HEMODYNAMICS and THROMBOEMBOLIC DISEASES Flashcards
also termed as phlebothrombosis
Venous thrombosis
Factor III is known as what?
Tissue Factor/ Thromboplastin
A chronic form of decompression sickness
Caisson Disease
when do the counter-regulatory mechanisms of hemostasis take place?
Thrombus and antithrombotic events
Coumarin is an anticoagulant. How does it mediate its actions?
by inhibiting vitamin K
finger pressure over substantially edematous subcutaneous tissue displaces the interstitial fluid and leaves a depression
Pitting edema
most physiologically relevant pathway for coagulation occuring when vascular damage has occurred
Extrinsic Pathway
severe generalized edema with widespread subcutaneous tissue spreading
Anasarca
What is obstructed in Parasitic filariasis which causes elephantiasis?
Lymphatics/ Lymph nodes
sudden or insidious onset of widespread fibrin thrombi in the microcirculation
(DIC) Disseminated Intravascular Coagulation
What are the 3 main etiologies of decreased plasma protein (albumin) concentrations that ultimately lead to Edema?
Nephrotic Syndrome Chronic Liver Disease Malnutrition
a membrane bound procoagulant glycoprotein that is synthesized by endothelium
Tissue factor/Factor 3/Thromboplastin
What is a secondary hemostatic plug?
irreversibly fused mass of platelets
sequence of hemostasis where thrombin cleaves fibrinogen to insolube fibrin
Secondary Hemostasis
Hyperemia typically results to Erythema while Congestion results to?
Cyanosis
Hydrostatic pressure in the arteriolar segment of the capillary
32 mmHg
Patterns of Tissue Hemorrhage
Hematoma Petechiae Purpura Ecchymoses
A form of cerebral edema that preferentially affects gray matter
Cytotoxic Cerebral Edema
what can be found inside the alpha granules of platelets?
Fibrinogen Fibronectin Factors 5 and 8 platelet factor 4 platelet-derived growth factor transforming growth factor-Beta
Subcutaneous Edema is Important. TRUE or FALSE.
TRUE
What are the Calcium-dependent factors?
1 2 10 13
Abnormal increase in interstitial fluid within tissues
Edema
Discharge of blood out of the vascular space
Hemmorhage
Differentiate Prostacyclin and Thromboxane as to: 1. Where is it derived 2. VC or VD 3. platelet Activator or Inhibitor
Prostacylin: VD, platelet inhibitor and endothelial derived Thromboxne VC, platelet activator and platelet derived
2 types of platelet cytoplasmic granules
Alpha and Sigma
most common primary genetic disorder of coagulability
Leiden Mutation
True or False. Salt & Water retention corrects the primary volume deficit caused by low serum protein
False.
accumulation of fluid in peritoneal space
Ascites
TRUE or FALSE. After exposure of Subendothelial surface from injury, Platelets adhere to a single factor in the ECM which is called the Von Willebrand Factor.
FALSE. it can also adhere to other factors such as Fibronectin
Microscopic morphology of Edema
Clearing Separation of ECM Subtle cell swelling
the Vitamin K dependent factors
9 10 7 2
An edema caused by increased hydrostatic pressure or decreased plasma preotein; protein poor fluid
Transudate
Gamna-Gandy bodies are seen in what organ as a result of congestion
Spleen
The initial wave of platelet aggregation is? (reversible or irreversible)
Reversible
accumulation of blood in the joint spaces
Hemarthrosis
a protease that cleaves plasminogen to form plasmin
t-PA (Tissue Plasminogen Activator)
Prothrombic properties
Platelet Procoagulant Antifibrinolytic
What are the color changes in Ecchymoses and their significance?
Red=RBC rupture Blue-green=bilirubin oxidation Gold/yellow-brown=Hemosiderin
components of Virchow’s triad
Endothelial injury Hypercoagulability Abnormal blood flow
Subcutaneous Hemorrhage is Important. TRUE or FALSE
FALSE
what are the fates of thrombus?
Propagation Embolization Dissolution Organization
Chronic passive pulmonary congestion is caused by?
impeded outflow of blood from the lungs
TRUE/FALSE. RBC and Leukocytes can be found in a normal platelet plug.
TRUE
A thrombus formed in one location that detaches from a vessel wall t its point of origin and travels to a distant site
thromboembolism
thrombi on heart valves
Vegetations
Sequence of hemostasis where Hemostatic plug is formed
Primary Hemostasis
AGGREGATION is accomplished by binding of fibrinogen to what platelet receptor?
Glycoprotein IIb-IIIa
the most common cause of systemic thromboembolism
Intracardiac mural thrombi
Standard Assay fro coagulation pathway which specifically asess functions of factors in extrinsic pathway
Prothrombin time
Passive Hyperemia; reduced blood outflow from a tissue
Congestion
A type of Clot without the prsence of Lines of Zahn
Postmortem Clot
a detached intravascular solid, liquid or gaseous mass that is carried by blood to a site distant from its origin
embolism
What are the type of infarcts seen in the folowing: Venous occlusion Arterial Occlusion
Venous Occlusion: Red infarct Arterial Occlusion: White Infarct
type of edema that reflects a global disorder of fluid and Electrolyte metabolism often times associated with Heart Failure
Generalized Edema
general sequences of hemostasis
Vasoconstriction Primary Hemostasis Secondary hemostasis thrombus and antithrombic events
most important coagulation factor
Thrombin
cerebral edema that is a consequence of hydrocephalus
Interstitial
Plasminogen Activators
t-PA Urokinase-like PA (u-PA) Streptokinase
laminations that represent pale fibrin and platelet deposits alternating with darker red cell-rich layer
Lines of Zahn
Subcutaneous hematoma; RBC’s in this lesion are degraded by Macrophages
Ecchymoses
What type of Edema is typically seen in the setting of Left Ventricular Failure?
Pulmonary Edema
Most common form of Cerebral edema; mainly in the white matter; BBB is disrupted
Vasogenic Cerebral Edema
more redblood cells are deposited in? (Arterial or Venous thrombosis)
Venous (more RBC’s. less platelet)
other ways by which lymphatic channels may be blocked
Malignant neoplasms Fibrosis Surgical ablation
Protein-rich fluid; a.k.a inflammatory edema
Exudate
a pentasaccharide inhibitor of factor 10
Fondaparinux
What are “Gamna-Gandy bodies”?
iron-containing fibrotic and calcified foci of old hemorrhage
Px exhibits only the manifestations of a hypercoagulable state and lack evidence of other immune disorders
Primary antiphospholipid Syndrome
an active process that increases blood flow at a local site
Hyperemia
binds calcium and serve as a critical nucleation site for the assembly of complexes containing the various coagulation factors
Phosphatidylserine
“nutmeg” Liver is a condition of
Passive Chronic congestion of the liver
What glycoprotein is deficient in Bernard Soulier Syndrome
Glycoprotein Ib
amount of Plasma oncotic Pressure
26 mmHg
A condition where glomeruli become leaky due to decreased plasma protein synthesis (albumin)
Nephrotic Syndrome
Engorgement of alveolar capillaries, Alveolar septa edema and focal intra-alveolar hemorrhage are charactersitic of what disease?
Acute pulmonary congestion
amount of Air in air embolism that can elicit clinical effect
>100ml
platelet derived stimulus that amplifies platelet aggregation which leads to the formation of primary hemostatic plug
Thromboxane A2
a.k.a. Heart-Failure cells
Hemosiderin-laden macrophages
consolidation of platelet plug
Secondary Hemostasis
Three forms of Cerebral edema
Vasogenic Cytotoxic Interstitial
What is more severe, Venous thrombi or Arterial Thrombi?
Arterial Thrombi (obstruction at critical sites (Cerebral and Coronary Vessels)
What disease characterizes a deficiency in Glycoprotein IIb-IIIa complex
Gianzmann Thrombasthenia
the major activator of the extrinsic clotting cascade
Tissue Factor
what are the classical findings in Amniotic Fluid Embolism
Fetal Squamous cells Lanugo Hair Fat from vernix caseosa Mucin in the maternal pulmonary vasculature (derived from Fetal Respiratory tract and GIT)
Major determinant of extracellular fluid volume (electrolyte)
Sodium or Total Body Sodium
the most common site of arterial thrombus are (3)
Coronary, Cerebral and Femoral Arteries
How does protein C mediate its action?
inhibits clotting by inactivating factors 5a and 8a
A detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from its point of origin
Embolism
An event when an embolus passes through an interatrial or interventricular defect and gain access to the systemic circulation
Paradoxical Embolism
an event that is dependent on platelet cytoskeleton that creates an irreversibly fused mass of platelets
Platelet contraction
an irreversible cyclooxygenase inhibitor
aspirin
An amplifying process of enzymatic conversions culminating in thrombin formation
Coagulation Cascade
Anti-coagulant effects of endothelium
Thrombomodulin Heparin-like molecule Protein S Tissue factor pathway Inhibitor
a form of respiratory distress in the lungs where gas bubble in the vasculature causes edema, hemorrhage, focal atelectasis or emphysema
Chokes
Edema of the lower extremities and thrombosis of hepatic veins
Budd-Chiari Syndrome
What do you call a polymerized fibrin and platelet aggregate and which sequence of hemostasis does it emerge?
Permanent Plug;Thrombus and antithrombotic events
infusion of amniotic fluid/ fetal tissue in the maternal circulation via a tear in the placetal membranes or rupture of uterine veins
Amniotic Fluid Embolism
Patients with burns are suffering from what type of edema?
Local Edema
Pathologic result of hemostasis; clot formation in intact vessels
Thrombosis
What is the function of Calcium in the Coagulation cascade?
holds components together and ensures that clotting is localized to the surface of activated platelet or endothelium
An area of ischemic necrosis caused by occlusion of either arterial supply or venous drainage
Infarction
What are the Symptoms in the Fat Embolism Syndrome?
(P-A-N-T) Pulmonary Insufficiency Anemia Neurologic Symptoms Thrombocytopenia
occurs when individuals experience sudden decrease in atmospheric pressure
Decompression sickness
Characterized by platelet adhesion, activation and aggregation
Primary Hemostasis (2nd step)
Accumulation of blood that may be external or contained within a tissue
Hematoma
sudden or insidious onset of widespread fibrin thrombi in the microcirculation
Disseminated Intravascular Coagulation (DIC)
pinpoint hemorrhages (1-2mm); reflects rupture of a capillary
Petechiae
functions as an adhesion bridge between subendothelial collagen and glycoprotein Ib platelet receptor
Von Willebrand Factor
painful condition from the rapid formation of gas bubbles within skeletal muscles and supporting tissues in and about the joints
Bends
Facilitates drainage of the interstitium
Lymphatics
Activates plasmin in the fluid phase
Urokinase-like PA
thrombus that occur in the heart chambers or in the aortic lumen
Mural thrombus
what can be found inside the delta granules of platelets?
ADP and ATP Ionized calcium Histamine Serotonin Epinephrine
the most common site of venous thrombosis (90%)
Veins of lower extremities
Screens for factor 12, 11, 9, 8, 10, 5 and 2
Partial Thromboplastin Time
Thrombus that originates at sites of turbulence or endothelial injury
Arterial/Cardiac thrombi
3 anti-thrombotic properties of endothelium
Antiplatelet Anticoagulant Fibrinolytic
Px with a well defined autoimmune dse such as SLE
Secondary antiphospholipid Syndrome
what 2 opposing movements control movement of water and LMW solutes between intravascular and interstitial spaces
Vascular Hydrostatic Pressure and Plasma Colloid Oncotic Pressure
induces a hypercoagulable state by causing endothelial injury via activation of platelets and complement directly
Antiphospholipid Antibody Syndrome
the most common cause of pulmonary embolism
Deep Vein Thrombosis
what are the characteristic features of Chronic pulmonary congestion?
thickened and fibrotic septae, hemosiderin-laden cells
Hydrostatic pressure in the middle segment of the capillary
20 mmHg
hemorrhages associated with trauma (>3mm)
Purpura
Thrombus that originates at sites of stasis
Venous thrombi
inactivates free plasmin thus preventing excessive lysing of thrombi elsewhere in the body
Alpha-2 Plasmin inhibitor
Antiplatlet effects of Endothelium
Prostacyclin, NO, ADP
polymerizes an insoluble gel that encases platelets and other circulating cells in the secondary hemostatic plug
Fibrin
an edema that is caused by injury to the endothelium where vascular bed become leaky
Traumatic/Inflammatory Edema
