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3rd: Pathology I > L11-12 Circulatory Disturbances (Exam 2) > Flashcards

L11-12 Circulatory Disturbances (Exam 2) Flashcards

1
Q

Circulatory System

A

Blood, heart, arterial, venous, microcirculation, lymphatics

“The circulatory system consist of blood, a central pump (the heart), blood distribution (arterial) and collection (venous) networks, and a system for exchange of nutrient and waste products between blood and extravascular tissue (microcirculation)”.
“ A network of vessels (lymphatics) that parallel the veins also contribute to circulation by draining fluid from the
extravascular spaces into the blood vascular system”.

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2
Q

Microcirculation

A

a system for exchange of nutrient and waste products between blood and extravascular tissue

All the metabolic exchange between the blood and tissues happens at this level (microcirculation) (in capillary beds)

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3
Q

Lymphatics

A

A network of vessels that parallel the veins also contribute to circulation by draining fluid from the
extravascular spaces into the blood vascular system

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4
Q

The function of the blood is:

A

to carry oxygen, nutrients and waste products that are generated in the normal metabolism

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5
Q

Arteries

A

Carry the blood to the tissues


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6
Q

Veins

A

Are blood vessels that carry blood toward the heart.

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7
Q

The main difference between 
arteries and veins:

A

Arteries: The bigger
arteries contain elastic fibers/lamminae
within the tunica media. Also in arteries
the tunica media is the thicker of the tunics

Veins: the tunica externa is the thicker
layer in veins; also veins have values (not seen
in arteries)

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8
Q

Capillaries

A

(small thin-walled vessel) Where metabolic exchange occurs

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9
Q

The right heart propels unoxygenated blood through the pulmonary circulation, and the left heart propels oxygenated blood through the systemic circulation.

True or False ?

A

True

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10
Q

Describe the basic circulation of blood
 after birth:

A

Poorly oxygenated blood will return
 to the right-side of the heart through
the caudal/cranial vena cava into the 
right atrium -> RV -> Lungs 
to get oxygenated and it will come back
through the pulmonary veins (carry oxygenated blood)
 -> LA -> LV -> Aorta -> tissues of the body

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11
Q

In the arteries the Blood Pressure is going to be 
higher than in the veins

True or False ?

A

True

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12
Q

The velocity of blood is higher in the arteries than the veins (little slower) and capillaries (lowest)

True or False ?

A

True

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13
Q

Once again describe the basic circulation of blood
 flow ( 7 steps)

A
  1. The arterial blood is
pumped through the
left ventricle into the
 aorta.
  2. will go to the systemic circulation
  3. comes back through
the veins cranial/caudal
 vena cava
  4. go into right ventricle
  5. pumped to the pulmonary artery into the pulmonary circulation
  6. into the lungs to get oxygenated
  7. and will come back
through the pulmonary
veins into the left atrium
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14
Q

Arterioles

A

small arteries proximal to a capillary bed

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15
Q

Metarterioles

A

arterial capillaries

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16
Q

Capillaries

A

thin, semipermeable vessels that connect arterioles and venules

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17
Q

Postcapillary venules

A

small vessels that merge to form veins after collecting

blood from a capillary network

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18
Q

Smooth muscle of the arterioles and metarterioles regulates flow of blood into the capillary bed.

True or False ?

A

True

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19
Q

There is a dramatic drop in pressure and blood
flow rate from the arterial to the venous side of
the microcirculation, facilitating interactions
between capillary blood and interstitial fluid.

True or False ?

A

True

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20
Q

Microcirculation consists of:

A

Arterioles; Metarterioles; Capillaries; Postcapillary venules

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21
Q

There is no net loss of fluid within the microciruculation

True or False ?

A

True

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22
Q

Vascular Endothelium

A

The epithelial lining inside the blood vessels; Simple squamous epithelium

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23
Q

Endothelium is both a physical barrier between intravascular and extravascular spaces, and it is
an important mediator of fluid distribution, hemostasis,
inflammation, and healing.

A

Vascular Endothelium

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24
Q

Arrest bleeding by the physiological properties of vasoconstriction and coagulation or by surgical means.

A

Hemostasis

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25
Q

What are the three major roles of vascular endothelium ?

A
  1. Role in hemostasis
  2. Modulates perfusion:
  3. Role in inflammation:
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26
Q

Most of the water in the body is located within cells

True or False ?

A

True

Intracellular Fluid (40%)

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27
Q

Homeostasis

A

“A tendency to stability in the normal body states”

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28
Q

Transcellular Fluid

A

~ about 5%

within body cavities ex. peritoneal cavity (normally has small amounts of fluid), pleural cavity, fluid in the joints

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29
Q

Plasma

A

~ about 4-5%

fluid in the blood

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30
Q

Interstitial Fluid

A

~ about 15%

in the extravascular space; in the interstitum

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31
Q

Interstitium

A

Space between tissue compartments (microcirculation and the cells).

 Is the medium through which all metabolic products must pass between the microcirculation and the cells.
 Composed of the Extracellular Matrix (ECM) and supporting cells

The place where you have the metabolic exchange between the blood and the tissues

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32
Q

Extracellular Matrix

A

Composed of structural molecules (collagen, reticulin, elastic fibers) and ground substance (glycoproteins like fibronectin & laminin, plus glycosaminoglycans, proteoglycans etc..)

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33
Q

Water distribution between plasma & the interstitium

is primarily determined by:

A

the hydrostatic & osmotic

pressures differences between the 2 compartments

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34
Q

Starling forces

A

the movement of fluid across capillary membranes vua hydrostatic and osmotic pressures

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35
Q

Most water leakage occurs in capillaries or post- capillary venules, which have a semi-permeable membrane wall that allows water to move more freely than proteins.

True or False ?

A

True

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36
Q

The hydrostatic pressure moves fluid into of the vasculature; the osmotic pressure of plasma proteins (oncotic pressure) moves fluid out of the vasculature.

True or False ?

A

False

Note: the hydrostatic pressure moves fluid OUT of the vasculature; the osmotic pressure of plasma proteins (oncotic pressure) moves fluid INTO the vasculature.

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37
Q

Increased hydrostatic pressure or diminished plasma
osmotic pressure will cause extravascular fluid to accumulate. Tissue lymphatics remove much of the excess volume, eventually returning it to the circulation via the thoracic duct; however, if the capacity for lymphatic drainage is exceeded, tissue edema results.

True or False ?

A

True

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38
Q

Edema

A

abnormal increase in the amount of fluid that remains in the interstitum

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39
Q

What are the 4 Pathomechanisms of Edema ?

A
  1. Increased blood hydrostatic pressure
  2. Decreased plasma colloidal osmotic (a.k.a.
    oncotic) pressure
  3. Lymphatic obstruction
  4. Increased vascular permeability (inflammation)
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40
Q

Inflammatory Edema

A

Increased vascular permeability – refers as an
“exudate”

Edema fluid in these cases is “protein rich”  an exudate
(high protein content (>30g/L), specific gravity (>1.025), total nucleated cells (

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41
Q

Non-inflammatory Edema

A

refers to as a “transudate”

Edema fluid in these cases is “protein poor”  low protein content (

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42
Q

Pericardial effusion
Pneumonia
Hyperemia

A

Examples of Inflammatory edema

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43
Q

edema of CHF
edema of liver failure
renal failure

A

Examples of non-inflammatory edema

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44
Q

Gross appearance of edema (name 5)

A
  1. Wet
  2. Gelatinous and heavy
  3. Swollen organs
  4. Fluid weeps from cut surfaces
  5. May be yellow-ish
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45
Q

Histological appearance of edema (Name 5)

A
  1. Clear or pale eosinophilic staining depending on whether is non-inflammatory or inflammatory edema. [Inflammatory edema will pick up the eosin 
stain - stain more pinkish]
  2. Spaces are distended
  3. Blood vessels may be filled with red blood cells
  4. Lymphatics are dilated [they will be draining all 
the fluid that was 
accumulated]
  5. Collagen bundles are separated
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46
Q

Pitting edema

A

When pressure is applied to an area of edema a depression or dent results as excessive interstitial
fluid is forced to adjacent areas

Ex. Horse with right-sided CHF; when you press it it will leave an 
indentation -> subcutaneous edema

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47
Q

Fluid in the thoracic cavity

A

Hydrothorax

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48
Q

Pericardial effusion

A

Accumulation of fluid within the pericardial sac

Ex. “mulberry heart disease”- (inflammatory
edema).

49
Q

Fluid (transudate) within the peritoneal cavity.

A

Ascites or hydroperitoneum

50
Q

Anasarca

A

Generalized edema with profuse accumulation of fluid
within the subcutaneous tissue.

Note: Generally associated with more severe
 cardiac anomalies

51
Q

Swelling in mandibular space

A

Submandibular edema (“bottle jaw”)

Note: Commonly associated with severe GI parasitism
and hypoproteinemia in sheep. Can be associated with CHF but mostly
associated with severe GI Parasitism. Primarily in ruminants and sheep; 
hymoncous contortus

52
Q

Hyperemia and Congestion

A

Both terms indicate a local increase in blood volume and flow within the vascular bed.

53
Q

Hyperemia

A

indicates increase of arteriole-mediated engorgement of the vascular bed. Blood is oxygenated

54
Q

Congestion

A

indicates passive, venous engorgement. Blood is not oxygenated. {Passive engorgement of vascular
beds caused by a decreased outflow of blood}

55
Q

Physiological Hyperemia (normal)

A

 Digestion: ↑ blood flow to the GI tract during digestion.
 Exercise: ↑ blood flow to muscles during exercise
 To dissipate heat: ↑blood flow to the skin to dissipate heat and cool down.
 Neurovascular: Involuntary ↑in blood flow to the face (facial hyperemia) as a result of embarrassment or emotional distress
 common in people with social anxiety.

56
Q

Pathological Hyperemia (abnormal)

A

 Caused by an underlying pathological process – usually inflammation.
 Arteriolar dilatation occurs secondary to inflammatory stimuli (inflammatory mediators).
 Reddening (“rubor”) is one of the cardinal signs of inflammation (tumor, calor, rubor, pain, loss of function).
 Often associated with edema

57
Q

Gingivitis

A

inflammation of the gums
; Pathological Hyperemia

58
Q

Bulbar and palpebral Conjunctivitis

A

inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera; Pathological Hyperemia

59
Q

Congestion will result in increased hydrostatic pressure within the veins -> this can lead to edema

True or False ?

A

True

60
Q

Name this:

Twisting of vessels obstructs gastric veins → severe venous congestion (acute, local, congestion) → ischemia (necrosis) →loss of endothelial integrity →hemorrhage →shock→death

A

Gastric volvulus (torsion)

Ex. of localized congestion

61
Q

Very often the small intestine will twist along its axis

A

Intestinal volvulus

Ex. of localized congestion

{Impaired venous return; leads to congestion, hypoxia, venous infarction with necrosis}

62
Q

Pulmonary congestion: Usually the result of
heart failure and associated with edema.

True or False ?

A

True

63
Q

SUBACUTE TO CHRONIC HEPATIC CONGESTION IS USUALLY THE RESULT OF RIGHT-SIDED CHF

True or False ?

A

True

64
Q

“Nutmeg liver” is an example of Chronic hepatic congestion

True or False ?

A

True

65
Q

The hepatocytes in zone 1 of the hepatic lobule are
 more resistant
 to hypoxia

True or False ?

A

True

66
Q

The Portal triad containins:

A

bile duct, portal 
vein and hepatic artery

67
Q

The central vein: Drains the caudal 
vena cava and is close to zone 3

True or False ?

A

True

68
Q

Zone 3 is more susceptible to hypoxia bc most of the O2 is already gone.

True or False ?

A

True

69
Q

Unoxygenated blood in the liver is
going to come through the hepatic
artery (located in the portal triads)

True or False ?

A

False

Note: Oxygenated blood in the liver is
going to come through the hepatic
artery (located in the portal triads)

70
Q

What are the 7 categories of Circulatory Disturbances ?

A
  1. Edema
  2. Hyperemia & Congestion
  3. Hemorrhage
  4. Hemostasis
  5. Thrombosis, Embolism & DIC
  6. Infarction
  7. Shock
71
Q

Siderophages

A

macrophages 
with hemosiderin in the middle; 
macrophages containing pigment

72
Q

Endothelial cells produce molecules that have a(n):

A

Anti-thrombotic & pro-fibrinolytic in the normal state
AND
Pro-thrombotic and anti-fibrinolytic during injury

73
Q

Pro-inflammatory cytokines produced by vascular endothelium cells:

A

will make blood vessels more leaky so plasma and proteins can go into this area in order to facilitate healing and repair. RBCS can go in and supply oxygen to the neutrophils and macrophages trying to repair damage

74
Q

Clinical significance of edema is dependent upon:

A

extent, location and duration

75
Q

Hepatic toxins will be very close to the portal circulation; so hepatocytes close to the portal triad will get damaged first

True or False ?

A

True

76
Q

Hemorrhage

A

 Is defined as the escape of blood from the blood vessels (extravasation)
 Can be external or internal (within tissues or body
cavities)

77
Q

Name 4 causes of hemorrhage

A
  1. Trauma
  2. Sepsis, viremia, bacteremia or toxic conditions
  3. Abdominal neoplasia may lead to hemoperitoneum
  4. Coagulation abnormalities (platelet and coagulation factor defects or deficiencies)
78
Q

Profuse blood loss is the most common cause of
hypovolemic shock; Hemorrhage in the brain or
heart can be fatal.

True or False ?

A

True

79
Q

Hemopericardium

A

Bleeding into the pericardial sac

leads to fatal cardiac tamponade. If this kind of hemorrage occurs acutely this can lead to death

80
Q

Rhexis

A

tear in the vascular wall (or heart). (Can cause hemorrhage)

81
Q

Dissecting aneurysm

A

an excessive localized enlargement of an artery caused by a weakening of the artery wall.

Ex. Copper deficiency (maintains the health of the vascular wall)

82
Q

Hemorrhage due to a small defect in the vessel wall or rbc‟s passing through the vessel wall in cases of inflammation or congestion (like in the lungs of
animals with left-sided CHF…)

A

Diapedesis

Vascular wall becomes leaky; Tight junctions will separate a little bit and the cells will squeeze out

83
Q

Hemorrhagic diathesis

A

Increased tendency to hemorrhage from usually
insignificant injuries (seen in a wide variety of clotting
disorders).

Ex. Animals with inherited clotting disorders

84
Q

Hemothorax

A

blood in the thoracic cavity

85
Q

Hemoperitoneum

A

blood in the peritoneal cavity

86
Q

Hemarthrosis

A

blood within a joint space

87
Q

Hemoptysis

A

Coughing up of blood or bloodstained sputum from the lungs or airways.

88
Q

Epistaxis

A

Bleeding from the nose.

Ex. From mycotic infections in the gutteral pouch of horses

89
Q

Petechia (pl. petechiae)

A

Very tiny hemorrage; associated with spesis. up to 1-2 mm in size. Especially found on skin, mucosal and serosal surfaces

90
Q

Ecchymosis (pl, ecchymoses)

A

Larger than petechia (up to ~1 or 2 cm). As seen in bruise (contusion) or small hematoma. When the hemorrage is still focal but bigger; basically large petechia

91
Q

Agonal Hemorrhages

A

Petechiae and ecchymoses associated with terminal hypoxia.

Often seen along the coronary groove in the heart of animals and also in the endocardial surface. Very often can indicate sepsis or hypoxia

92
Q

Suffusive hemorrhage

A

larger than ecchymosis and contiguous. Multifocal to coalesing

93
Q

Paint-brush hemorrhage

A

Looks like if red paint was hastily applied with a paint brush. Most common on mucosal and serosal surfaces.

94
Q

Central mass of fibrin & red blood cells
surrounded by supportive vascular connective tissue 
macrophages will eventually phagocytize this lesion.

A

Organizing hematoma (A hemorrhage resolution)

95
Q

This process is a hemotoma resolution

Hemoglobin (dark red blue color)  enzymatically converted to bilirubin (blue-green color) and
eventually into hemosiderin (gold-brown color).

True or False ?

A

True

96
Q

Normal hemostasis is a physiological response to
vascular damage  Provides a mechanism to seal an
injured vessel to prevent blood loss.

True or False

A

True

Hemostasis is something that is good - it is a physiological process that helps to repair an area of vascular damage

97
Q

The pathological form of hemostasis is ____________

A

thrombosis

Thrombosis is a pathological process; hemostasis is normal

98
Q

Thrombosis:

A

a clot (thrombus) forms within a vessel which is not injured or only mildly injured.

Thrombosis can be viewed as an inappropriate activation of the normal hemostatic process

Aggregate of platelets, fibrin and entrapped blood cells.
Can result in occlusion of the vascular lumen and embolism
It is adhered to the vascular wall as opposite to a blood clot.

99
Q

Virchow triad:

A

describes the three broad categories of factors that are thought to contribute to thrombosis

  1. Endothelial injury (more important factor)
  2. Alterations in blood flow (turbulence or stasis)
  3. Hypercoagulability
     ↑in coagulation factors (or ↑sensitivity to)
     ↓ in coagulation inhibitors
    All of these play a significant role in the formation of a thrombosis
100
Q

Pulmonary thrombosis

A

Seen in dogs with severe renal glomerular
disease -> protein losing nephropathy -> Significant loss of
Antithrombin III, a major inhibitor of thrombin

101
Q

Verminous thrombosis

A

Cause by vermin infection

Ex. thrombus formation in the cranial mesenteric artery of horses with Strongylus vulgaris infection

102
Q

FATE (Feline Aortic Thromboembolism, or Saddle Thrombus)

A

Happens in cats

The split where the aorta becomes the left and right iliac arteries is called the saddle.

A saddle thrombus is a blood clot that breaks off from a larger blood clot in the heart, travels down the aorta and lodges at the saddle.

Acute onset of paralysis

103
Q

If pieces of a thrombus break off from the
original mass and sail downstream to lodge at
a distant site, that process is called ________

A

Embolism

Embolism is the passage through the venous or the arterial circulation of any material capable of lodging in a blood vessel lumen

104
Q

Embolus

A

The mass that brakes off

“An embolus is any detached intravascular mass (solid, liquid or gaseous) which is carried by the blood to a site distal to the point of origin; most emboli originate from detached pieces of a thrombus, hence the commonly used term of thromboembolism”.

water divers can develop this compression embolism; so have to go up very slowly to prevent this

105
Q

In cattle it is not uncommon to see vena cava thrombosis (Thrombis of the veins)- ruminal acidosis - multiple pulmonary abcessation and they can die from that.

True or False ?

A

True

106
Q

Fat embolism

A

Could be a complication of long bone fractures

Ex. of fat embolism due to CPR

Fractures of bone can result in trauma; fat can get into
systemic system and produce pulmonary embolism and infarction

107
Q

Infectious causes of thrombosis/ thromboembolism

A

Bacterial valvular endocarditis in cattle
often involve the right AV valve and can
give rise to septic emboli that will lodge in the
pulmonary arteries  inflammation/ abscess
Formation (embolic pneumonia).

108
Q

Thrombotic Meningoencephalitis (TME)

A

Associated with hemorrhage and inflammation
Etiology: Histophilus somni infection – results in vasculitis and thrombosis; bacteria in cattle that has the ability to produce vascular endocarditis

109
Q

Disseminated Intravascular Coagulation (DIC)

A

“Potentially catastrophic systemic reaction (thrombo-hemorrhagic disorder) in which there is generalized activation of the blood coagulation system.”

Signs of tissue hypoxia, infarction or/and hemorrhage are seen.

110
Q

Infarction

A

Localized area of ischemic necrosis in a tissue or organ caused by occlusion of either the arterial supply or the venous drainage

111
Q

Venous infarcts are usually intensely hemorrhagic as blood backs up into the affected tissue behind
the obstruction

True or False ?

A

True

112
Q

Arterial infarcts are often initially hemorrhagic
but become pale as the area of coagulation
necrosis becomes evident

True or False ?

A

True

113
Q

Microscopically an infarct is a focal area of
coagulation necrosis

True or False ?

A

True

114
Q

Shock (Cardiac collapse)

A

Shock is the final common pathway for a number of
potentially lethal clinical events.

shock gives rise to systemic hypoperfusion; it can be caused either by reduced cardiac output or by reduced effective circulating blood volume.

End Result: hypotension, impaired tissue perfusion, and
cellular hypoxia.

115
Q

Types of Shock:

A
  1. Cardiogenic shock
  2. Hypovolemic Shock
  3. Blood Maldistribution
    • Anaphylactic (Type 1 hypersensitivity)
    • Neurogenic
    • Septic
116
Q

Cardiogenic shock

A

failure of the heart to maintain normal cardiac output

117
Q

Hypovolemic Shock

A

Fluid loss due to hemorrhage, vomiting, diarrhea

118
Q

Most cases of septic shock are caused by endotoxin-producing gram-negative bacilli (endotoxic shock)

T or F

A

True

Endotoxins are bacterial wall lipopolysaccharides (LPS) consisting of a toxic fatty acid (lipid A) core common to all gram-negative bacteria, and a complex polysaccharide coat (including O antigen) unique for each species. LPS and other microbial substances induce injury & activation of the vascular endothelium plus stimulate (“activate”) WBCs to release cytokines  vasodilation & pro-thrombotic diathesis (DIC).

3rd: Pathology I (17 decks)

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