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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
What is a Thromboembolism
When a thrombus detaches and travels as an embolus
26
How does an arterial emboli form
It originates in the LA or the LV and enters into systemic circulation
27
How does a venous emboli form
It originates in the deep leg/pelvic veins from deep vein thrombosis and travel to the pulmonary arterial system
28
What are clinical scenarios of a venous emboli
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
29
Define Air Embolism
Accidental introduction of more than 100cc air into venous system - sudden death
30
What is a nitrogen embolism
Occurs when air is breathed at high pressure (scuba) increased amount of gas dissolved. rapid ascension = nitrogen bubbles forming a gas embolus
31
What is a fat embolism
Occurs following soft tissue crush injury (bone fracture) fat and marrow enter blood stream and hit lung and brain
32
What is a tumor emboli
Tumor invades into vascular spaces and travels to other organs resulting in metastatic disease (brain, lungs, liver)
33
What is a septic embolism
Bacterial endocarditis containing thrombi/vegetations trapped in bacteria. Fragments detach and travel systemically and can lodge in spleen/other organs
34
What is an infarction
Occlusion of arteries or obstruction of venous drainage. Can result in irreversible cell injury and death. Will heal with fibrosis
35
What factors determine infarcts
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
What is Shock
Clinical state associated with failure to maintain adequate perfusion of vital organs. Characterized by decreased effective CO, hypotension, and decreased tissue perfusion
37
What are the 3 types of shock
1. Hypovolemic Shock 2. Cardiogenic Shock 3. Septic Shock
38
What is hypovolemic shock
External fluid loss (dehydration) Internal fluid loss due to increased vascular permeability (burns)
39
Cardiogenic Shock
Severe reduction in CO due to primary cardiac disease
40
Septic Shock
With Gram Nematic Septicemia
41
What are the 7 pathologies of shock
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
What is Atherosclerosis
Disease of med. and large. arteries under high pressures in the system circulation.
43
What are common sites of Atherosclerosis
lower abdominal aorta, coronary/internal carotid parties, brain
44
What is the pathogenesis atherosclerosis
"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
What is the complication of narrowing of the lumen
Ischemia, infarction, stroke, gangrene
46
What are complications of plaque
Thrombosis, plaque ulceration, hemorrhage into plaque, pressure atrophy
47
Dental management of patients w/ischemic heart disease
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
Dental management of patients with cerebrovascular disease
avoid extractions med consult careful selection of sedation avoid outpatient IV general anesthesia
49
What is an Aneurysm
Localized abnormal dilatation of a vessel secondary to weakening of a wall
50
What is a Berry Aneurysm
Aneurysm due to development defect ``` Congenital Cerebral vessels Subarachnoid hemmorhage Multiple sudden onset of severe headache Sporadic or associated with polycystic kidney disease ```
51
What are example of aneurysms caused by systemic diseases
Atherosclerosis | Vasculitis
52
What are complications of Aneuryms
Rupture Thrombosis Stenosis or occlusion of vessel branches Impingement of adjacent structures
53
What is an atherosclerotic aneurysm
Most common cause by atherosclerotic plaque Elderly males - smokers Graft intervention based on size Lower abdominal aorta below renal arteries
54
Dental Management of Aneurysm patients
Avoid stress, increased blood pressure Use prophylactic antibiotics
55
What is Vasculitis
Inflammatory response involving blood vessels
56
How is the damage of vasculitis characterized?
Frequently idiopathic, sometimes secondary to immune mechanisms, infectious agents, radiation, trauma, toxins
57
What are some systemic symptoms of vasculitis?
Ab-Ag immune complexes Attack on vessels by Ab Cell mediated immunity
58
What are some examples of vasculitis?
Direct invasion by infectious organisms Immune reaction with vasculitis secondary to viral Ag-Ab complex Anti Neutrophil cytoplasmic auto antibodies
59
What is the pathology of vasculitis?
Narrowing of lumen Destruction of internal elastic lamina Fibrosis Thrombosis Aneurysm
60
What are Gian Cell Arteritis (Temporal Arteritis)
Most common type or arteritis effecting head and neck Affects temporal artery and ophthalmic vessels Elderly women Treat with Croticosteroids
61
What is wagerer's granulomatosis arteritis
Idiopathic systemic disease affecting lungs, kidneys Middle aged males Immunosuppressive drugs Diagnostic serologic studies include c-ANCA positivity
62
what is Polyarteritis Nodosa
idiopathic systemic disease affecting kidneys, heart, GI Middle Aged Males Hep B surface Ag positivity Rx with anti-inflammatory/ immunosuppress
63
What is a granuloma Pyogenicum
Polypod nodule of granulation tissue On Skin/Mucosal Surfaces Trauma or Preganancy
64
what is a capillary/Cavernous Hemangioma
Benign Neoplasm Proliferation of thin walled capillaries - nodule in skin, mucosal membrane Cavernous are composed of larger dilated vascular channers
65
What is an Angiosarcoma
Malignant endothelial neoplasm Skin, soft tissue, breast, liver Thorotrast
66
Kaposi's Sarcoma
Loss of immunity seen in AIDs HHV8 Skin patches, plaques on extermities
67
What are varicose veins?
Abnormally dilated veins Due to incresaed intraluminal pressure
68
When does lower extremity varicose veins occur?
With age (degenerative), heredity, occupations with prolonged standing, obesity
69
what are hemorrhoids?
Dilations of veins around anorectal regions Aggravated by constipation and pregnancy
70
What is vein thrombosis
Thrombi in superficial veins as thrombophlebitis
71
Where does deep Thrombi generally occur?
In leg or pelvic veins associated with prolonged bed rest or reduced CO. Can embolus to lungs
72
What does lymphatic obstruction lead to?
Lymphedema (distention of tissue by lymph) Follows inflammatory or post radiation scarring.
73
What is lymphangioma?
A bening lymphatic neoplasm

Pathology Exam 3 (4 decks)

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