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Pathology > Hemodynamics and Shock (not on test) > Flashcards

Hemodynamics and Shock (not on test) Flashcards

1
Q

Embolus

A

A freely movable, intravascular mass that is carried from one anatomic site to another by blood

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2
Q

Name the 4 types of emboli

A
  1. Thromboemboli
  2. Liquid emboli
  3. Gaseous emboli
  4. Solid particle emboli
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3
Q

Thromboemboli

A

fragments of thormbi carried by venous or aterial blood. (infected thrombi give rise to septic emboli)

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4
Q

Liquid emboli

A

fat emboli - occur after bone fracture

amniotic fluid emboli - caused by entry of amniotic fluid into the uterine veins during delivery

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5
Q

Mural thrombus

A
  • arterial embolus

- most often in patients with Afib

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6
Q

Acute bacterial endocarditis

A
  • creates a septic embolus

- Staph aureus is the #1 cause (likes to form abcesses)

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7
Q

What is the classic triad for a fat embolism?

A

After trauma (breakage of long bone- femur, tibia)

  1. Difficulty breathing
  2. Neurosymptoms (disorientation, coma)
  3. Thrombocytopenia (platelets love to adhere to fat globules)
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8
Q

Gaseous emboli

A

air embolism can be produced by injecting air into veins (also with decompression sickness, ie the Bends)

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9
Q

Solid particle emboli

A

Ex.

  • cholesterol crystals can detach from atherosclerotic plaques
  • tumor cells
  • bone marrow emboli
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10
Q

Which type of malignancy is notorious for creating tumor emboli?

A

Renal cell carcinoma (especially renal vein)

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11
Q

Which type of emboli is most common?

A

thromboemboli

classified on basis of vessels through which they are carried in blood

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12
Q

Where do venous emboli originate and lodge?

A

these originate in veins and typically lodge in the pulmonary artery and its branches

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13
Q

Where do arterial emboli originate?

A
  • left atrium
  • ventricle
  • aorta
  • major arteries
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14
Q

Paradoxical emboli

A

venous emboli that enter arterial circulation through the foramen ovale or interventricular septal defect

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15
Q

Name 3 common places arterial emboli originate from

A
  1. endocardium
  2. valve
  3. ulcerated atherosclerotic plaques of the aorta
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16
Q

Where sized arteries do arterial emboli tend to lodge in?

A
  • Medium-sized arteries
  • smaller arteries

*fragment because arterial blood flows fast

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17
Q

Which organ is at greatest risk for arterial emboli?

A

Emboli of cerebral circulation

*typically lodge in the middle cerebral artery and causes infarcts of the basal ganglia

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18
Q

Where do arterial emboli typically lodge in the brain?

A

middle cerebral artery

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19
Q

What does an embolism in the middle cerebral artery cause?

A

infarct of the basal ganglia

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20
Q

What organs are vulnerable to arterial emboli?

A
  1. Spleen
  2. Kidney
  3. Intestine
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21
Q

Sharp subcostal pain is associated with what type of emboli?

A

splenic infact (arterial embolism)

22
Q

Thrombus

A

transformation of the fluid bood into a solid aggregate encompassing blood cells and fibrin

23
Q

Fibrin

A

polymerized fibrinogen that forms a meshwork of thin filaments that bind together the cellular elements of the blood

24
Q

Pathologically, how are thrombi classified?

A

based on location

25
Q

Name the 3 types of thrombi

A
  1. Intramural thrombi
  2. Arterial thrombi
  3. Venous thrombi
26
Q

Intramural thrombi

A

attached to the mural endocardium of the heart chambers and commonly are found overlying a MI which may embolize

27
Q

Arterial thrombi

A

attached to arterial wall and typically cover ulcerated atheromas in an atherosclerotic aorta or the coronary arteries

28
Q

Venous thrombi

A

-found in dilated veins (varicose veins)

(Long-standing venous thrombi are organized by granulation tissue, which may give an impression of inflammation (thrombophlebitis))

29
Q

Name 5 common sites of thrombus formation

A
  1. Varicose veins
  2. Heart (valves, over myocaridal infarct)
  3. Aorta (atherosclerosis, aneurysm)
  4. Coronary arteries
  5. Carotid and cerebral arteries
30
Q

Name the two types of thrombi (based on pathologic features)

A
  1. Red thrombi

2. Layered thrombi

31
Q

Which throbus type is composed of tightly intermixed RBC’s and fibrin

A

Red thrombi

32
Q

Which thrombus type shows distinct layering of cellular elements and fibrin

A

Layered thrombi

33
Q

Thrombi in small vessels tend to be _______

A

red thrombi

34
Q

Thrombi in larger arteries and veins, and mural thrombi tend to be _______

A

layered thrombi

35
Q

“Lines of Zahn”

A

white layers of fibrin in microscopic thrombi

36
Q

What type of thrombi are lines of Zahn associated with?

A

layered thrombi

37
Q

Infarct

A

insufficiency of blood supply of sudden onset that results in an area of ischemic necrosis

38
Q

Most infarctions are caused by? (2)

A
  1. Thrombosis

2. Emboli

39
Q

How can infarcts be classified pathologically?

A

Gross appearance

  • white
  • red
40
Q

White infarcts

A
  • white or pale
  • arterial occlusion
  • solid organs (heart, kidney, etc)
41
Q

In what type of infarction would you expect to see an area of ischemic necrosis caused by the arterial obstruction, typically paler than the surrounding tissue, often rimmed by a thin red zone containing extravasated blood that was destined to reach the ischemic zone from surrounded anastomotic blood vessels

A

White infarct

42
Q

Red infarct

A
  • venous obstruction
  • involve intestines (volvulus) or testes (torsion)
  • Typical of organs with dual blood supply (ex. liver and lungs)

*venous circulation interrupted by twisting of the organ

43
Q

What happens as a result of venous compression with red infarct?

A
  • venous congestion
  • local ischemia
  • necrosis
44
Q

Which two organs cannot be repaired after infarction?

A

Heart and Brain

45
Q

What happens to heart tissue after infarction?

A

damaged cells are replaced with fibrous tisssue, resulting in myocardial fibrosis and scarring

46
Q

What happens to necrotic brain tissue after infarction?

A

liquefied brain tissue is resorbed, leaving behind cyst fillled with clear fluid that later undergoes gliosis

47
Q

Shock

A

state of hypoperfusion of tissues with blood

48
Q

Name the 3 mechanisms of shock

A
  1. Cardiogenic shock (heart fails to pump)
  2. Hypovolemic shock (loss of fluid/blood)
  3. Septic shock (gram negative bacteremia)
49
Q

What is characteristic of all 3 forms of shock?

A
  • collapse of circulation

- disproportion between circulating blood volume and vascular space

50
Q

What does cellular or tissue hypoxia cause?

A
  • shift from aerobic to anaerobic metabolism

- increased lactic acid production (lactic acidosis)

51
Q

How does cardiogenic shock most often take place?

A

results from pump failure of the heart usually after an area of heart muscle infarcts and dies

52
Q

Causes of hypovolumic shock

A
  • massive hemorrhage
  • diarrhea
  • burn
  • vomiting

Pathology (15 decks)

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