Lecture 9 - Hemodynamic Diseases

Question 1

Hydrothorax

Answer 1

Edema - excessive fluid in intestinal spaces of thoracic and pleura cavity

Question 2

Hydropericardium

Answer 2

Edema - excessive fluid in interstitial spaces of pericardium cavity around the heart

Question 3

Hydroperitoneium / Ascites

Answer 3

Edema - excessive fluid in interstitial spaces of peritoneal cavity (abdominal cavity)

Question 4

Anasarca

Answer 4

• total body edema (excessive fluid in interstitial spaces), including soft tissue

Question 5

Hyperemia

Answer 5

• intravascular increase of blood volume to tissue
• active process
• arteries are pumping more blood into an area/organ than there should be

Question 6

Congestion

Answer 6

• intravascular increase of blood volume to tissue
• passive process
• veins draining tissue is blocked causing a build up

Question 7

Hematoma

Answer 7

• blood clot (accumulation of extravasated blood).

- can be severe (ex: epidural bleed) or minor (ex: clot where blood was drawn)

Question 8

Petechiae

Answer 8

• very small (1-2 mm) mucosal/skin hemorrhages due to increased local intravascular pressure, low platelet count, defective platelet function, or clotting factor deficiencies. (ex. bleeding abnormalities or sneeze = pressure)

Question 9

Purpura

Answer 9

• larger than petechiae hemorrhages (3-5 mm), but similar causes. More commonly caused by defective platelet function.

Question 10

Ecchymoses

Answer 10

• 1-2 cm, a hematoma beneath the skin (subcutaneous).

- AKA = bruise

Question 11

Hemothorax

Answer 11

• hemorrhage into pleural cavity (ex. hemorrhage of heart goes into thorax)

Question 12

Hemopericardium

Answer 12

• hemorrhage of area around the heart / into pericardial cavity. (can appear after a heart attack)

Question 13

Hemoperitoneium

Answer 13

• hemorrhage into abdominal cavity (ex. ruptured aneurysm)

Question 14

Thrombus

Answer 14

• a blood clot within the cardiovascular system (during life, not postmortem)

Question 15

Mural thrombus

Answer 15

• thrombi that forms in the chambers of heart or lumen of aorta (larger portions of cardiovascular system).

Question 16

Arterial thrombus

Answer 16

• thrombi that form in arteries on plaques, vascular injuries, or inflammation. Can be occlusive = block the artery and create an infarct.

Question 17

Venous thrombus

Answer 17

• phlebothrombosis
• thrombi that form in veins, can be occlusive = blocking blood from leaving the tissue.
• commonly found in lower extremities, ovarian, and periuterine veins.
• often results from stasis and coagulation problems.

Question 18

Embolus

Answer 18

• a clot that is in a different spot from were it originated.
• detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin

Question 19

Thromboembolus

Answer 19

• detached blood clot

- 2 types: Pulmonary thromboemboli and Systemic thromboemboli

Question 20

Pulmonary thromboemboli

Answer 20

• typically clinically silent and causes sudden death
• venous thrombi propagate and reach the right ventricle of the heart = right ventricular failure = cor pulmonale (dilation of the heart).
• significant obstruction of lung (pulmonary circulation) required to block it

Question 21

Systemic thromboembolism

Answer 21

• emboli in arterial circulation from mural thrombi (of left ventricle) but can also be from aneurysms, aortic pathologies, or paradoxical = venous thrombi that gained access via intraventricular defect (slipped through valve defect getting from right to left heart)

Question 22

Fat embolus

Answer 22

• emboli made from fat cells
• seen in fractures of long bones and soft tissue trauma
• most are asymptomatic but symptoms can begin at 1-3 days of trauma
• cause occlusion and coagulation defects causing blood clotting

Question 23

Air embolus

Answer 23

• gaseous mass from obstetric procedures or chest wall injury
• more than 100 mL of air required for clinical effects
• causes decompression syndrome: caused by sudden exposure to changes in atmospheric pressure = “bends” from bubble liberating into muscles
• can lead to caisson disease - foci of necrosis in bones/joints from chronic bubbles

Question 24

Infarction

Answer 24

• area of ischemic necrosis due to thrombosis and embolization in vessels resulting in a blockage of blood to tissues
• this results in majority of death in Us (heart/cerebral)
• can also be caused by local vasospasm, intraplaque hemorrhage. and extrinsic compression or vessel twisting / traumatic rupture (less common)

Question 25

Red Infarct

Answer 25

• re-perfusion (thrombus dissolves after blocking a tissue from blood flow causing hemorrhage)
• due to venous obstruction in loose tissues and organs with dual blood supplies (lung/small intestine)

Question 26

White infarct

Answer 26

• due to arterial occlusions (blockage), occur in solid organs (heart, spleen, kidney)

Question 27

Septic infarct

Answer 27

• sepsis = infection of the bloodstream

- white blood cells and bacteria create blockages (vegetation)

Question 28

Shock

Answer 28

• systemic hypo-perfusion due to reduced cardiac output and/or reduced effective circulation
• decreased perfusion = all cells are starved for oxygen due to body wide / global decreased circulation

Question 29

Cardiogenic shock

Answer 29

• heart failing to pump, can be due to heart infarct

Question 30

Hypovolemic shock

Answer 30

• due to blood loss (from trauma, aneurism)

Question 31

Septic shock

Answer 31

• microbial infection
• bacteria (Gram neg.) produce toxins that have the same effect of neurogenic shock (cause loss of vascular tone).
• 25-50% mortality rate, #1 cause of death in critical care units
• 70% are gram neg, endo-toxin bacteria
• cause systematic vasodilatation, decreased myocardial contractility, and endothelial damage.