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Pathology > Hemodynamics I > Flashcards

Hemodynamics I Flashcards

1
Q

What is edema?

A

Swelling of tissue due to increased fluid in interstitial spaces.

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2
Q

What is ascites?

A

Fluid in the abdominal cavity.

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3
Q

What is anasarca?

A

Generalized edema.

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4
Q

What is hyperemia?

A

Erythema; an active increase in arterial blood flow.

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5
Q

What is congestion?

A

Passive decrease in venous outflow.

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6
Q

What is hemorrhage?

A

Extravasation of blood due to blood vessel rupture.

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7
Q

What is hematoma?

A

Hemorrhage enclosed within tissue.

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8
Q

What is petechia?

A

Tiny (1-2 mm) hemorrhage due to platelet deficiency.

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9
Q

What is hemostasis?

A
  1. The maintenance of blood in a free-flowing liquid state in normal blood vessels
  2. The formation of a blood clot at a site of vascular injury
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10
Q

What are platelets?

A

Anucleate cellular components of blood.

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11
Q

What are platelets important in?

A

In initiation and propagation of clotting.

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12
Q

Do platelets have granules?

A

Yes, but no nucleus.

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13
Q

What is thrombosis?

A

Inappropriate formation of blood clot in a blood vessel; usually occlusive.

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14
Q

What is hypercoagulability?

A

Abnormal tendency to form blood clots.

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15
Q

What is coagulopathy?

A

Abnormal tendency to bleed.

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16
Q

What is an embolus?

A

Detached intravascular solid, liquid, or gaseous mass carried by blood to a site distant from its point of origin.

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17
Q

What is an infarction?

A

Area of ischemic necrosis.

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18
Q

Generalized edema due to renal failure initially appears where?

A

Tissues with loose connective tissue matrix i.e. periorbital edema.

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19
Q

What is pitting edema?

A

Transient pit forms in the skin at site of finger pressure.

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20
Q

What are the 5 pathophysiologic categories of edema?

A
  1. Increased hydrostatic pressure
  2. Decreased plasma osmotic pressure
  3. Sodium retention
  4. Inflammation
  5. Lymphatic obstruction
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21
Q

What are the 4 most common causes of edema?

A
  1. Increased hydrostatic pressure
  2. Decreased plasma osmotic pressure
  3. Sodium retention
  4. Inflammation
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22
Q

What are 3 examples of edema due to increased hydrostatic pressure?

A
  1. Lungs: due to left heart failure
  2. Lower body: due to right heart failure
  3. Leg: due to deep venous thrombosis
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23
Q

What is dependent edema?

A

Edema due to increased hydrostatic pressure is worse in legs when standing and sacrum when lying down.

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24
Q

What are 2 example of edema due to decreased plasma osmotic pressure?

A
  1. Nephrotic syndrome: due to protein loss.
  2. Hepatic cirrhosis: due to increased hydrostatic pressure in portal venous system and decreased plasma osmotic pressure due to protein loss into ascites and deficient hepatic protein synthesis
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25
Q

T or F. Edema due to sodium retention is always generalized with increased hydrostatic pressure.

A

T.

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26
Q

What are 2 types of edema due to inflammation?

A
  1. Localized: at site of infection

2. Generalized: with SIRS or sepsis

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27
Q

What is edema due to lymphatic obstruction called?

A

Lymphedema.

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28
Q

Lymphedema can be caused by what 5 things?

A
  1. Tumor
  2. Inflammation
  3. Surgery
  4. Radiation
  5. Scar
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29
Q

Is lympedema usually localized or generalized?

A

Localized.

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30
Q

What is peau d’ orange?

A

Lymphedema from breast cancer causes skin over tumor to resemble the skin of an orange.

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31
Q

What is the most common cause of pulmonary edema?

A

Left heart failure. Others: ARDS, hypersensitivity reaction, pneumonia, and renal failure.

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32
Q

What kind of fluid is found in pulmonary edema?

A

Frothy fluid. Pink too if blood present.

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33
Q

What is the symptom of pulmondary edema?

A

Dyspnea.

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34
Q

What is the sign of pulmonary edema?

A

Pulmonary crackles.

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35
Q

Airspaces in pulmonary alveolar edema are filled with what?

A

Pink, proteinaceous fluid.

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36
Q

Localized cerebral edema is caused by what 2 things?

A
  1. Abscess

2. Tumor

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37
Q

Generalized cerebral edema is caused by what?

A

Encephalitis.

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38
Q

What does the brain look like with generalized cerebral edema?

A

Swollen gyri and narrowed sulci.

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39
Q

How can cerebral edema be fatal?

A

Herniation of cerebellar tonsils into foramen magnum compressing the brainstem’s respiratory center.

40
Q

When congestion is due to heart failure, what happens to the liver? Lung?

A

Nutmeg liver. Hemophages in alveoli.

41
Q

What is nutmeg liver?

A

Alternating red centrilobular and tan peripherilobular tissue.

42
Q

What is a purpura?

A

Medium (3-10 mm) bleed due to vasculitis, vessel fragility, etc.

43
Q

What is an ecchymosis?

A

Larger (over 1 cm) subcutaneous hemorrhage. Often called a bruise.

44
Q

Why do ecchymoses go from red-blue to blue-green to gold-brown?

A

Color change due to progression of hemoglobin break down.

45
Q

What is hemothorax?

A

Hemorrhage into a pleural cavity.

46
Q

What are the 4 stages of hemostasis at site of vascular injury?

A
  1. Vasoconstriction
  2. Primary hemostasis
  3. Secondary hemostasis
  4. Thrombus and antithrombotic events
47
Q

Describe the first stage of hemostasis: vasoconstriction.

A

Brief arteriolar vasoconstriction mediated by reflex neurogenic mechanisms. Increased by local secretion of vasoconstrictors.

48
Q

What is endothelin?

A

A potent endothelium-derived vasoconstrictor.

49
Q

Describe the second stage of hemostasis: primary hemostasis.

A

Platelet adhesion to thrombogenic ECM-activation-shape change-GpIIb/IIIa binds fibrinogen-aggregation-release of ADP and TXA2-platelet recruitment and aggregation.

50
Q

Describe the third stage of hemostasis: secondary hemostasis.

A

Coagulation cascade activated by tissue factor and platelet factors. Results in activated thrombin.

51
Q

What does activated thrombin do?

A

Cleaves fibrinogen to fibrin to solidify primary hemostatic plug.

52
Q

Describe the fourth stage of hemostasis: thrombus maturation and antithrombotic events.

A

Formation of solid permanent plug of aggregated platelets that are polymerized by fibrin. Counter-regulatory mechanisms contain the hemostatic plug to the site of injury.

53
Q

What are the 3 predisposing factors to thrombosis?

A
  1. Endothelial injury
  2. Abnormal blood flow
  3. Hypercoagulability
54
Q

Thrombosis is more common in what but more serious in what?

A

More common in veins. More serious in arteries.

55
Q

What is the most important factor predisposing to thrombosis?

A

Endothelial injury.

56
Q

What are 3 ways endothelial injury can occur, other than trauma?

A
  1. Hemodynamic stress of HTN
  2. Toxicity of hypercholesterolemia
  3. Smoking: absorbed tobacco products can increase EC procoagulant factors and decrease anticoagulant factors
57
Q

What 2 states of abnormal blood flow predispose to thrombosis?

A
  1. Turbulence: over ulcerated atherosclerotic plaques

2. Stasis: in arterial aneurysms

58
Q

What are the 2 forms of hypercoagulability?

A
  1. Primary: congenital/genetic

2. Secondary: acquired

59
Q

What are 6 examples of primary hypercoagulability diseases?

A
  1. Factor V Leiden mutation
  2. Prothrombin G20210A mutation
  3. Methylenetetrahydrofolate reductase homozygous C677T mutation
  4. Anti-thrombin-3 deficiency
  5. Protein C deficiency
  6. Protein S deficiency
60
Q

What are 7 way to get a secondary hypercoagulability disease?

A
  1. Surgery
  2. Cancer
  3. Trauma
  4. Bed-ridden state
  5. Disseminated intravascular coagulation
  6. Heparin-induced thrombocytopenia
  7. Antiphospholipid antibody syndrome
61
Q

T or F. Surgery inevitably creates a hypercoagulable state in the patient but anticoag therapy risks bleeding in the surgical site.

A

T.

62
Q

T or F. Surgery to treat morbidity causes morbidity including hypercoag, adhesions, and other conditions.

A

T.

63
Q

What is a white thrombi and where is it found?

A

Rich in platelets. Arterial.

64
Q

What is a red thrombi and where is it found?

A

Rich in erythrocytes. Venous.

65
Q

Where does a mural thrombi form?

A

On the wall of the heart.

66
Q

Thrombi on heart valves are called what?

A

Vegetations.

67
Q

What are some examples of vegetations?

A

Non-bacterial thrombotic endocarditis and Libman-Sacks endocarditis in SLE.

68
Q

What are the 4 fates of a thrombus?

A
  1. Dissolution
  2. Propagation
  3. Embolization
  4. Organization (and recanalization)
69
Q

What happens in the organization of a thrombus?

A

Fibroblasts convert it to fibrous tissue with ingrowth of new capillaries which can recanalize an occluded vessel.

70
Q

What is the danger of catheters?

A

Clots form around EVERY catheter which can lead to embolization and infection of the clot.

71
Q

What are 6 types of emboli?

A
  1. Thrombus (most common)
  2. Atheromatous debri
  3. Fat
  4. Air
  5. Amniotic fluid
  6. Tumor fragments
72
Q

T or F. Most pulmonary thromboembolisms are clinically silent.

A

T.

73
Q

What do most pulmonary thromboembolisms form in the legs?

A

Deep vein thrombosis.

74
Q

What can medium sized pulmonary thromboembolisms cause?

A

Hemorrhagic infarction if bronchial arterial portion of the lung’s dual blood supply is impaired.

75
Q

What can large sized pulmonary thromboembolisms cause?

A

Acute cor pulmonale (right heart failure) and sudden death.

76
Q

Where are saddle emboli found?

A

Pulmonary trunk.

77
Q

What are paradoxical emboli?

A

Emboli that pass through patent foramen ovale or atrial septal defect to go to organs besides lungs.

78
Q

T or F. Numerous small emboli can cause pulmonary HTN.

A

T.

79
Q

Systemic thromboembolisms most commonly come from where and go to where?

A

Come from heart. Go to legs or brain.

80
Q

Fat emboli are most commonly from what?

A

Long bone fractures.

81
Q

T or F. Most fat emboli are clinically silent.

A

T.

82
Q

Fat emboli can cause a syndrome consisting of what features?

A

Sudden onset dyspnea, tachypnea, tachycardia, irritability, restlessness, anemia, and thrombocytopenia.

83
Q

How big must an air embolism be to have a clinical effect?

A

More than 100 mL.

84
Q

Can air emboli be fatal?

A

Yes.

85
Q

What are 4 causes of air emboli?

A
  1. Getting air into IV infusion
  2. Sudden change in atmospheric pressure
  3. Chest wall injury
  4. Back surgery in prone position
86
Q

What is an amniotic fluid embolism caused by?

A

Tear in placental membrane.

87
Q

What 4 things get into pulmonary circulation with amniotic fluid emboli?

A
  1. Fetal squamous cells
  2. Lanugo hair
  3. Vernix caseosa fat
  4. Mucin
88
Q

In gross morphology, what is indicative of an infarct?

A

Wedge-shaped necrosis.

89
Q

What are white anemic infarcts?

A

Increased density of tissue prevents RBCs from diffusing through necrotic tissue.

90
Q

Where are white anemic infarcts found?

A

In solid organs with end-arterial circulation i.e. heart, spleen, kidney.

91
Q

What are red hemorrhagic infarcts?

A

Loose-textured tissue allows RBCs to diffuse through necrotic tissue.

92
Q

Where are red hemorrhagic infarcts found?

A

Typical with venous occlusion, dual or anastomosing blood supply organs, or reperfusion.

93
Q

Coagulative necrosis is apparent how many hours after insult?

A

12-18 hours.

94
Q

In coagulative necrosis, the acute inflammatory response peaks when and is then followed by infiltration of what cell types?

A

1-2 days. Macrophages and fibroblasts.

95
Q

The likelihood of an infarction taking place is determined by what 4 things?

A
  1. Vulnerability to hypoxia
  2. Rate of development of occlusion
  3. Nature of blood supply
  4. Oxygen content of blood
96
Q

How long can neurons survive without oxygen? Heart?

A

3 minutes. 20 minutes.

Pathology (6 decks)

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