MHD Lecture 6 & 7 - Circulation & Neoplasia I Flashcards
Hypermia & Congestion both refer to what?
Which one is described by the following:
- Active process
- state an example - Tissues appear “redder”
ex: inflammation
- excercising skeletal muscle
Which one is:
- Passive
- state an example - Systemic process (CHF) vs isolated process (deep vein thrombosis)
- Acute vs Chronic
- Tissues have abnormal “red-blue” color (since associated with venous blood)
- increased intravascular blood volume
in tissue, an organ, or body part - Hyperemia
ex: arteriolar dilation & increase blood flow (rubor)
CONGESTION:
passive –> impaired outflow of venous blood from tissue
(veins do not dilate because of the active influence of a sympathetic discharge or chemical mediator)
How does hepatic congestion result due to CHF?
systolic dysfunction
- poor pumping of heart, right side starts to get weak and blood cannot pump so there is a back flow of blood = pooling of blood in the liver (HEPATIC CONGESTION)
What is:
A series of regulated processes that
a) maintain blood in a fluid clot-free state in normal vessels
&
b) rapidly form a localized hemostatic plug at the site of vascular injury
HEMOSTASIS
_____ is Flow of blood from a ruptured blood vessel
Blood may flow into tissue, into a body cavity (pleura, pericardia, peritoneal space, join space) or outside the body.
Why?
Hemorrhage
WHY?
- stabbed/lacerated
- Congested leading to focal hemorrhage
- Aortic aneurism (aorta starts to bulge)
What are 2 ways a hemorrhage can form?
What is the only clinical correlation in which hemorrhage is NORMAL?
What does seriousness depend on?
Bleeding occurs when large or small blood vessel is disrupted by:
- mechanical force
- pathologic process
(congestion, inflammation, neoplastic erosion of vessel, ROS –> lead to DNA damage)
**Abnormal hemostasis causes a predisposition to bleeding
- MENSTRUAL BLEEDING
- Seriousness depends on site as well as rate/amount of blood loss
(intracerebral hemorrhage vs. subcutaneous hematoma)
____ is the result of movement of fluid from vasculature into interstitial spaces or body cavities.
Accumulation of abnormal amounts of fluid in interstitial spaces or body cavities.
EDEMA
- normally prevented by balance between hydrostatic & plasma oncotic pressure & take up by lymphatics
What are 5 causes of edema?
Can you name some examples that might cause these?
- Increased hydrostatic pressure
-CHF
Local = impaired venous return post DVT - Decrease colloid osmotic pressure, due to reduced plasma albumin
- hypoalbuminemia
- liver disease
- malnutrition
- nephrotic syndrome = increased loss - Lymphatic obstruction
- neoplasm - Increased vascular permeability
* *inflammation** - Sodium Retention
- Renal failure
(retaining sodium & pulling fluid in which overwhelms the circulature)
What is an example of a state of malnutrition that causes full body edema?
Kwashiorkor
Malnutrition, liver disease, and nephrotic syndrome all lead to decreased ______
Heart failure leads to:
- plasma albumin
- a) increased capillary hydrostatic pressure
b) decreased renal blood flow & thus renin-ATII system active
= EDEMA
What is the difference between exudate & transudate?
exudate:
- high protein content
- white & red cells
- *vasodilation**
transudate:
- low protein content
- few cells
- CHF, venous outflow obstruction
- decreased plasma oncotic pressure due to liver disease, kidney disease (loss of protein)
Define the following:
Formation of blood clot within an intact vessel.
Is this always a pathologic process?
Thrombosis
- yes
What are the 3 key elements of hemostatic processes?
- Vascular Wall – endothelial cells must be intact
- Platelets
- Coagulation Cascade
What are 3 mechanisms of thrombosis?
- Endothelial injury
ex: inflammation
- advanced atherosclerosis
- Altered blood flow:
Clinical examples:
a) turbulence (atherosclerotic vessel narrowing)
b) stasis (atrial fibrillation - not pumping regularly due to conduction abnormality)
- Hypercoagulable state:
- Predisposition to easy clot formation
Clinical examples:
Inherited: Protein C deficiency
Acquired: woman who smokes and uses oral contraceptives; disseminated cancer
What is the most important factor in Virchow’s triad in thrombosis?
endothelial integrity!!!
What are the fates of a VENOUS thrombus? (4)
- Resolution
- Embolization to lungs
- Organization
- incorporated into the blood vessel - Organized & recantized
- new blood vessels
What is an embolism?
What are the 4 types?
Intravascular substance (solid, liquid, gas) which is carried by blood from point of origin to distant site.
- Fragments of thrombi
(thromboembolism) - Amniotic fluid
- Amniotic fluid enters placental membranes and/or uterine vein rupture. - Air (gas)
- medical procedures like air trapped during bypass surgery, or cerebral artery during near surgery - Fat & Marrow embolism
- soft tissue crush injury where marrow vascular sinusoid releases microscopic fat globules
- severe trauma to bone
Embolus derived from a lower-extremity deep venous thrombus lodged in a
pulmonary artery branch is called___
Saddle pulmonary embolism
56-year old woman develops a popliteal venous thrombosis after hip replacement surgery. She recovers and returns to her job as a teacher. Three months later, which of the following term would describe the process mostly likely seen in the popliteal vein? A. Acute inflammation B. Granulomatous inflammation C. Embolization D. Organization (at 3 month mark) E. Propagation
D. organization
_____ is an area of ischemic necrosis (cell death as result of cell injury) caused by occlusion of vascular supply to affected tissue
Infarction
-Majority of infarcts are associated with thromboembolism and involve arterial occlusions.
Which type of infarct is the following:
- Arterial occlusion
- Solid organ with end-arterial circulation (not dual)
- Heart, liver, spleen, kidney
- Ischemic
WHITE (pale) infarct
