Hemodynamics-1 Lecture and Word Doc Flashcards
What is edema?
Swelling of tissue due to increased fluid in interstitial tissue spaces
What is ascities?
Fluid in the abdominal cavity
What is anasarca?
Generalized edema
What is hyperemia?
An active increase in arterial blood flow
What is congestion?
Passive decrease in venous flow
What is a hemorrhage?
Extravasation of blood due to blood vessel rupture
What is petechia?
Tiny (1-2 mm) hemorrhage due to platelet deficiency
What is hematoma?
A hemorrhage enclosed within a tissue
What is hemostasis?
(1) the maintenance of blood in a free-flowing liquid state in normal blood vessels and (2) the formation of a blood clot at a sit of vascular injury
What is a hemostatic plug?
Another term for blood clot
What are platelets?
Anucleate cellular components of blood
What are platelets important in?
Initiation and propagation of clotting
T or F: Platelets have granules.
True
What is thrombosis?
Inappropriate formation of blood clot in a blood vessel
T or F: Blood clots formed during thrombosis are not usually occlusive.
False
What is hypercoagulability?
Abnormal tendency to form clots
What is coagulopathy?
Abnormal tendency to bleed
What is an embolus?
detached intravascular solid, liquid, or gaseous mass carried by the blood to a site distant from it’s point of origin
What is an infarction?
Area of ischemic necrosis
What are the 2 types of edema?
Localized and generalized
Where does generalized edema initially appear?
Tissues with a loose connective tissue matrix (i.e. around the eyes = periorbital edema)
What is pitting edema?
Transient pit in the skin at the site of finger pressure
Important concept 1: What are four most common causes of edema?
Increased hydrostatic pressure
Decreased plasma oncotic pressure
Sodium retention
Inflammation
What can cause edema in the lungs due to increased hydrostatic pressure?
Left heart failure
What can cause edema in the lower body due to increased hydrostatic pressure?
Right heart failure
What can cause edema in the leg body due to increased hydrostatic pressure?
Venous thrombosis
What is dependent edema?
Edema that worsens due to gravity
**when in lying down, dependent edema is worse in the sacrum and when standing, it is worse in the legs
T or F: dependent edema is specific to increased hydrostatic pressure as the etiology
false
What can nephrotic syndrome (protein loss) cause?
Edema due to decreased plasma osmotic pressure
Why can hepatic cirrhosis lead to edema?
It causes…
- an increase in the hydrostatic pressure in the portal venous system
- a decrease in the plasma osmotic pressure due to protein loss from (a) proteins going into ischities and (b) deficient hepatic protein synthesis
What usually causes edema due to sodium retention?
Heart or renal failure
Edema due to sodium retention is always ___(type of edema) _____ and seen with ______. (this is testing you ability to read minds too)
Generalized; increased hydrostatic pressure
(and, to a lesser extent, dilutional decrease in plasma osmotic pressure
Where does localized edema due to inflammation present?
At the site of infection
Generalized edema due to inflammation is seen with _______
SIRS or sepsis
What type of edema is associated with edema due to lymphatic obstruction (lymphedema)?
Usually localized
What causes edema due to lymphatic obstruction (lymphedema)?
Tumor Inflammation Surgery Radiation Scar
What is peau d’ orange?
Lymphedema due to breast cancer (causes skin over tumor to resemble the skin of an orange)
What is the most common cause of pulmonary edema?
Left heart failure
Describe the fluid that can be aspirated from pulmonary edema.
Frothy fluid (pink if blood in it)
What symptom is associated with pulmonary edema? Sign?
Dyspnea (symptom) Pulmonary crackles (sign)
Important Concept 2: Pulmonary edema is common and (serious or not serious)
serious
Cerebral edema can be localized as a(n) ____ or _____
Abscess or tumor
Describe the (gross?) morphology of generalized cerebral edema.
Swollen gyri and narrowed sulci all over brain
Important concept 3: Brain edema can be fatal and due to ____
Herniation of cerebellar tonsils into foramen magnum which compresses the brainstem (respiratory center)
Erythema is _____
Hyperemia
Cyanosis is _____
Congestion
When heart failure causes cyanosis/congestion, the patient often will also have ______ and ______
“Nutmeg liver”: alternating red centrilobular and tan peripherilobular tissue (whatever the fuck that is)
AND
hemophages in pulmonary alveoli
Important concept 4: Hyperemia and congestion are common and (serious or not serious)
Not serious
What is purpura?
Medium (3-10 mm) bleed due to vasculitis, vessel fragility, etc.
What is ecchymosis?
Larger (over 1 cm) subcutaneous hemorrhage that goes from red-blue → blue green → gold-brown as the hemoglobin breaks down
What is a hemothorax?
Hemorrhage into pleural cavity
What is the size of a pupra?
3-10 mm
What is the size of an ecchymosis?
Over 1 cm
Important concept 5: hemorrhages are common and (serious or not serious) and described with a large number of precise terms that are commonly used imprecisely
serious
What are the 4 stages of hemostasis at the site of vascular injury?
- vasoconstriction
- primary hemostasis
- secondary hemostasis
- thrombus and antithrombic events
Describe stage 1 of hemostasis at the site of vascular injury. What mediates it and augments it.
Brief arteriolar vasoconstriction mediated by reflex neurogenic mechanism and augmented by local secretion of vasoconstrictors (i.e. endothelium, a potent endothelium-derived vasoconstrictor)
What is endothelin?
a potent endothelium-derived vasoconstrictor; mediates the first stage (vasoconstriction) of hemostasis at the site of vascular injury
Describe stage 2 of hemostasis at the site of vascular injury.
Primary homeostasis:
- platelet adhesion to thrombogenic ECM
- Activation and shape change
- GpIIb/IIIa receptor expressed (binds fibrinogen and mediates aggregation)
- Release of ADP and TXA2
- Platelet recruitment and aggregation
What is GpIIb/IIIa?
A receptor that is expressed on the surface of platelets after they become activated. This receptor binds fibrinogen and mediates aggregation.
What is released during primary homeostasis? Who releases this?
ADP and TXA2
Describe stage 3 of hemostasis at the site of vascular injury.
Secondary Hemostasis
- activation of the coag cascade by tissue factor and platelet factors
- culminates in conversion of fibrinogen to fibrin by activated thrombin
What is (/describe) the tissue factor that initiates the activation of the coag cascade during secondary hemostasis?
Clotting factor III
-Membrane bound pro-coagulant made by endothelium
Describe stage 4 of hemostasis at the site of vascular injury.
Thrombus maturation and antithrombotic events:
- Formation of a solid, permanent plug of aggregated platelets and polymerized fibrin
- Counterreglatory mechanisms to limit the hemostatic plug at the site of injury
What are 3 factors that predispose the formation of a thrombosis?
Endothelial injury
Abnormal blood flow
Hypercoagulability
Important concept 6: Thrombosis is common and (serious or not serious).
Serious
Thrombosis is more common in ________
Veins
Thrombosis is more serious in ________
Arteries
What is the most important factor prompting thrombosis?
Endothelial injury
What are 3 conditions that cause endothelial injury → thrombosis?
- hemodynamic stress of hypertension
- toxicity if hypercholesterolemia
- products absorbed from smoking → inc pro-coag factors or decreases anti-coag factors