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CMOD/PCM- Block 2 > Path: Hemodynamics 1 > Flashcards

Path: Hemodynamics 1 Flashcards

1
Q

What is edema?

A

Swelling of tissue due to increased fluid in interstitial spaces; can be localized or generalized

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2
Q

What is the most common cause of edema?

A

Heart failure

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3
Q

What is effusion?

A

abnormal excess fluid in a serosal body cavity

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4
Q

____ is fluid in a pleural cavity, also called ____ ____.

A

Hydrothorax; pleural effusion

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5
Q

Ascites is what?

A

fluid in the abdominal cavity, also called peritoneal effusion

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6
Q

Fluid in the pericardial cavity is called ____ ____.

A

Pericardial effusion

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7
Q

Pulmonary effusion is what?

A

fluid in the lung

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8
Q

Anasarca is ____ ____.

A

generalized edema

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9
Q

Periorbital edema is frequently the first sign of ____ ____ noticed by mothers of 2-6yr ol children.

A

nephrotic syndrome

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10
Q

If finger pressure on edematous subcutaneous tissue leaves a temporary impression, this is called ____ ____.

A

pitting edema

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11
Q

There are five pathophysiologic categories of edema; what are they?

A

(1) increased hydrostatic pressure
(2) decreased plasma osmotic pressure
(3) lymphatic obstruction
(4) sodium retention
(5) inflammation

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12
Q

What are two places that edema can easily accumulate?

A

periorbital space and scrotum

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13
Q

Edema from increased hydrostatic pressure occurs in the leg due to ____; in the lungs due to ____; and in the lower body due to ____.

A

DVT; left heart failure; right heart failure

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14
Q

Heart failure causes decreased renal blood flow, which activates the ____ system.

A

renin-angiotensin-aldosterone

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15
Q

How does increased aldosterone lead to edema?

A

it causes increased sodium retention, which means increased water retention

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16
Q

Edema from decreased plasma osmotic pressure is a feature of nephrotic syndrome due to ______.

A

protein loss through the kidneys

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17
Q

What is the major protein maintaining plasma oncotic pressure?

A

albumin

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18
Q

True or false: edema due to sodium retention is always generalized.

A

True

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19
Q

Edema due to ____ can be localized (like at the site of infection) or generalized (like in SIRS or sepsis).

A

inflammation

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20
Q

Why is edma transudative in generalized inflammatory edema?

A

In generalized inflammatory edema, chemokines are few throughout the circulation (compared to site of initiating event), so the outpouring is transudative.

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21
Q

What is lymphedema?

A

edema due to lymphatic obstruction

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22
Q

Lymphedema is usually localized and caused by what?

A

tumor, inflammation, surgery, radiation, or scar

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23
Q

Lymphedema due to ____ ____ can cause massive edema of elephantiasis.

A

parasitic filariasis

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24
Q

The major signs/symptoms of pulmonary edema are ____ and ____.

A

dyspnea (difficulty breathing), and crackles (inspiratory crackling sound on auscultation)

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25
Q

What type of heart failure is the most common cause of pulmonary edema?

A

left heart failure (pressure builds up in the pulmonary vein, eventually in the pulmonary capillaries as well)

26
Q

When pulmonary capillary pressure reaches 20mmHg fluid begins to transudate into ____ and causes ____. When the pressure reaches 25mmHg fluid begins to transudate into ____ causing ____.

A

the interstitium and causes pulmonary interstitial edema; the alveoli causing pulmonary alveolar edema

27
Q

What do “moist or wet crackles” indicate?

A

pulmonary alveolar edema

28
Q

Low blood levels of ____ cause water to enter cells; this is especially dangerous to the ____.

A

sodium; brain

29
Q

Neurons die after ___minutes without oxygen.

A

4

30
Q

Cerebral edema can be fatal due to ____ of cerebellar tonsils into foramen magnum compressing the _______.

A

herniation (protrusion); brainstem respiratory center

31
Q

What is hypermia (erythema) and what is the most common cause?

A

an active increase in arterial blood flow; inflammation

32
Q

What is congestion? (in the context of hemodynamics)

A

a passive decrease of venous outflow

33
Q

True or false: cyanosis is always caused by congestion?

A

False - congestion causes cyanosis, but it can also occur without congestion

34
Q

What is central cyanosis?

A

generalized cyanosis resulting from a failure of the lungs to load the blood with oxygen (either because there’s a defect in the lungs, or an anatomic abnormality that prevents the blood from flowing through the lungs)

35
Q

Right heart failure causes passive congestion of what organ?

A

liver

36
Q

The necrosis causing the nutmeg appearance of the liver is mostly due to … ?

A

inadequate arterial perfusion of the liver due to passive congestion caused by right heart failure

37
Q

True or False: In the context of hemodynamic, both hyperemia and congestion are common but not serious.

A

True

38
Q

What are “heart failure cells”?

A

the appearance of hemophages accumulated in pulmonary alveoli with iron from blood that has leaked into the alveoli due to capillary burst from the high pressure; this is caused by chronic sublethal left heart failure

39
Q

What is the difference between hemorrhage and hematoma?

A

A hemorrhage is extravasation of blood due to blood vessel rupture. Hematoma is
when a hemorrhage is enclosed within tissue.

40
Q

What are petechiae?

A

tiny (1-2mm) hemorrhages due to platelet deficiency

41
Q

What are purpura?

A

medium (3-10mm) hemorrhages due to vasculitis or vessel fragility

42
Q

What are ecchymoses?

A

larger (>1cm) subcutaneous hemorrhages that go from red-blue to blue-green to gold-brown as the hemoglobin breaks down; frequently called bruises but bruise carries the connotation of trauma - ecchymosis not always due to trauma

43
Q

____ is hemorrhage into a pleural cavity.

A

Hemothorax

44
Q

____ is hemorrhage into a joint.

A

Hemarthrosis

45
Q

Two big factors that affect the lethality of hemorrhages include:

A

location & timing

46
Q

What is hemostasis?

A

formation of a blood clot to “plug” the site of vascular injury

47
Q

What three components regulate hemostasis?

A
  1. vascular wall (endothelium)
  2. platelets
  3. coagulation cascade
48
Q

What are the four stages of hemostasis at the site of vascular injury?

A

1) vasoconstriction
2) primary hemostasis
3) secondary hemostasis
4) thrombus and antithrombotic events

49
Q

In stage 1 of hemostasis, there is a brief arteriolar vasoconstriction mediated by ____ ____ mechanisms augmented by local secretion of vasoconstrictors such as ____.

A

reflex neurogenic mechanisms; endothelin

50
Q

In stage 2 of hemostasis (primary hemostasis) what takes place?

A

patelet adhesion to thrombogenic ECM

51
Q

What factor mediates platelet adhesion to ECM in stage 2 of hemostasis, and what does it bind to?

A

von Willebrand factor, binds to the GpIb receptors on platelets

52
Q

What are 2 cytokines released from platelet granules that are associated with platelet activation?

A

ADP and thromboxane A2

53
Q

In secondary hemostasis, or stage 3, what happens with regard to the coagulation cascade?

A

activated by tissue factor and platelet factors, the cascade culminates in the conversion of fibrinogen to fibrin by activated thrombin

54
Q

What are the major jobs of thrombin in the coagulation cascade?

A
  • converts fibrinogen to fibrin
  • stimulates endothelial cells to adhere to neutrophils
  • stimulates platelets to release TXA2
  • activates monocytes and lymphocytes
  • Plus - later in hemostasis will stimulate endothelial cells to release NO, t-PA, and PC
55
Q

What is the character of the plug or clot formed in stage 4 of hemostasis?

A

semi-permanent plug of aggregated platelets and polymerized fibrin

56
Q

Counter-regulatory mechanisms limit the hemostatic plug to the site of injury. Describe some of these mechanisms.

A
  • expression of thrombomodulin on endothelial cells (works to activate protein C)
  • fibrinolytic system (includes t-PA, plasmin, tissue factor pathway inhibitor, antithrombin III, heparin-like molecules, protein S, and urokinase)
57
Q

What is seen in a patient with a deficiency of von Willebrand factor?

A

a tendency to bleed excessively with surgery/menstruation

58
Q

What is seen in a patient with overactivity of von Willebrand factor? (For bonus points: what is this disorder called?)

A

a tendency to clot in small blood vessels and then bleed from having used up too many platelets and clotting factors –called thrombotic thrombocytopenic purpura

59
Q

Deficiency of what causes the rare Bernard-Soulier syndrome?

A

deficiency of platelet GpIb receptors for von Willebrand factor; results in bleeding tendency

60
Q

Deficiency of what causes the rare Glanzmann thrombasthenia syndrome?

A

deficiency of platelet GpIIb/IIIa receptors; results in bleeding tendency due to deficient platelet aggregation

61
Q

What is eptifibatide (brand Integrilin)?

A

medication that binds GpIIb/IIIa receptors to inhibit platelet aggregation; used IV for patients who are clotting coronary arteries, or IA for patients with intracerebral clots

62
Q

What is clopidogrel (brand Plavix)?

A

medication that blocks platelet ADP receptors thereby preventing the conformational change that ADP would induce in the GpIIb/IIIa receptors that would allow them to bind fibrinogen for platelet aggregation

CMOD/PCM- Block 2 (41 decks)

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