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Pathology > Human Pathology Hemodynamic Disorders > Flashcards

Human Pathology Hemodynamic Disorders Flashcards

1
Q

Hyperemia

A

Active Process
Increased blood flow
Arteriolar Dialation
Produces redness in the affected tissue

Example: Blushing

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2
Q

Congestion

A

Passive Process
Impaired flow of venous blood
Affected tissues have blue or red color

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3
Q

Morphology of Congestion

A

Distended venules , sinusoids
Microscopic hemorrhages
Hemosiderin laden macrophages

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4
Q

Edema

A

Edema is defined as increased fluid in the interstitial tissues.

Abnormal accumulation of fluid within interstitial spaces or body cavities

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5
Q

How much of the body is water?

A

60%

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6
Q

Anasarca

A

Severe generalized edema

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7
Q

Ascities

A

Collection of fluid in the abdominal cavity

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8
Q

Pleural Effusion

A

Collection of fluid in the pleural cavity. Also called Hydrothorax

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9
Q

Pericardial Effusion

A

Collection of fluid in the pericardial sac. Also called hydropericardium

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10
Q

Transudate

A

Edema fluid occurring with volume or fluid overload or with reduced plasma protein.

Liver not making enough protein or kidney pee out proteinWhat

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11
Q

Left sided heart failure causes congestion in which organ?

A

Lung

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12
Q

Right sides heart failure causes congestion in which part of the body?

A

Systemically

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13
Q

Localized Edema

A

An organ or extremity

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14
Q

Blood in pleural space is called

A

hemothorax

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15
Q

What causes edema?

A

An increase in hydrostatic pressure and reduced oncotic pressure

Sodium retention
Lymphatic obstruction

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16
Q

How does congestive pericarditis cause edema?

A

Impaired blood flow to the heart due to opening of superior vena cava come into right atrium which impairs filling of heart

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17
Q

What is the systemic cause of edema?

A

Impaired venous return

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18
Q

What is the cause of Ascities?

A

Impaired blood flow through the liver which cause an accumulation of edema within the abdominal cavity.

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19
Q

What medical condition caused localized edema?

A

Thrombosis Cause edema in a localized fashion

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20
Q

How can external pressure mass affect edema?

A

Tumor can impair lymph flow and it impair venous return as it gets bigger because it press on veins which do not resist the pressure to keep open.

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21
Q

Hypoproteinemia

A

Losing protein due to reduced plasma osmotic pressure

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22
Q

How does malnutrition affect development of edema?

A

You do not have enough amino acids from broken down food to contribute to the synthesis of proteins/

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23
Q

Protein losing gastroenteropathy

A

Losing protein through the GI tracr

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24
Q

How does neoplastic affect edema?

A

Obstruct lymphatics or veins

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25
Q

Post surgical and radiation can affect edema in which way?

A

Removal or scarring of lymphatics by radiation

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26
Q

How does renal hypoperfusion affect the development of edema?

A

The kidney is not getting enough blood and it thinks the body is dehydrated and hypovolemic so it reabsorb sodium to give more blood volume because water follows sodium

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27
Q

Which vein allows the fluid that does not get absorbed by the oncotic pressure at the venous end of the capillary, to flow back into systemic circulation?

A

Left Subcalvian vein

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28
Q

The main cause of left heart failure is ..

A

Right heart failure

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29
Q

What does heart failure affect?

A

Decreased renal blood flow
Retention of sodium and water
Increase in blood volume

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30
Q

What is subcutaneous edema?

A

Pitting edema

How long does it take for tissue to bounce back

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31
Q

Dependent Edema

A

Occur in lower areas of the body.

Happen when standing

32
Q

If a patient is within a nursing home and lying in bed, where do you look for edema?

A

Near the sacrum.

The part of the body that is lowest in the bed

33
Q

Pulmonary Edema

A

Fill alveoli with fluid. impair patient ability to oxygenate

34
Q

Edema within the brain

A

Can be fatal.

Swelling of brain reduced brain function

35
Q

What are the visceral edemas

A

Brain

Pulmonary Edema

36
Q

Hemorrhage

A

Exravasation of blood due to rupture of the vessel

37
Q

What are the types of hemorrhages?

A

Petechiae which are 1 to 2mm that are in the skin, mucus membranes

Purpura slightly larger 3 to 5 mm

38
Q

What are bruises classified as ?

A

Ecchymoses

39
Q

What causes iron deficiency?

A

Chronic blood loss

40
Q

What causes epidermal hemmorhage?

A

Bleeding of middle menigeal artery

Blood on top of dura

41
Q

Shock

A

A final common pathway for potentially lethal events.
It is systemic hypoperfusion in either cardiac output or in the effective circulating blood volume.

Results in hypoxic injury to cells

42
Q

What conditions cause shock?

A

Severe Hemorrhage
Extensive Trauma or burns
Large myocardial infarction due to effective heart volume decrease which leads to decrease in perfusion of tissues

43
Q

What are the categories of shock?

A

cadiogenic
hypovolemic’septic
neurogenic
anaphylatic

44
Q

What causes cardiogenic shock?

A

Due to myocardial infarction or arrythmia which prevents the heart from pumping blood.

Extrinsic Compression which is called tamponade or outflow obstruction such as pulmonary embolism

45
Q

What is hypovolemic shock?

A

Loss of blood or plasma volume caused by hemorrhage, fluid loss , severe burns, trauma

46
Q

What is septic shock?

A

Microbial infection by an endotoxin from gram negative bacteria or just a gram positive bacteria.

47
Q

What metabolic imbalance do you get when you go through shock?

A

Lactic acidosis

48
Q

What is neurogenic shock?

A

Anesthetic shock or spinal injury

Loss of vascular tone with peripheral pooling of blood

49
Q

Anaphylactic Shock

A

Initiated by generalized IgE mediated hypersensitivity response

Systemic vasodialation and increased vascular permeability

50
Q

What are the stages of shock?

A

Nonprogressive Stage and Progressive Stage

51
Q

Which organ is the last to be affected by ischemia?

A

Brain

52
Q

A person who has died of shock has certain characteristics morphologically?

A

Brain- ischemic encephalopathy
Kidney- acute tubular necrosis
Heart- contraction band necrosis or coagulative necrosis
Lungs- Adult Respiratory distress syndrome called Acute

53
Q

What characterizes the progressive stage of shock?

A

Widespread tissue hypoxia
Intracellular aerobic respiration is replaced by anaerobic glycolysis which produces lactic acid production and lactic acidosis blunts vasomotor response resulting in peripheral pooling of blood.

54
Q

What are the characteristics of an irreversible stage of shock?

A

Leakage of lysosomal enzymes
Increased NO synthesis
Ischemia of organs
Worsen myocardial contractile function

55
Q

What is normal hemostasis?

A

Maintenance of the blood in a fluid clot free state in normal vessels

56
Q

What are the components of hemostasis?

A

Vascular Wall
Platelets
Coagulation Cascade

57
Q

Thrombosis

A

The formation of a clotted mass of blood constituents in the uninterrupted vascular system

58
Q

What are the effects of a thrombosis?

A

decrease vascular flow
Embolize
Obstruct blood flow-infarction

59
Q

What causes thrombosis?

A

Endothelial injury
Lamellar blood flow change
Hypercoagulability

60
Q

What causes endothelial injury?

A

Ulcerated arthersclerotic plaques

Myocardial infarction

Inflammatory cardiac valve disease

Hypertension due to greater pressure

Turbulence due to arthersclerosis

Bacterial toxins

Immunologic injury

61
Q

What impacts changes in laminar blood flow?

A

Stasis due to the activation of platlets and cause slower rate of blood flow which retards dilution of activated factors and hepatic clearance.
Stasis retards inflow of inhibitors.

Turbulence activates platelets and cause endothelial injury and retard flow of inhibitors

62
Q

Hypercoagulability

A

Altered state of blood requiring less than normal clot promoting activities to produce thrombosis

63
Q

What causes hypercoagulability

A

Mutation in Factor 5

Prothrombin mutation

Antithrombin 2 deficiency

Protein C or S deficiency

Defects in fibrinolysis when you cant break down the clot

Tissue damage

Myocardial infarction

Oral contraceptives due to estrogen leveles

Heparin Induced thrombocytopenia

Lupus anticoagulant

Late Pregnancy and following delivery because baby press on inferior vena cava and trauma to tissue in delivery with the high estrogen levels

64
Q

How can you tell if a clot is pre-mortem ?

A

Pre mortem have the Lines of Zahn.
Mass of platlets, RBC and fibrin
Attached to underlying vessel wall

65
Q

What does a clot look like post mortem?

A

Soft and rubbery
No lines of Zahn
Chicken fat or current jelly

Mural Thrombus

Occur in large diameter vessels or heart

Do not fill entire lumen

66
Q

Arterial Thrombus

A

Usually occlusive
Usually associated with athersclerotic plaque

Most common site is coronary, cerebral and femoral arteries

67
Q

What is vegetation of thrombus?

A

Thrombosis of cardiac valve

68
Q

What happens to a thrombus over time?

A

It can embolize which means it breaks off and travels downstream.

Dissolution by the process of Fibrinolysis can break it down to become

Propagate which means it can get bigger

Organize in which it incorporate into blood vessel wall

69
Q

Embolism

A

A detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin.

70
Q

Which veins of the lower leg embolize, superficial or deep?

A

Deep and it wind up in lung

71
Q

When do we see small emboli?

A

When more than 60% of the pulmonary circulation is obstructed

72
Q

How much are small emboli are silent?

A

60 to 80 percent

73
Q

What are systemic thromboemboli?

A

Arterial Emboli which originate from intracardiac mural thrombi 80 percent of the time.

Sites:

Lower extremities 75%
Brain 10% these give stroke

74
Q

What are the characteristics of Fat Embolism Syndrome?

A

Begins 1 to 3 days following injury

Sudden onset of dyspena, tachypnea and tachycardia

Neurologic symtoms which are irritability, restlessness which can progress to a coma.

Diffuse petechial rash, thrombocytopenia

Full blown form is fatal in 10%

75
Q

Air Embolism

A

Gas bubbles in the circulation can coalesce causing obstruction of vascular flow

Pathology (10 decks)

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