn?
Gross or microscopic morphological changes of a thrombus that include pale platelet/fibrin layers that alternate with dark RBC-rich areas.
What are the three types of thrombi?
- Mural - happens in heart chambers or aortic lumen
- Arterial
- Venous (aka phlebothrombosis)
What type of thrombi is characterized by a long red cast in the vessel lumen?
venous
A gelatinous clot with a yellow supernatant region and a RBC-rich lower region is a _________ clot.
postmortem
What are the four fates of a thrombi?
- Propagation
- Embolization
- Dissolution
- Organization and recanalization
Is original lumen size retained after recanalization?
Nope it gets smaller
When an emboli lodge in small blood vessels, downstream tissues can undergo _______ necrosis.
ischemic
Are fat droplets, nitrogen bubbles, atherosclerotic debris, tumor fragments, bone marrow, or foreign bodies types of thrombi?
Yeah
The lungs and liver are more likely to incur a ____ infarct because blood from the alternate supply can infiltrate the ischemic cells.
red
Do red infarcts happen with venous, or arterial occlusions?
venous
White infarcts happen in _____ organs and are often ______-shaped.
solid organs, wedge-shaped
What are the three types of shock?
Cardiogenic, hypovolemic, septic
What is the clinical triad of septic shock?
- Hypotension
- Disseminated intravascular coagulation (DIC)
- Metabolic disturbances
What are the three stages of shock?
- Initial nonprogressive stage
- Progressive stage
- Irreversible stage
