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General Pathology > Hemodynamics Disorders, Thromboembolic Disease And Shock > Flashcards

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

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2
Q

Increased intestitial fluid is caused by

A

Increased capillary pressure or diminished colloid osmotic pressure

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3
Q

Increased interstitial fluid

A

Edema

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4
Q

Fluid in the various cavities

A

Hydrothorax, hydropericardium, hydroperineum, ascites

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5
Q

Severe systemic edema

A

Anasarca

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6
Q

Systemic edema is most commonly due to

A

Congestive heart failure ( compromised right heart function leads to venous blood pooling)

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7
Q

Reduced plasma volume leads to

A

Diminished renal perfusion and resultant renin production

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8
Q

Effect of primary salth retention and water retention in osmotic and hydrostatic pressure

A

Increased hydrostatic; decreased osmotic

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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)

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10
Q

Finger pressure over substantial subcutaneous edema leaves an imprint called as

A

Pitting edema

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11
Q

Edema from hypoproteinemia is most evident where?

A

In loose connective tissue (ex. Eyelids causing periorbital edema)

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12
Q

Charateristics of pulmonary edema

A

Frothy, blood-tinged mixture of air, edema fluid and rbc

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13
Q

Appearance of generalized brain edema

A

Swollen brain with narrowed sulci and distended gyro flattened against the skull

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14
Q

What is hyperemia?

A

Active process due to augmented blood inflow from arteriolar dilation

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15
Q

Tissue in hyperemia appear red. Why?

A

Engorgement with oxygenated blood

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16
Q

What is Congestion?

A

Passive process caused by impaired outflow from a tissue

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17
Q

Color of tissue in congestion

A

Blue-red or cyanosis

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18
Q

Worsening congestion leads to accumulation of

A

Deoxyhemoglobin

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19
Q

Capillary bed congestion is commonly associated with

A

Interstitial edema

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20
Q

In chronic congestion, capillary rupture may cause

A

Focal hemorrhage

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21
Q

In liver, acute congestion manifests what?

A

Central vein and sinusoidal distention, central hepatocyte degeneration(occassionaly)

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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)

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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)

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24
Q

Release f blood into extravascular space

A

Hemorrhage

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25
Q

T or F: Capillary can occur with chronic digestion

A

True

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26
Q

Hemorrhage enclosed within a tissue

A

Hematoma

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27
Q

Minute, 1 to 2 mm hemorrhages in skin, mucous membranes or serosal surfaces

A

Petechiae

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28
Q

Petechiae occur due to

A

Increased intravascular pressure, low platelet count or defective platelet function

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29
Q

Minute, 1 to 2 mm hemorrhages in skin, mucous membranes or serosal surfaces

A

Petechiae

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30
Q

Petechiae occur due to

A

Increased intravascular pressure, low platelet count or defective platelet function

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31
Q

> 3mm hemorrhages

A

Purpura

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32
Q

> 1 to 2cm subcutaneous hematoma

A

Ecchymoses

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33
Q

Clinical significance of hemorrhage depends on what?

A

Volume and rate of blood loss

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34
Q

Chronic blood loss caused what type of anemia

A

Iron deficiency anemia

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35
Q

Hemostasis and thrombosis are related processes that depend upon 3 components:

A

Endothelial, platelets and coagulation cascade

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36
Q

Prostacylcin(PGI2) and NO inhibit platelet binding. T or F

A

True

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37
Q

Major activator of extrinsic clotting cascade

A

Tissue factor production

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38
Q

Platelet-ECM adhesion is mediated thru

A

vWF

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39
Q

Act as bridge bt. platelet receptors(mostly what?) and exposed collagen

A

vWF; glycoprotein Ib

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40
Q

Genetic deficiencies of vWF and Gp1b

A

Bernard-Soulier syndrome

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41
Q

Platelet aggregation in hemostasis is promoted by

A

ADP and TXA2

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42
Q

Function of ADP activation

A

Changes platelet GpIIb-IIIa receptor conformation to allow fibrinogen binding

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43
Q

GpIIb-IIIa deficiencies result to

A

Glanzmann thrombastenia

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44
Q

Action of TXA2

A

Platelet aggregation and potent vasoconstrictor

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45
Q

Action of PGI2

A

Inhibits platelet aggregation and poten vasodilator

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46
Q

What stage does extrinsic and intrinsic pathways converge?

A

Stage of factor X activation

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47
Q

Intrinsic cascade is initiated by

A

Activation of Hageman factor(factor XII)

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48
Q

Extrinsic cascade activated by

A

Tissue factor

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49
Q

Endothelial thrombomodulin modifies thrombin so it can cleave

A

Protein C and S(inactivate factors Va and VIIIa)

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50
Q

Free plasmin is rapidly neutralized by what?

A

Serum a2-plasmin inhibitor

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51
Q

Inappropriate activation of blood clotting im uninjured vasculature

A

Thrombosis

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52
Q

What is the Virchow’s triad?

A
  1. Endothelial injury
  2. Alterations in normal blood flow
  3. Hypercoagulability
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53
Q

What is the normal blood flow?

A

Laminar

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54
Q

Stasis causes thrombosis where?

A

Venous circulation, cardiac chambers and arterial aneurysm

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55
Q

Turbulence causes thromobosis where?

A

In arterial circulation and endothelial injury

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56
Q

Factor V gene mutation result to

A

Leiden mutation(factorV resistant to protein C inactivation)

57
Q

Deficiencies of antithrombin III, protein C and S result to

A

Venous thrombosis and recurrent thromboembolism

58
Q

Patient with antibodies against anionic phospholipid

A

Antiphospholipid antibody syndrome(activate platelets or interfere with protein C activity)

59
Q

Venous thrombi occur where?

A

In sites of stasis and are occlusive

60
Q

Arterial or cardiac thrombi begin where?

A

At sites of endothelial injury or turbulence

61
Q

Arterial and cardiac mural thrombi have what gross and microscopic lines?

A

Lines of Zahn

62
Q

Lines of Zahn are produced by what?

A

Pale layers of platelets and fibrin alternating with darker erythrocyte-rich layers

63
Q

Phlebothrombosis most commonly affects what?

A

Veins of lower extrimities(deep and superficial leg veins)

64
Q

Verrucous endocarditis occurs in?

A

SLE due to immune complex deposition; inflammation can cause valve scarring

65
Q

Superficial thrombi usually occur in

A

Varicose saphenous vein (causing local congestion amd pain)

66
Q

Deep thrombi usually occur in

A

Larger veins above the knee(popliteal,femoral,iliac veins)

67
Q

Major cause of arterial thrombi due to abnormal flow and endothelial damage

A

Atherosclerosis

68
Q

Prime targets of cardiac and aortic mural thrombi

A

Brain,kidneys and spleen

69
Q

Widespread fibrin microthrombi in the microcirculation

A

Disseminated intravasculat coagulation

70
Q

Any intravascular solid, liquid or gaseous mass carried by blood flow to a site from its origin

A

Embolism(arise from thrombi)

71
Q

Emboli pass thru atrial or ventricular defects into systemic circulation

A

Paradoxical embolism

72
Q

Multiple emboli overtime can cause

A

pulmonary hypertension and right ventricular failure

73
Q

Emboli in the arterial circulation

A

Systemic thromboembolism

74
Q

Major sites form arteriolar embolization are

A

Lower extremities(75%) and brain(10%)

75
Q

Consequences of arterial emboli depend on what?

A
  1. Collateral vascular supply
  2. Tissue vulnerability to ischemia
  3. Vessel caliber
76
Q

Pulmonary embolization of microscopic fat globules occurs when?

A

After fractures of long bones or rarely after burns and soft tissue trauma

77
Q

Gas bubbles within the circulation that obstruct vascular blood flow and cause ishemia

A

Air embolism

78
Q

Special form of air embolism caused by sudden changes in atmospheric pressure

A

Decompression sickness

79
Q

Formation of gas bubbles in skeletal muscles and joints causes?

A

Painful bends

80
Q

In lungs, hemorrhage, edema and focal emphysema lead to…

A

Respiratory distress or strokes

81
Q

A more chronic form of decompression sickness

A

Caisson diease

82
Q

Second objective of nutritional support

A

To meet the substrate requirements for protein synthesis

83
Q

Early enteral nutrition is associated with what?

A
  1. Better small intestinal carbohydrate absorption
  2. Shorter duration of mechanical ventilation
  3. Shorter time in ICU
84
Q

Early enteral nutrition may positively modulate…

A

Initial hypermetabolic response and help to maintain mucosal immunity

85
Q

Refer to providing a minimal amount of enteral feedings

A

Trophic feedings

86
Q

Best studied immunonutrients

A

Glutamine, arginine, omega-3 PUFA

87
Q

Most abundant amino acid in the human body

A

Glutamine(75% found in the skeletal muscle)

88
Q

Major fuel source for enterocytes

A

Glutamine

89
Q

Use of indirect calorimetry un critically ill patient is what?

A

Labor intensive and leads to overestimation of caloric requirements

90
Q

Volume of blood pumped by each ventricle per minute

A

Cardiac output

91
Q

Represents the total blood flow in pulmonary and systemic circuits.

A

Cardiac output

92
Q

Cardiac output is the product of?

A

Heart rate and stroke volume.

93
Q

Indicator of ventricular function

A

Cardiac index

94
Q

Difference in dynamic pressure between two points along a blood vessel

A

Perfusion pressure(driving pressure)

95
Q

Local control of perfusion depends on what?

A

Continuous modulation of microvascular beds by HORMONAL, NEURAL, METABOLIC AND HEMODYNAMIC FACTORS

96
Q

Sum of the factors that determine regional blood flow in each organ.

A

Peripheral vascular resistance

97
Q

2/3s of the resistance in the systemic vasculature is determined by?

A

Arterioles

98
Q

Assessment of heart’s response to inflow and outflow relies on what?

A

Cardiac reflexes, cardiac muscle integrity and neurohormonal regulation.

99
Q

Main functions of aorta and arteries

A

To transport blood to organs and convert pulsatile flow into sustained regular flow.

100
Q

Pulsatile flow of aorta and arteries come from?

A

Elastic properties of aorta and resistance produced by the arteriolar spinchters

101
Q

Main functions of aorta and arteries

A

To transport blood to organs and convert pulsatile flow into sustained regular flow.

102
Q

Pulsatile flow of aorta and arteries come from?

A

Elastic properties of aorta and resistance produced by the arteriolar spinchters

103
Q

Important contributor to all forms of hyperemia and edema

A

Microcirculation (target in septic shock)

104
Q

Provides continuous partition between blood and tissues

A

Endothelium

105
Q

Important contributor to all forms of hyperemia and edema

A

Microcirculation (target in septic shock)

106
Q

Provides continuous partition between blood and tissues

A

Endothelium

107
Q

How many of TBV resides in venous system?

A

64%

108
Q

Provides means for the delivery of nutrients and elimination of water

A

Interstitial fluid between cells

109
Q

Most of interstitial water is bound to what?

A

Dense network of glycosaminoglycans

110
Q

Hemodynamic disorders is charactized by what that results in organ and cellular injury?

A

Disturbed perfusion

111
Q

An excess of blood in an organ

A

Hyperemia

112
Q

Increased blood supply in active hyperemia occurs by what?

A

Arteriolar dilation and recruitment of unperfused capillaries

113
Q

Most striking active hyperemia occurs in association with what?

A

With inflammation

114
Q

Reactive hyperemia occurs after what?

A

After temporary interruption of blood supply or ischemia

115
Q

Engorgement of an organ with venous blood

A

Passive hyperemia or congestion

116
Q

Acute passiv congestion is a clinically a consequence of what?

A

Acute left or right ventricular failure

117
Q

With acute failure of right ventricle, what organ can becom severely congested?

A

Liver

118
Q

Thrombosis of the hepatic vein

A

Budd-Chiari syndrome

119
Q

It impedes blood flow out of the lungs and gives rise to chronic passive pulmonary congestion.

A

Chronic left ventricular failure

120
Q

Most commom cause of death after major orthopedic surgery

A

Pulmonary embolism

121
Q

Most frequent nonobstetric cause of postpartum death

A

Pulmonary embolism

122
Q

Pulmonary infarction is usually seen in

A

Congestive heart failure or chronic lung disease

123
Q

Most serious effect of fluid overload

A

Induction of cerebral edema or congestive heart failure in patients with cardiac dysfunction

124
Q

Major cause of morbidity and mortality in ICU

A

Shock

125
Q

Primary goal in treating shock

A

Rapid restoration of systemic blood flow

126
Q

Most common cause of septic shock

A

Septicemia with gram negative organisms

127
Q

Most potent stimulus for TNF release

A

LPS

128
Q

Important hemodynamic parameters

A

Cardiac output, perfusion pressure and peripheral vascular resistance

129
Q

Most consistent genetic associations with arterial thrombosis are with ?

A

Factor VII and fibrinogen

130
Q

Major complication of thrombi in any location in heart is?

A

Detachment of fragments and their lodging in blood vessels at distant sites (embolization)

131
Q

Most common gene variant associated with venous thrombosis. Is?

A

Factor V leiden

132
Q

In severe cases, complete or near-complete venous obstruction in a limb may result in what?

A

Phlegmasia cerulea dolens(pain, swelling,edema and cyanosis)

133
Q

Most common embolus

A

Thromboembolus

134
Q

Most common source of arterial thromboemboli which usually arise from mural thrombi or diseased valves

A

Heart

135
Q

Second most common cause of death in sport diving

A

Air embolism

136
Q

Most serious effect of fluid overload is what?

A

Induction of cerebral edema or congestive heart failure in pts with cardiac dysfunction

137
Q

A late sign in shock and indicates failure of compensatio

A

Hypotension

138
Q

Common consequence of initial decrease in tissue perfusion

A

Cellular hypoxia

139
Q

End result if shock

A

Multiple organ dysfunction syndrome

General Pathology (8 decks)

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