Hemodynamics Disorders, Thromboembolic Disease And Shock Flashcards
1
Q
Movement of water and solutes between intravascular and interstitial spaces is maintained by
A
Plasma colloid osmotic pressure and vascular hydrostatic pressure
2
Q
Increased intestitial fluid is caused by
A
Increased capillary pressure or diminished colloid osmotic pressure
3
Q
Increased interstitial fluid
A
Edema
4
Q
Fluid in the various cavities
A
Hydrothorax, hydropericardium, hydroperineum, ascites
5
Q
Severe systemic edema
A
Anasarca
6
Q
Systemic edema is most commonly due to
A
Congestive heart failure ( compromised right heart function leads to venous blood pooling)
7
Q
Reduced plasma volume leads to
A
Diminished renal perfusion and resultant renin production
8
Q
Effect of primary salth retention and water retention in osmotic and hydrostatic pressure
A
Increased hydrostatic; decreased osmotic
9
Q
Type of edema that may be diffuse or occur where hydrostatic pressures are greatest
A
Subcutaneous edema (influenced by gravity called dependent edema)
10
Q
Finger pressure over substantial subcutaneous edema leaves an imprint called as
A
Pitting edema
11
Q
Edema from hypoproteinemia is most evident where?
A
In loose connective tissue (ex. Eyelids causing periorbital edema)
12
Q
Charateristics of pulmonary edema
A
Frothy, blood-tinged mixture of air, edema fluid and rbc
13
Q
Appearance of generalized brain edema
A
Swollen brain with narrowed sulci and distended gyro flattened against the skull
14
Q
What is hyperemia?
A
Active process due to augmented blood inflow from arteriolar dilation
15
Q
Tissue in hyperemia appear red. Why?
A
Engorgement with oxygenated blood
16
Q
What is Congestion?
A
Passive process caused by impaired outflow from a tissue
17
Q
Color of tissue in congestion
A
Blue-red or cyanosis
18
Q
Worsening congestion leads to accumulation of
A
Deoxyhemoglobin
19
Q
Capillary bed congestion is commonly associated with
A
Interstitial edema
20
Q
In chronic congestion, capillary rupture may cause
A
Focal hemorrhage
21
Q
In liver, acute congestion manifests what?
A
Central vein and sinusoidal distention, central hepatocyte degeneration(occassionaly)
22
Q
Chronic congestion of liver appearance
A
Central regions of hepatic lobules are grossly red-brown and slightly depressed relative to surroundingg uncongested tan liver (nutmeg liver)
23
Q
Part of liver that is most subject to necrosis when liver perfussion is compromised
A
Centrilobular area( at distal end of hepatic blood supply)
24
Q
Release f blood into extravascular space
A
Hemorrhage
25
T or F: Capillary can occur with chronic digestion
True
26
Hemorrhage enclosed within a tissue
Hematoma
27
Minute, 1 to 2 mm hemorrhages in skin, mucous membranes or serosal surfaces
Petechiae
28
Petechiae occur due to
Increased intravascular pressure, low platelet count or defective platelet function
29
Minute, 1 to 2 mm hemorrhages in skin, mucous membranes or serosal surfaces
Petechiae
30
Petechiae occur due to
Increased intravascular pressure, low platelet count or defective platelet function
31
>3mm hemorrhages
Purpura
32
>1 to 2cm subcutaneous hematoma
Ecchymoses
33
Clinical significance of hemorrhage depends on what?
Volume and rate of blood loss
34
Chronic blood loss caused what type of anemia
Iron deficiency anemia
35
Hemostasis and thrombosis are related processes that depend upon 3 components:
Endothelial, platelets and coagulation cascade
36
Prostacylcin(PGI2) and NO inhibit platelet binding. T or F
True
37
Major activator of extrinsic clotting cascade
Tissue factor production
38
Platelet-ECM adhesion is mediated thru
vWF
39
Act as bridge bt. platelet receptors(mostly what?) and exposed collagen
vWF; glycoprotein Ib
40
Genetic deficiencies of vWF and Gp1b
Bernard-Soulier syndrome
41
Platelet aggregation in hemostasis is promoted by
ADP and TXA2
42
Function of ADP activation
Changes platelet GpIIb-IIIa receptor conformation to allow fibrinogen binding
43
GpIIb-IIIa deficiencies result to
Glanzmann thrombastenia
44
Action of TXA2
Platelet aggregation and potent vasoconstrictor
45
Action of PGI2
Inhibits platelet aggregation and poten vasodilator
46
What stage does extrinsic and intrinsic pathways converge?
Stage of factor X activation
47
Intrinsic cascade is initiated by
Activation of Hageman factor(factor XII)
48
Extrinsic cascade activated by
Tissue factor
49
Endothelial thrombomodulin modifies thrombin so it can cleave
Protein C and S(inactivate factors Va and VIIIa)
50
Free plasmin is rapidly neutralized by what?
Serum a2-plasmin inhibitor
51
Inappropriate activation of blood clotting im uninjured vasculature
Thrombosis
52
What is the Virchow's triad?
1. Endothelial injury
2. Alterations in normal blood flow
3. Hypercoagulability
53
What is the normal blood flow?
Laminar
54
Stasis causes thrombosis where?
Venous circulation, cardiac chambers and arterial aneurysm
55
Turbulence causes thromobosis where?
In arterial circulation and endothelial injury
56
Factor V gene mutation result to
Leiden mutation(factorV resistant to protein C inactivation)
57
Deficiencies of antithrombin III, protein C and S result to
Venous thrombosis and recurrent thromboembolism
58
Patient with antibodies against anionic phospholipid
Antiphospholipid antibody syndrome(activate platelets or interfere with protein C activity)
59
Venous thrombi occur where?
In sites of stasis and are occlusive
60
Arterial or cardiac thrombi begin where?
At sites of endothelial injury or turbulence
61
Arterial and cardiac mural thrombi have what gross and microscopic lines?
Lines of Zahn
62
Lines of Zahn are produced by what?
Pale layers of platelets and fibrin alternating with darker erythrocyte-rich layers
63
Phlebothrombosis most commonly affects what?
Veins of lower extrimities(deep and superficial leg veins)
64
Verrucous endocarditis occurs in?
SLE due to immune complex deposition; inflammation can cause valve scarring
65
Superficial thrombi usually occur in
Varicose saphenous vein (causing local congestion amd pain)
66
Deep thrombi usually occur in
Larger veins above the knee(popliteal,femoral,iliac veins)
67
Major cause of arterial thrombi due to abnormal flow and endothelial damage
Atherosclerosis
68
Prime targets of cardiac and aortic mural thrombi
Brain,kidneys and spleen
69
Widespread fibrin microthrombi in the microcirculation
Disseminated intravasculat coagulation
70
Any intravascular solid, liquid or gaseous mass carried by blood flow to a site from its origin
Embolism(arise from thrombi)
71
Emboli pass thru atrial or ventricular defects into systemic circulation
Paradoxical embolism
72
Multiple emboli overtime can cause
pulmonary hypertension and right ventricular failure
73
Emboli in the arterial circulation
Systemic thromboembolism
74
Major sites form arteriolar embolization are
Lower extremities(75%) and brain(10%)
75
Consequences of arterial emboli depend on what?
1. Collateral vascular supply
2. Tissue vulnerability to ischemia
3. Vessel caliber
76
Pulmonary embolization of microscopic fat globules occurs when?
After fractures of long bones or rarely after burns and soft tissue trauma
77
Gas bubbles within the circulation that obstruct vascular blood flow and cause ishemia
Air embolism
78
Special form of air embolism caused by sudden changes in atmospheric pressure
Decompression sickness
79
Formation of gas bubbles in skeletal muscles and joints causes?
Painful bends
80
In lungs, hemorrhage, edema and focal emphysema lead to...
Respiratory distress or strokes
81
A more chronic form of decompression sickness
Caisson diease
82
Second objective of nutritional support
To meet the substrate requirements for protein synthesis
83
Early enteral nutrition is associated with what?
1. Better small intestinal carbohydrate absorption
2. Shorter duration of mechanical ventilation
3. Shorter time in ICU
84
Early enteral nutrition may positively modulate...
Initial hypermetabolic response and help to maintain mucosal immunity
85
Refer to providing a minimal amount of enteral feedings
Trophic feedings
86
Best studied immunonutrients
Glutamine, arginine, omega-3 PUFA
87
Most abundant amino acid in the human body
Glutamine(75% found in the skeletal muscle)
88
Major fuel source for enterocytes
Glutamine
89
Use of indirect calorimetry un critically ill patient is what?
Labor intensive and leads to overestimation of caloric requirements
90
Volume of blood pumped by each ventricle per minute
Cardiac output
91
Represents the total blood flow in pulmonary and systemic circuits.
Cardiac output
92
Cardiac output is the product of?
Heart rate and stroke volume.
93
Indicator of ventricular function
Cardiac index
94
Difference in dynamic pressure between two points along a blood vessel
Perfusion pressure(driving pressure)
95
Local control of perfusion depends on what?
Continuous modulation of microvascular beds by HORMONAL, NEURAL, METABOLIC AND HEMODYNAMIC FACTORS
96
Sum of the factors that determine regional blood flow in each organ.
Peripheral vascular resistance
97
2/3s of the resistance in the systemic vasculature is determined by?
Arterioles
98
Assessment of heart's response to inflow and outflow relies on what?
Cardiac reflexes, cardiac muscle integrity and neurohormonal regulation.
99
Main functions of aorta and arteries
To transport blood to organs and convert pulsatile flow into sustained regular flow.
100
Pulsatile flow of aorta and arteries come from?
Elastic properties of aorta and resistance produced by the arteriolar spinchters
101
Main functions of aorta and arteries
To transport blood to organs and convert pulsatile flow into sustained regular flow.
102
Pulsatile flow of aorta and arteries come from?
Elastic properties of aorta and resistance produced by the arteriolar spinchters
103
Important contributor to all forms of hyperemia and edema
Microcirculation (target in septic shock)
104
Provides continuous partition between blood and tissues
Endothelium
105
Important contributor to all forms of hyperemia and edema
Microcirculation (target in septic shock)
106
Provides continuous partition between blood and tissues
Endothelium
107
How many of TBV resides in venous system?
64%
108
Provides means for the delivery of nutrients and elimination of water
Interstitial fluid between cells
109
Most of interstitial water is bound to what?
Dense network of glycosaminoglycans
110
Hemodynamic disorders is charactized by what that results in organ and cellular injury?
Disturbed perfusion
111
An excess of blood in an organ
Hyperemia
112
Increased blood supply in active hyperemia occurs by what?
Arteriolar dilation and recruitment of unperfused capillaries
113
Most striking active hyperemia occurs in association with what?
With inflammation
114
Reactive hyperemia occurs after what?
After temporary interruption of blood supply or ischemia
115
Engorgement of an organ with venous blood
Passive hyperemia or congestion
116
Acute passiv congestion is a clinically a consequence of what?
Acute left or right ventricular failure
117
With acute failure of right ventricle, what organ can becom severely congested?
Liver
118
Thrombosis of the hepatic vein
Budd-Chiari syndrome
119
It impedes blood flow out of the lungs and gives rise to chronic passive pulmonary congestion.
Chronic left ventricular failure
120
Most commom cause of death after major orthopedic surgery
Pulmonary embolism
121
Most frequent nonobstetric cause of postpartum death
Pulmonary embolism
122
Pulmonary infarction is usually seen in
Congestive heart failure or chronic lung disease
123
Most serious effect of fluid overload
Induction of cerebral edema or congestive heart failure in patients with cardiac dysfunction
124
Major cause of morbidity and mortality in ICU
Shock
125
Primary goal in treating shock
Rapid restoration of systemic blood flow
126
Most common cause of septic shock
Septicemia with gram negative organisms
127
Most potent stimulus for TNF release
LPS
128
Important hemodynamic parameters
Cardiac output, perfusion pressure and peripheral vascular resistance
129
Most consistent genetic associations with arterial thrombosis are with ?
Factor VII and fibrinogen
130
Major complication of thrombi in any location in heart is?
Detachment of fragments and their lodging in blood vessels at distant sites (embolization)
131
Most common gene variant associated with venous thrombosis. Is?
Factor V leiden
132
In severe cases, complete or near-complete venous obstruction in a limb may result in what?
Phlegmasia cerulea dolens(pain, swelling,edema and cyanosis)
133
Most common embolus
Thromboembolus
134
Most common source of arterial thromboemboli which usually arise from mural thrombi or diseased valves
Heart
135
Second most common cause of death in sport diving
Air embolism
136
Most serious effect of fluid overload is what?
Induction of cerebral edema or congestive heart failure in pts with cardiac dysfunction
137
A late sign in shock and indicates failure of compensatio
Hypotension
138
Common consequence of initial decrease in tissue perfusion
Cellular hypoxia
139
End result if shock
Multiple organ dysfunction syndrome
