HEMODYNAMICS HY PP

Question 1

EXUDATE VS TRANSUDATE

Answer 1

Transudate

a. This noninflammatory edema fluid results from altered intravascular hydrostatic or osmotic pressure.
b. Has low protein content
c. specific gravity= less than 1.012.

Exudate
a. This edema fluid results from increased vascular permeability caused by inflammation.
b. It has a high protein content,
specific gravity =exceeding 1.020,

characteristically contains large numbers of inflammatory leukocytes.
Because the metabolically active leukocytes consume glucose, the glucose content is often =greatly reduced

Question 2

DEFINE THROMBUS,

antithrombotic and prothrombotic activity of endothelium

Answer 2

THROMBUS
Thrombosis is intravascular coagulation of blood, often causing significant interruption of blood flow.
1. Can occur in an artery or vein
2. Most common location is the deep veins (DVT) of the leg below the knee

ANTITHROMOTIC ACTIVITY
1) Platelet inhbitory effect-
releases factors to inhbiti platelet activation and aggregation
PGI2
NO both PGI2 and NO inhibt platelet aggregation
Adenosine diphosphatase degrades ADP further -inhbits platelet aggregation
endothelial cells bind and alter activity of thrombin

2) Anticoagulant effect
Thrombomodulin C binds thrombin (alters from pro-anticoagulant effect) hence activates PoteinC in pres of proteinS (cofactor)
TFPI tisse Factor Pathway Inhibitor inactivates VIIA complement
Heparin Like Molecule - activates antithrombin3, which inactivates thrmobin and fac 9,10,11,12

Fibrinolytiv effect via tPA , tissue plasminogen activator

PROTHROMBIC ACTIVITY

1) Platelet activation - secretes VWF(cofactor for platelet matrix aggregation)
2) Procoagulant effect via TF
3) AntiFibrinolytic effect inhibits PAIs Plasminogen-activation, limits fibrinolysis and tend to favour thrombosis

Question 3

EDEMA DEFINITION

AND TYPES

Answer 3

This is an abnormal accumulation of fluid in interstitial tissue spaces or body cavities
B. Types of edema
1. Anasarca 
2. Hydrothorax 
3. Hydropericardium 
4. Hydroperitoneum (ascites) 
5. Transudate
6. Exudate

Question 4

DEFINE SHOCK

Answer 4

shock is gernalized decrease in tissue perfusion
blood is not going into microcirculation
gernalized phenomenon

This condition represents circulatory collapse with resultant hypoperfusion and decreased
oxygenation of tissues

Question 5

PATHOGENEISU OF CARDIOGENIC SHOCK

EMBOLI

Answer 5

dec blood in micrciruckation due to comprmised heart force , unable to pump the blood
genralized tissue hypoxia
varioious causes of cardiogenic shock
th treatment is entriely different than hypovolumic shock

DEF by book
is circulatory collapse resulting from pump failure of the left ventricle,
most often caused by massive myocardial infarction

Question 6

DEFINE SHOCK, DISCUSS IN DETAIL PATHOGENEISU OF CARDIOGENIC SHOCK

Answer 6

Septic shock is most characteristically associated with gram-negative infections, which
cause gram-negative endotoxemia: also occurs with gram-positive and other infections.
a. Initially, vasodilation may result in an overall increase in blood flow; however, significant
peripheral pooling of blood from peripheral vasodilation results in relative
hypovolemia and impaired perfusion.
b. Lipopolysaccharide (endotoxin from the outer membrane of gram-negative bacteria)
and other bacterial products appear to induce a cascade of cytokines (e.g., TNF, IL-1,
IL-6, and IL-8), activate complement components and the kinin system, and cause
direct toxic injury to vessels.
c. E ndothelial injury can lead to activation of the coagulation pathways and to DIC.
d. A group of toxic molecules, the so-called superantigens, produces septic shock-like
manifestations. The release of these molecules occurs in the “toxic shock syndrome,”
which is most often associated with Staphylococcus aureus infection.
e. T he systemic inflammatory response syndrome (SIRS) is a generalized immune and
inflammatory reaction that may complicate septic shock. This constellation of findings
may also be caused by a number of other mechanisms such as infection, ischemia,
trauma, and so on.
f. T he multiple organ dysfunction syndrome (MODS), a possible outcome of septic shock, is
characterized by systemic shut-down of vital processes, requiring major intervention
to maintain homeostasis.