Hemodynamic Disorders I & II - Parsa

Question 1

Total Body Water

Answer 1

40 L (60% of body weight)

Question 2

Intracellular fluid

Answer 2

25 L (40% of body weird) (2/3 TBW)

Question 3

Extracellular fluid

Answer 3

15 L

Question 4

Interstitial fluid

Answer 4

12 L (75% ECF)

Question 5

Plasma

Answer 5

3 L (25% ECF)

Question 6

Edema

Answer 6

Excess accumulation of fluid in the interstitial tissue space

Question 7

What does hydrostatic pressure do?

Answer 7

• Forces fluid out

* high at arteriolar end of the capillary bed

Question 8

What does plasma colloid osmotic pressure do?

Answer 8

• Draws fluid into the capillaries

* High at venous end of capillary bed

Question 9

What is localized edema?

Answer 9

• Inflammation
• Allergic reaction
• Venous obstruction
• Lymphatic obstruction

Question 10

What is an example of lymphatic obstruction?

Answer 10

Inguinal lymphatic obstruction due to filariasis (elephantiasis)

Question 11

What is generalized edema?

Answer 11

• Congestive heart failure: increased hydrostatic pressure
• Hypoproteinemia: decreased oncotic pressure due to decreased protein in blood from liver or kidney damage.
• Sodium retention

Question 12

What is anasarca?

Answer 12

Severe edema throughout entire body

Question 13

What is hyperemia?

Answer 13

• Inflammatory associated diseases
• Increased inflow of blood as a result of arteriolar vasodilation
• Tissues appear redder and warmer

Question 14

What is congestion?

Answer 14

• Increased blood volume due to impaired venous outflow
• Unoxygenated blood backs up
• Results in cyanosis and dusty coloration
• Typically due to heart failure

Question 15

What results from left-sided heart failure?

Answer 15

• Pulmonary edema
• Acute: MI
• Chronic: hemosiderin-laden macrophages (heart failure cells) in alveoli

Question 16

What results from right-sided heart failure?

Answer 16

• Pooling of blood on to venous side of circulation
• Can be secondary to lung disease or left-sided heart failure
• Can mess up liver (“nutmeg liver”)

Question 17

What is a hemorrhage?

Answer 17

Vascular rupture due to: trauma, atherosclerosis, congenital aneurysms, inflammatory conditions and erosion by a mass

Question 18

What is a hematoma?

Answer 18

A hemorrhage contained within a tissue or body cavity

Question 19

What is hemostasis?

Answer 19

Arrest of blood flow

Question 20

What is the primary platelet plug and when is it formed?

Answer 20

• Platelets aggregating and binding to site of endothelial injury
• First thing that happens after injury

Question 21

What is the definitive platelet plug and when is it formed?

Answer 21

• Formed after primary platelet plug
• Formed as a result of activation of coagulation cascade
• Platelets + coagulants

Question 22

What happens during the coagulation cascade?

Answer 22

• Prothrombin → thrombin
• Thrombin catalyzes cleavage of fibrinogen to fibrin
• Fibrin helps created definitive platelet plug

Question 23

What is thrombosis?

Answer 23

• The process of thrombus formation
• A result of dysregulation or imbalance between pro and anti coagulation mechanisms
• Normal hemostasis, but in an abnormal location

Question 24

What are some inhibitors of thrombosis?

Answer 24

• Heparin-like molecules
• Thrombomodulin
• Tissue factor pathway inhibitor

Question 25

What are some activators of thrombosis?

Answer 25

• Endothelial injury

* Tissue factor

Question 26

Does a blood clot use platelets? Coagulation cascade? Both?

Answer 26

Coagulation cascade ONLY

Question 27

What is a thrombus?

Answer 27

A solid mass formed by both the platelet and coagulation mechanisms

Question 28

What things promote thrombus formation (aka Virchow Triad)?

Answer 28

1. Endothelial injury
2. Abnormal blood flow
3. Hypercoagulability

Question 29

What are the 3 types of thrombosis?

Answer 29

1. Arterial
2. Cardiac
3. Venous

Question 30

What is arterial thrombosis?

Answer 30

• Thrombii located in an artery
• Usually occurs with atherosclerosis
• Thrombus grows in opposite direction of blood flow

Question 31

What are some common sites for arterial thrombosis?

Answer 31

Cerebral, coronary and femoral arteries

Question 32

What is cardiac thrombosis?

Answer 32

• Aka mural thrombi because they attach to the wall but don’t block the lumen
• Thrombii located in ventricles, atria or aorta
• In microscopy, look for “Lines of Zahn” or layered appearance

Question 33

What is venous thrombosis?

Answer 33

• Thrombii located in the veins

* Can be superficial (SVT) or deep (DVT)

Question 34

SVT

Answer 34

• Common in greater or lesser saphenous veins
• Secondary to varicose vein formation
• More common in lower extremities
• Symptoms include: pain, warmth, edema, tenderness

Question 35

DVT

Answer 35

• Prone to embolism
• Common in lower extremities
• Harder to recognize
• Milking movement of veins by leg muscles causes thrombi to break off and embolize

Question 36

So you’ve got a thrombus, now what can happen?

Answer 36

1. It can dissolve by the fibrinolytic system
2. It can continue to grow or propagate until it occlude the lumen
3. It can recanalyze
4. It can embolize

Question 37

What can you take to prevent a thrombus?

Answer 37

• Aspirin: blocks platelet aggregation
• Coumadin
• Heparin: inhibits coagulation
• Plasmin: breaks down fibrin (clots)

Question 38

Exudate fluid type

Answer 38

• Damage to integrity of vessel without bursting
• Results in increased vascular permeability or due to the action of inflammatory mediators
• Cloudy, turbent appearance with proteins present

Question 39

Transudate fluid type

Answer 39

• Due to non-inflammatory causes like renal failure, chronic liver disease, or congestive heart failure
• Due to increased hydrostatic pressure, decreased oncotic pressure or lymphatic obstruction
• No change in vascular permeability
• Get clear yellow fluid
• Just water and maybe some electrolytes getting out; no proteins