Hemodynamic Disorders I Flashcards

1
Q

edema

A

increased interstitial fluid

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2
Q

anasacara

A

edema with subQ tissue swelling

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3
Q

fluid in body cavity

A

hydro-

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4
Q

transudate

A

protein poor

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5
Q

exudate

A

protein rich

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6
Q

ascites

A

liver cirrhosis

-reduced albumin - reduced plasma osmotic pressure

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7
Q

nephrotic syndrome

A

glomeruli leaky - albumin loss

-lead to edema

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8
Q

sodium and water retention

A

can cause edema

-kidney disorders

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9
Q

CHF

A

renal hypoperfusion
-leads to edema

early - RAAS activated with increased ADH - restore renal perfusion

over time - retained fluid causes edema

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10
Q

subQ edema

A

influenced by gravity - dependent edema
-displaced - pitting edema

can signify underlying cardiac or renal pathology

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11
Q

pulmonary edema

A

left ventricular failure

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12
Q

hyperemia

A

active process

-artery dilation - increased blood flow

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13
Q

erythema

A

tissue turns red

response to hyperemia

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14
Q

congestion

A

passive process

-reduced outflow of blood from tissue

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15
Q

cyanotic

A

tissue is reddish blue

response to congestion
-deoxygenated Hg

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16
Q

acute pulmonary congestion

A

engorged capillaries with edema

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17
Q

chronic pulmonary congestion

A

septa thickened and fibrotic

-hemosiderin macrophages

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18
Q

heart failure cells

A

hemosiderin M0s - in chronic pulmonary congestion

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19
Q

acute hepatic congestion

A

central vein and sinusoids are distended

  • centrilobular cells ischemic
  • periorbial better oxygenated
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20
Q

chronic passive hepatic congestion

A

centrilobular red-brown and depressed - nutmeg liver

-hemosiderin M0s

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21
Q

centrilobular area of liver

A

likely to undergo necrosis

-at edge of blood supply

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22
Q

hemorrhage

A

extravasation of blood into extravasculature

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23
Q

hematoma

A

hemorrhage maintained in a tissue

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24
Q

petechiae

A

1-2mm hemorrhage in skin, mucous membrane, or serosa

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25
Q

purpura

A

> 3mm hemorrhages in skin, mucous membrane, or serosa

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26
Q

ecchymoses

A

> 1-2mm subQ hematoma

typical bruise
Hg (red-blue) > bilirubin (blue green) > hemosiderin (gold brown)

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27
Q

thrombosis

A

clot in intact vessels

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28
Q

site of vascular injury

A

vasoconstriction - due to endothelin
ECM promotes platelet adherence and activation

platelets aggregate to form plug

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29
Q

primary hemostasis

A

platelet aggregation forming hemostatic plug

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30
Q

tissue factor

A

factor III, or thromboplastin

-activates factor VII in extrinsic pathway of coagulation

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31
Q

thrombin

A

cleaves fibrinogen to fibrin

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32
Q

secondary hemostasis

A

fibrin and platelets

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33
Q

permanent plug

A

polymerized fibrin and platelet aggregates

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34
Q

t-PA

A

limit hemostatic plug at site of injury

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35
Q

antithrombosis of endothelium

A

adenosin diphosphatase, prostacyclin and NO - antiplatelet

heparin-like mlcs > antithrombin III, thrombomodulin - anticoagulant

t-Pa - fibrinolytic

36
Q

thrombomodulin

A

binds thrombin and converts it to anticoagulant

  • its ability to activate protein C
  • inactivates factors Va and VIIIa
37
Q

prothrombosis of endothelium

A

vWF - platelet binding

tissue factor - in response to TNF and IL-1 - extrinsic clotting

PAIs - antifibrinolytic

38
Q

platelets

A

shed from megakaryocytes

39
Q

alpha granules of platelets

A
P-selectin
fibrinogen
fibronectin
factor V and VIII
PF4
PDGF
TGF-beta
40
Q

delta granules of platelets

A
ADP
ATP
calcium
histamine
serotonin
epinephrine

**important for coagulation and platelet aggregation

41
Q

platelet adhesion

A

vWF > GpIb

42
Q

bernard soulier syndrome

A

deficient GpIb

no platelet adhesion to vWF

bleeding disorder

43
Q

TxA2

A

vasoconstrictor

also stimulates platelet aggregation

44
Q

thrombin activity

A

1 - binds to PAR - activates platelet aggregation

2 - converts fibrinogen to fibrin

45
Q

fibrinogen

A

binds to platelet GpIIb-IIIa receptor

-bridging interactions

46
Q

glanzmann thrombasthenia

A

deficiency in GpIIb-IIIa receptor

-no fibrinogen bridging of platelets

47
Q

clopidogrel

A

block ADP binding

block platelet aggregation

48
Q

prostacyclin

A

PGI2

-vasodilator and inhibits platelet aggreagation

49
Q

aspirin

A

irreversible COX inhibitor
-blocks synthesis TxA2

used to decreased chance of thrombosis

50
Q

reactions of coagulation

A

surface of phospholipid

-held together by Ca2+

51
Q

coumadin

A

anti-thrombotic agent

  • inhibits binding of coagulation factors
  • rxn that requires Vit K normally
52
Q

blood coagulation converge on

A

factor V

53
Q

intrinsic clotting pathway

A

factor XII

54
Q

extrinsic clotting pathway

A

requires exogenous trigger

55
Q

PT time

A

assays extrinsic pathway

factors VII, X, II, V, fibrinogen

add TF to citrated plasma
-add calcium - measure time to clot

56
Q

PTT time

A

assays intrinsic pathway

factors XII, XI, IX, VIII, X, V, II, fibrinogen

negative charged particle (glass)
-time to clot measured

57
Q

thrombin proinflammatory

A

through binding PARs

58
Q

endogenous anticoagulants

A

antithrombins
protein C and S
TFPI

59
Q

plasmin

A

breaks down fibrin
-releases fibrin split products

fibrinolytic cascade

60
Q

t-PA

A

activates plasminogen to plasmin

61
Q

virchows triad

A

lead to thrombus

1 - endothelial injury
2 - stasis or turbulent blood flow
3 - hypercoagubility of blood

62
Q

thrombi in cardiac chambers

A

often due to endothelial injury

63
Q

thrombophilia

A

hypercoagulability

64
Q

leiden mutation

A

point mutation in factor V gene
-lead to hypercoagulabiltiy

resistant to cleavage by protein C

65
Q

prothrombin gene mutation

A

hypercoagulability

66
Q

homocystein

A

prothrombic effects

67
Q

rare inherited causes of primary hypercoagulability

A

deficiency in antithrombin III, protein C, protein S

68
Q

patients under age 50 with thrombosis

A

need to consider genetic causes

69
Q

smoking and obesity

A

hypercoagulability

70
Q

oral contraceptive

A

hypercoagulability

71
Q

heparin induced thrombocytopenia syndrome

A

administration of unfractionated heparin
-antibodies for heparin and platelet complexes

results in thrombocytopenia
-also - prothrombotic state

72
Q

antiphospholipid antibody syndrome

A

recurrent thrombosis
repeated miscarriage
valve vegetations
thrombocytopenia

antibodies to plasma proteins
-induce hypercoagulable state

false positive for syphilis**

secondary - to some other disorder
primary - no evidence of autoimmune disorder

73
Q

growth of thrombi

A

toward heart

arterial - retrograde
venous - anterograde

74
Q

lines of zahn

A

laminations in thrombi
-platelet/fibrin layers and red cell layers

show it was in flowing blood
-not postmortem

75
Q

mural thrombi

A

in heart chambers or in aortic lumen

76
Q

arterial thrombi

A

often occlusive

-coronary, cerebral, femoral arteries

77
Q

phlebothrombosis

A

venous thrombi
-almost always occlusive

lots of red cells - red (stasis) thrombi

78
Q

postmortem clots

A

gelatinous with dark red portion where red cells settled and yellow chicken fat upper portion

usually not attached to underlying wall

79
Q

vegetations

A

thrombi on heart valves

80
Q

libman sacks endocarditis

A

SLE vegetations

81
Q

fate of thrombi

A

propagation
embolization
dissolution
organization and recanalization

82
Q

venous thrombi

A

can embolize to lung

83
Q

superficial venous thrombi

A

saphenous vein

-rarely embolize

84
Q

deep venous thrombi

A

DVT

  • popliteal, femoral, iliac veins
  • can embolize to lung
85
Q

trousseau syndrome

A

migratory thrombophlebitis

86
Q

arterial thrombosis

A

often with atherosclerosis

87
Q

DIC

A

disseminated intravascular coagulation

widespread fibrin thrombin in microcirculation

platelet and coagulation consumption
-can result in excessive bleeding catastrophe