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Pathology > Organ Failure > Flashcards

Organ Failure Flashcards

1
Q

define lymphatics

A

blind ended capsillaries that dump into venous system

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2
Q

what maintains the flow of lymphatics?

A

muscle contractions since it is low pressure and valved

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3
Q

how much of the body weight is fluid? what is this fluid comprised of?

A

60% = intracellular 40% + extracellular 20% (plasma 4% + interstitium 16%)

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4
Q

which circulation is this?

A

lymphatic vessel

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5
Q

which circulation is this?

A

arteriole/venule
gaps in endothelium allow movement of fluid

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6
Q

what forces interstitial fluid into lower pressure venules and lymphatics?

A

hydrostatic pressure

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7
Q

here for Liz Brain

A
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8
Q

list the main controls of fluid movement

A

hormones - RAAS, ANP (cardiomyocytes)
receptors - osmoreceptors, baroreceptors
osmotic/hydrostatic forces
integrity of vascular system

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9
Q

what does RAAS do that controls fluid movement?

A

vasoconstriction and water retention

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10
Q

what does atrial natriuretic peptide (ANP) do that controls fluid movement?

A

promotes renal sodium and water excretion and stimulates vasodilation

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11
Q

define shock

A

cardiovascular collapse - systemic hypoperfusion due to macro/micro-circulatory failures

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12
Q

describe the outcome of shock (pathogenesis)

A

hypotension > impaired tissue perfusion > cellular hypoxia > anaerobic metabolism > cellular degeneration > cell death

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13
Q

describe the progression of shock to an irreversible state in terms of metabolism

A

hypovolemic shock > initial compensation > progression, metabolism shift to glycolysis > progressive morphological deterioration of cells

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14
Q

list the types of shock via macrocirculatory failure and define each

A
  1. cardiogenic - failure of heart to properly pump blood
  2. hypovolemic - reduced circulation of blood volume by massive blood/fluid loss
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15
Q

list examples of cardiogenic macrocirculatory failure

A

myocardial infarction
ventricular tachycardia
HCM
DCM
cardiac output obstruction (pulmonary embolism, aortic stenosis)
pericardial tamponade

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16
Q

ID pathology - what type of shock?

A

cardiogenic shock - macrocirculatory failure in horse

expanded pericardial sac, cardiac tamponade

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17
Q

define cardiac tamponade

A

compression of heart caused by fluid collecting in sac surrounding the heart
*example of cariogenic shock > macrocirculatory failure

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18
Q

ID pathology

A

aortic rupture and cardiac tamponade

19
Q

ID pathology

A

hemangiosarcoma at R auricle and cardiac tamponade

20
Q

list the types of shock due to microcirculatory failure

A

blood maldistribution
1. anaphylactic shock
2. septic shock
3. neurogenic shock

21
Q

Describe how blood is maldistributed in microcirculatory failure?

A

decreased peripheral vascular resistance and polling of blood in peripheral tissue

22
Q

what type of hypersensitivity of anaphylactic shock?

A

type I (IgE) hypersensitivity

23
Q

what mainly causes septic shock?

A

endotoxemia from gram negative bacilli

24
Q

what causes neurogenic shock?

A

trauma, spinal cord injury, electrocution, fear, emotional stress

25
Q

anaphylactic shock pathogenesis

A

exposure of insect/plant/drug/vaccine > IgE mediated mast cell degranulation > histamine/mediators > systemic vasodilate and increased vascular permeability > blood hypotension > tissue hypoperfusion

26
Q

septic shock (most common) pathogenesis

A

Toxin (ex. LPS from gram negative bacterial cell walls) > LPS forms a complex with blood proteins > LPS bind to TLR-4 > down-regulation of anticoagulants (tissue factor pathway inhibitor and thrombomodulin) and increasing production of IL-1, IL-6, TNF (monocytes/macrophages)

27
Q

list the major antithrombotic systems

A
  1. protein c - protein s thrombomodulin system
  2. antithrombin III
  3. tissue factor pathway inhibitor
28
Q

LPS intoxication is ___ dependent

A

dose

29
Q

Describe the pathogenesis of high production of TNF, IL-1, IL-6/8, NO, and PAF leading to septic shock?

A

High production of TNF, IL-1, IL-6/8, NO, and PAF promotes systemic vasodilation and increased capillary permeability>intravascular plasma protein loss decreases oncotic forces > additional intravascular fluid loss > toxins and cytokines induce loss of peripheral vascular tone > hypotension > hypoperfusino > septic shock

30
Q

LPS effect on endothelium triggers coag cascade and damages capillaries, which can lead to what two things?

A

DIC (disseminated intravascular coagulopathy)
ARDS (acute respiratory distress syndrome)

31
Q

what can be a result from pathological activation of coagulation due to disseminated intravascular coagulopathy (DIC)?

A
  1. small blood clot form inside blood vessels throughout body
  2. consumption of coag proteins and platelets > disruption of normal coag causing abnormal bleeding
  3. clots plug normal blood flow to organs > ischemic injury
32
Q

list what could trigger disseminated intravascular coagulopathy (DIC)

A

bacterial endotoxins, sepsis
parasites
viruses
carcinoma, hemangiosarcoma, leukemia
heat stroke, antigen-Ab complexes

*diffuse endothelial damage and/or generalized platelet activation initiates

33
Q

define acute respiratory distress syndrome (ARDS)

A

multifactorial source of injury to respiratory capillary endothelium (primary)
epithelium (secondary)

34
Q

list the main causes of acute respiratory distress syndrome (ARDS)

A

endotoxemia, sepsis, extensive trauma (hit by car), DIC, pancreatitis

35
Q

ID pathology

A

ARDS

blue - inflammatory cells
dilated blood vessels

36
Q

Describe the pathogenesis of ARDS

A

Damaged vessels allow leakage of fibrin and fluid > formation of hyaline membranes (protein, fibrin, surfactant and cell debris) > resolution through scarring

37
Q

*Liz Brain

A
38
Q

neurogenic shock pathogenesis

A

trauma, spinal cord injury, fear, electricity > triggers generalized ANS > sympathetic tone lost, parasympathetics dominate > massive peripheral dilation and bradycardia > pooling of blood > hypoperfusion > neurogenic shock

39
Q

what types of microcirculatory shock trigger cytokines and which triggers autonomic discharge?

A

anaphylactic and endotoxic shock - cytokine
neurogenic shock - autonomic discharge

40
Q

describe what occurs at each stage in the development of shock

A

compensation - increased HR, vasoconstriction, ADH and AII released > increased BP and blood diversion to vital tissue

progression - anaerobic metabolism > acidosis > peripheral vasoconstriction cannot be maintained so dilation occurs

irreversible - cell and tissue necrosis

41
Q

which of the following stages of shock is reversible?

A

compensation

42
Q

define cause (etiology) of death

A

injury or disease that began a sequence of events that ultimately led to death

43
Q

define mechanism (pathogenesis) of death

A

biochemical or physiological abnormalities that result in death

44
Q

define death

A

cessation of all vital functions of body - heartbeat, brain activity, and respiration

Pathology (12 decks)

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