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Pathology Exam 3 > Hemodynamic Disorders > Flashcards

Hemodynamic Disorders Flashcards

1
Q

Define Normal Fluid Exchange

A

Equilibrium between the interstitial, intravascular, and intracellular compartments

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2
Q

What is Capillary Fluid Exchange

A

Continuous exchange of Oxygen, metabolites, and salts for metabolic byproducts with the movement of fluid

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3
Q

When Hydrostatic pressure at the arteriolar end of the capillary bed exceeds the plasma colloid osmotic pressure what happens?

A

Movement of water, salts, and organic molecules from the intravascular space to the interstitial space

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4
Q

What happens when the colloid osmotic pressure at the venous end of the capillary bed exceeds the hydrostatic pressure?

A

Return of fluid into the vascular lumen

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5
Q

What determines extracellular fluid volume?

A

Total Body Sodium

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6
Q

What is Edema

A

Fluid accumulation in interstitial tissues or cavaties

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7
Q

Pericardial/Pleural/Peritoneal Effusion

A

Fluid accumulation in serosal cavaties

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8
Q

Transudative Effusion (Low Protein) is what disease?

A

Heart Failure

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9
Q

Exudative Effusion (High Protein) is what disease

A

Tumor, Inflammation

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10
Q

What are the 4 Pathogenesis of Edema

A
  1. Increased Hydrostatic Pressure
  2. Decreased Plasma Oncotic Pressure
  3. Increased Capillary Permeability
  4. Lymphatic Obstruction
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11
Q

Give 3 reasons for increased hydrostatic pressure

A

Inflammation, Increased venous pressure, Increased blood volume

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12
Q

Give 3 reasons for decreased plasma onctotic pressure

A

Nephrotic Syndrome, Cirrhosis, Malnutrition

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13
Q

Give 4 reasons for increased capillary permeability

A

Acute inflammation, allergic reactions, shock, burns

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14
Q

Give 4 reason for lymphatic obstruction

A

malignancy, fibrosis post radiation or inflamation, post surgery

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15
Q

What are some examples of localized edema

A

Inflammation, venous obstruction, lymphatic obstruction, allergic reaction, burns

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16
Q

What are some examples of generalized edema

A

Cardiac failure, nephrotic syndrome, malnutrition

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17
Q

What are a few clinicopathologic features of edema

A

L. Heart Failure leading to pulmonary edema
R. Heart Failure leading to lower limb edema
Cerebral edema secondary to brain trauma, meningitis, infarcts, tumors

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18
Q

Define Thrombosis

A

Formation of intravascular solid mass within the heart or intravascular system.

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19
Q

What does thrombosis adhere to

A

The luminal surfaces of vessels.

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20
Q

What is thrombosis normally opposed by

A

Fibrinolytic system

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21
Q

What are 3 predisposing factors for a formation of a thrombus

A
  1. Endothelial damage - trauma, inflammation
  2. Change in blood flow - narrowed arteries, aneurysms
  3. Change in blood coagulability - malignancy, oral contraceptics
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22
Q

Outcomes of a thrombus

A
  1. Fibronlysis with dissolution
  2. Propagation of the thrombus - enlargement
  3. Occlusion of a vessel lumen
  4. Organization with recanalization (reestablish continuity)
  5. Thromboembolism
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23
Q

Clinical Effects of a thrombus

A

Will depend on the size and site of the involved vessels and can lead to ischemia and infarction

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24
Q

Define Embolism

A

Embolism is the transportation of a detached intravascular particle or mass in the bloodstream as far as its size will allow then it will get lodged and obstruct

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25
Q

What is a Thromboembolism

A

When a thrombus detaches and travels as an embolus

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26
Q

How does an arterial emboli form

A

It originates in the LA or the LV and enters into systemic circulation

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27
Q

How does a venous emboli form

A

It originates in the deep leg/pelvic veins from deep vein thrombosis and travel to the pulmonary arterial system

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28
Q

What are clinical scenarios of a venous emboli

A

Patient may be asymptomatic

Pulmonary infarction = cough, pain, shortness of breath

Massive pulmonary embolism = acute R. heart failure - death

Multiple pulmonary emboli = hypertension and chronic r. heart failure

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29
Q

Define Air Embolism

A

Accidental introduction of more than 100cc air into venous system - sudden death

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30
Q

What is a nitrogen embolism

A

Occurs when air is breathed at high pressure (scuba) increased amount of gas dissolved. rapid ascension = nitrogen bubbles forming a gas embolus

31
Q

What is a fat embolism

A

Occurs following soft tissue crush injury (bone fracture) fat and marrow enter blood stream and hit lung and brain

32
Q

What is a tumor emboli

A

Tumor invades into vascular spaces and travels to other organs resulting in metastatic disease (brain, lungs, liver)

33
Q

What is a septic embolism

A

Bacterial endocarditis containing thrombi/vegetations trapped in bacteria. Fragments detach and travel systemically and can lodge in spleen/other organs

34
Q

What is an infarction

A

Occlusion of arteries or obstruction of venous drainage. Can result in irreversible cell injury and death. Will heal with fibrosis

35
Q

What factors determine infarcts

A

Presence or absence of a collateral circulation or dual blood supply

Rate of development of obstruction

Vulnerability of tissue hypoxia

Oxygen carrying capacity of blood.

36
Q

What is Shock

A

Clinical state associated with failure to maintain adequate perfusion of vital organs.

Characterized by decreased effective CO, hypotension, and decreased tissue perfusion

37
Q

What are the 3 types of shock

A
  1. Hypovolemic Shock
  2. Cardiogenic Shock
  3. Septic Shock
38
Q

What is hypovolemic shock

A

External fluid loss (dehydration)

Internal fluid loss due to
increased vascular permeability (burns)

39
Q

Cardiogenic Shock

A

Severe reduction in CO due to primary cardiac disease

40
Q

Septic Shock

A

With Gram Nematic Septicemia

41
Q

What are the 7 pathologies of shock

A
  1. Kidney - Acute tubular necrosis
  2. Lung - Diffuse alveolar damage
  3. Heart - Petechial hemorrhages
  4. Liver - Centrilobular Necrosis
  5. GIT - Duodenal Ulcer, hemorrhage
  6. Pancreas - Acute Panreatitis
  7. Adrenals - hemorrhages
42
Q

What is Atherosclerosis

A

Disease of med. and large. arteries under high pressures in the system circulation.

43
Q

What are common sites of Atherosclerosis

A

lower abdominal aorta, coronary/internal carotid parties, brain

44
Q

What is the pathogenesis atherosclerosis

A

“response to injury hypothesis”: Endothelial damage

Deposition of extracellular lipid & myointimal proliferation

Plaque as it enlarges causes pressure atrophy of the muscle layer & disruption of elastic lamina - weakens walls

45
Q

What is the complication of narrowing of the lumen

A

Ischemia, infarction, stroke, gangrene

46
Q

What are complications of plaque

A

Thrombosis, plaque ulceration, hemorrhage into plaque, pressure atrophy

47
Q

Dental management of patients w/ischemic heart disease

A
  1. Sedation
  2. stop procedure if there is tachycardia, fatigue
  3. Avoid hypoxia
  4. Arrhythmias - avoid local anesthetics
  5. Anticoagulants = adjust Rx
  6. Med Consult
  7. Develop chest pain - Rx oxygen
48
Q

Dental management of patients with cerebrovascular disease

A

avoid extractions
med consult
careful selection of sedation
avoid outpatient IV general anesthesia

49
Q

What is an Aneurysm

A

Localized abnormal dilatation of a vessel secondary to weakening of a wall

50
Q

What is a Berry Aneurysm

A

Aneurysm due to development defect

Congenital
Cerebral vessels
Subarachnoid hemmorhage
Multiple
sudden onset of severe headache
Sporadic or associated with polycystic kidney disease
51
Q

What are example of aneurysms caused by systemic diseases

A

Atherosclerosis

Vasculitis

52
Q

What are complications of Aneuryms

A

Rupture

Thrombosis

Stenosis or occlusion of vessel branches

Impingement of adjacent structures

53
Q

What is an atherosclerotic aneurysm

A

Most common cause by atherosclerotic plaque

Elderly males - smokers

Graft intervention based on size

Lower abdominal aorta below renal arteries

54
Q

Dental Management of Aneurysm patients

A

Avoid stress, increased blood pressure

Use prophylactic antibiotics

55
Q

What is Vasculitis

A

Inflammatory response involving blood vessels

56
Q

How is the damage of vasculitis characterized?

A

Frequently idiopathic, sometimes secondary to immune mechanisms, infectious agents, radiation, trauma, toxins

57
Q

What are some systemic symptoms of vasculitis?

A

Ab-Ag immune complexes

Attack on vessels by Ab

Cell mediated immunity

58
Q

What are some examples of vasculitis?

A

Direct invasion by infectious organisms

Immune reaction with vasculitis secondary to viral Ag-Ab complex

Anti Neutrophil cytoplasmic auto antibodies

59
Q

What is the pathology of vasculitis?

A

Narrowing of lumen

Destruction of internal elastic lamina

Fibrosis

Thrombosis

Aneurysm

60
Q

What are Gian Cell Arteritis (Temporal Arteritis)

A

Most common type or arteritis effecting head and neck

Affects temporal artery and ophthalmic vessels

Elderly women

Treat with Croticosteroids

61
Q

What is wagerer’s granulomatosis arteritis

A

Idiopathic systemic disease affecting lungs, kidneys

Middle aged males

Immunosuppressive drugs

Diagnostic serologic studies include c-ANCA positivity

62
Q

what is Polyarteritis Nodosa

A

idiopathic systemic disease affecting kidneys, heart, GI

Middle Aged Males

Hep B surface Ag positivity

Rx with anti-inflammatory/ immunosuppress

63
Q

What is a granuloma Pyogenicum

A

Polypod nodule of granulation tissue

On Skin/Mucosal Surfaces

Trauma or Preganancy

64
Q

what is a capillary/Cavernous Hemangioma

A

Benign Neoplasm

Proliferation of thin walled capillaries - nodule in skin, mucosal membrane

Cavernous are composed of larger dilated vascular channers

65
Q

What is an Angiosarcoma

A

Malignant endothelial neoplasm

Skin, soft tissue, breast, liver

Thorotrast

66
Q

Kaposi’s Sarcoma

A

Loss of immunity seen in AIDs

HHV8

Skin patches, plaques on extermities

67
Q

What are varicose veins?

A

Abnormally dilated veins

Due to incresaed intraluminal pressure

68
Q

When does lower extremity varicose veins occur?

A

With age (degenerative), heredity, occupations with prolonged standing, obesity

69
Q

what are hemorrhoids?

A

Dilations of veins around anorectal regions

Aggravated by constipation and pregnancy

70
Q

What is vein thrombosis

A

Thrombi in superficial veins as thrombophlebitis

71
Q

Where does deep Thrombi generally occur?

A

In leg or pelvic veins associated with prolonged bed rest or reduced CO.

Can embolus to lungs

72
Q

What does lymphatic obstruction lead to?

A

Lymphedema (distention of tissue by lymph)

Follows inflammatory or post radiation scarring.

73
Q

What is lymphangioma?

A

A bening lymphatic neoplasm

Pathology Exam 3 (4 decks)

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