Patho exam 2 Flashcards by Lauren McMahan

___ ___ is a vein in which blood has pooled.

Distended, tortuous, and palpable veins.

Causes by trauma or gradual venous distention.

Risk factors: 
Age
Female
Family history
Obesity
Pregnancy 
DVT
Prior leg injury

Varicose veins

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___ ___ ___ inadequate venous return over a long period

Due to varicose veins or valvular incompetence

Venous stasis ulcers

Chronic venous insufficiency

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___ ___ ___ syndrome

Progressive occlusion of the superior vena cava

Leads to venous distention of upper extremities and head.

Oncologic emergency

Superior vena cava syndrome

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Veins return blood to the heart, via the vena cava, or the pulmonary vein.

Veins are wide and thinner and less muscular, have valves and hold a lot of the circulating blood.

Know

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___ ___ thrombus formation in the veins

Obstruction of venous flow leading to increased venous pressure

Factors promoting thrombosis (triad of virchow)
Venous stasis, venous endothelial damage, hypercoagulable state, cancer, orthopedic surgery trauma, heart failure.

Venous thrombosis

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___ is blood clot attached to a vessel wall

Thrombus

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___-___ is a detached blood clot (moves around)

Thrombo-embolus

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___ is a consistent elevation of systemic arterial blood pressure

Sustained systolic blood pressure of 130 mmHG or greater or a diastolic pressure of 80mmHG or greater

Hypertension

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___ hypertension is essential or idiopathic

Genetic and environmental factors

Affects 92% to 95% of individuals with hypertension

Risk factors: family history, diet(high sodium, low K+, calcium, magnesium)

Tobacco and alcohol consumption

Obesity and glucose intolerance

Primary hypertension

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___ hypertension is caused by a systemic disease process that raises peripheral vascular resistance or cardiac output.

Renal vascular or parenchymal disease, adrenocortical tumors, adrenomedullary tumors, and drugs

Secondary

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___ hypertension- chronic hypertensive damage to blood vessels and tissues leading to target organ damage in the heart, kidney, brain, and eyes

-myocardial hypertrophy

Complicated hypertension

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___ __ rapidly progressive hypertension

Systolic pressure >180mmHg and or diastolic pressure usually >120mmHg

Life threatening

Hypertensive crisis

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___ hypotension- decrease in both systolic and diastolic blood pressure upon standing.

Lack of normal blood pressure compensation in response to gravitational changes on the circulation.

Acute orthostatic hypotension- more common in elderly, if electrolyte is off, bed bound, dehydration

Chronic orthostatic hypotension- secondary to a disease

Orthostatic hypotension

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___ is a local dilation or outpouching of a vessel wall or cardiac chamber

True aneurysms- weakening of all three layers of the wall.

Aorta is most susceptible, especially abdominal

Causes atherosclerosis, hypertension

Can lead to aortic dissection or rupture

Aneurysm

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__ __ is a blood clot that remains attached to the vessel wall.

Risk factors: intimal injury/ inflammation, obstruction of flow, pooling (stasis)

Thromboembolus- mobile blood clot

Thrombus formation

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____ is a bolus of matter that is circulating in the blood steam.

Dislodged thrombus 
Air bubble
Amniotic fluid 
Aggregate of fat
Bacteria
Cancer cells
Foreign substance

Embolism

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Peripheral vascular disease

___ ___ autoimmune disease of the peripheral arteries

*strongly associated with smoking.

Characterized by the formation of thrombi filled with inflammatory and immune cells

Thrombi become organized and fibrotic, result in permanent occlusion of portions of small and medium sized arteries in feet and hands.

*causes pain tenderness in hands and affected area

Can often lead to gangrenous lesions and amputations

Thromboangitis obliterans (buerger disease)

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Peripheral vascular disease

___ ___ is episodic vasospasm in arteries and arterioles of the fingers, less commonly the toes.

Primary- vasospastic disorder of unknown origin

Raynaud phenomenon

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Peripheral vascular disease

____ ___ ___ is secondary to other systemic diseases or condition:

Collagen vascular disease, pulmonary hypertension, hypothyroidism, long term exposure to cold environments, changes in skin color and sensation

Secondary raynaud phenomenon

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_____ is a form of arteriosclerosis

Thickening and hardening caused by accumulation of lipid laden macrophages In arterial wall.

Plaque development

Risk factors: diabetes, smoking, hyperlipidemia, dyslipidemia, hypertension, autoimmunity

Atherosclerosis

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___ is progression- inflammation of endothelium

Cellular proliferation
Macrophage migration and adherence
LDL oxidation (foam cell formation) *
Fatty streak
Fibrous plaque 
Complicated plaque

Results inadequate perfusion, ischemia, necrosis

Atherosclerosis

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___ __ ___ in the lower extremities Is also linked to coronary artery disease

Atherosclerotic disease of arteries that perfuse limbs

Intermittent claudication

Toe nails, hair, skin color/numbness seen also

Peripheral arterial disease

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___ ___ ___ is any vascular disorder that narrows or occludes the coronary arteries leading to myocardial ischemia

Atherosclerosis is the most common cause

Primary cause of heart disease in US

Coronary artery disease

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___ __ ___ is conventional (major) risk factors

Nonmodifiable *
Increase age *
Family history*
Male gender or female gender post menopausal

Modifiable* 
Dyslipidemia 
Hypertension 
Cigarette smoking 
Diabetes mellitus and insulin resistance 
Obesity/sedentary lifestyle 
Atherogenic diet

Coronary artery disease

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Blood flow through heart Superior vena cava> right atrium> tricuspid valve> right ventricle > pulmonary valve> pulmonary artery> lungs > left atrium> left ventricle> aorta> rest of body

Know

___ ___ ___ is transient * myocardial ischemia Local, temporary deprivation of the coronary blood supply

Coronary artery disease

___ angina most common, recurrent, predicable chest pain. Can be relieved w rest or NTG No damage to heart

Stable

___ ___ asymptomatic and seen in diabetics. No damage to heart tissue

Silent ischemia

___ angina results from reversible myocardial ischemia.

Unstable

___ ___ extended obstruction of the myocardial blood supply causing myocyte necrosis

Myocardial infarction

MI- complete occlusion of artery is ___

STEMI

MI is partial occlusion of artery ____

Non stemi

The first 24 hours after MI is important bc they can have sudden death. Arrhythmias is major.

Know

Myocardial infarction Manifestations: sudden severe chest pain, may radiate Nausea vomiting Diaphoresis Dyspnea Complications: sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability

Know

___ ___ inflammation of pericardium, viral or bacterial

Acute pericarditis

___ __ accumulation of fluid in pericardium cavity

Pericardial effusion

___ is medical emergency, rapid accumulation of fluid compresses heart contraction.

Tamponade

___ ___ caused by a virus that causes the two pericardium layers to stick together, gradual, fibrous scar

Constrictive pericarditis

Disorders of endocardium ___ ___ mitral valve prolapse syndrome, acute rheumatic fever and rheumatic heart disease, infective endocarditis

Valvular dysfunctions

___ __ ___ ___ one of both cusps of mitral valve billow upward into left atrium during systole Mitral regurgitation if blood leaks into atrium Patients can be asymptomatic or have vague symptoms *most common valve disorder in US

Mitral valve prolapse syndrome

__ __ is a systemic, inflammatory disease caused by a delayed immune response to pharyngeal infection by the group A B hemolytic streptococcus Febrile illness Inflammation of the joints, skin, nervous system, and heart. If left untreated may cause rheumatic heart disease

Rheumatic fever

___ ___ ``` Common manifestations: Fever Lymphadenopathy Arthralgia Nausea/vomiting and abdominal pain Tachycardia Epistaxis (nose bleed) ``` ``` Major clinical manifestations: Carditis Poly arthritis Chorea Erythema marginatum (rash) Subcutaneous nodules ``` Treatment: treat strep infection

Rheumatic fever

___ ___ is inflammation of the endocardium ``` Agents: Bacteria Viruses Fungi Rickettsiae Parasites ``` Patho genesis- Damaged (prepared) endocardium Blood borne microorganisms adherence (IV drug user or dental procedure) Proliferation of the microorganism (vegetation)

Infective endocarditis

___ ___ classic findings: Fever Murmur* Petechial lesions of the skin, conjunctiva, and oral mucosa Characteristic finding: Osler nodes Janeway lesions Other: weight loss, back pain, night sweats, and heart failure. Picline and 6-10 week of IV abx at home and sometime oral abx after and then possibly valve replacement

Infective endocarditis

___ ___ heart is unable to generate adequate cardiac output Inadequate perfusion of tissues Increased diastolic filling pressure of left ventricle Pulmonary capillary pressures increase

Heart failure

___ a period of relaxation when the heart is filling with blood

Diastole

___ is a period of contraction when the heart is pulling blood from ventricles

Systole

Left heart failure __ heart failure Ejection fraction less than 40% Inability of the heart to generate adequate cardiac output to perfume tissues Stroke volume: contractility- ability of heart to eject blood, preload- amount of stretch the ventricles fill, after load the Amount of pressure the ventricles exert. Disruptions decrease cardiac output Failing cardiac output progressively worsens heart Manifestations: dyspnea, orthopnea, cough of frothy sputum, fatigue, decrease urine output, and edema Pulmonary edema, hypotension/hypertension, S3 gallop

Systolic heart failure

___ heart failure Inability of right ventricle to provide adequate blood flow at a normal venous pressure Most commonly caused by a diffuse hypoxic pulmonary disease Manifestations: peripheral edema, hepatosplenomegly

Right heart failure

___ is where cardio vascular system fails to perfuse the tissues adequately Leads to impaired cellular metabolism Impaired oxygen use Impaired glucose use Manifestations: based on type, often include Feeling weak, cold, hot, nauseated, dizzy, confused, afraid, thirsty, sob, Hypotension, tachycardia, increased respiratory rate

Shock

Type of shock ___ =heart failure

Cardiogenic

Type of shock __ = insufficient intravascular fluid volume

Hypovolemic

Type of shock __= neural alterations of vascular smooth muscle tone

Neurogenic

Type of shock ___= immunologic processes Sudden onset, can die within mins if not addressed. Anxious, dizzy, SOB, hives

Anaphylactic

Type of shock __ =infection can lead to bacteremia the sepsis and septic shock

Septic

___ ___ ___ syndrome Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to illness or injury Causes: most common: sepsis, septic shock Other: severe trauma, burns, major surgery, blood transfusion, renal or liver failure, pancreatitis

Multiple organ dysfunction syndrome

Multiple organ dysfunction syndrome Manifestations: ``` Fever Tachycardia Dyspnea Altered mental status Hyper dynamic/hyper metabolic of individual organ systems seen Renal GI Cardiac Nervous ```

Know

Three lethal arrhythmias Asystole Ventricular tachycardia Ventricular fibrillation

Know

___ is a subjective sensation of uncomfortable breathing

Dyspnea

___ dyspnea when a person is lying down

Orthopnea

___ ___ ___ awaken at night gasping for air

Paroxysmal nocturnal dyspnea

S/S of ___ ___ Cough- Acute-develops due to URI Chronic-smoker or contact with resp irritants at work Abnormal sputum- identify debris or organisms to determine therapy needed Hemoptysis-blood sputum pink or red Abnormal breathing patterns- kussmaul respiration’s (tachypnea) (metabolic acidosis-DKA patients) and cheyne stokes respiration’s-breathing is no longer regulated and bad sign. Right before death. Deep slow breathing to rapid shallow breathing then a pause

Pulmonary disease

S/S of pulmonary disease Cyanosis-bluish discoloration as a result of low o2 saturation Clubbing-result of chronic hypoxemia/chronic lung conditions Pain-pleural lining infection/inflammation, coughing, chest wall non-compliance

Know

Conditions caused by pulmonary disease or injury ___ is increased carbon dioxide concentration in arterial blood

Hypercapnia

Conditions caused by pulmonary disease or injury ___ is reduced oxygenation of arterial blood** Ventilation perfusion abnormalities

Hypoxemia

Conditions caused by pulmonary disease or injury ___ __ __ is result if inadequate alveolar ventilation ** requires support

Acute respiratory failure

___ refers to the air flow to the alveoli

Ventilation

____ refers to the blood flow to the tissues, in the lungs refers to the blood amount in the capillaries around the alveoli (area of gas exchange)

Perfusion

VQ ratio = ventilation perfusion ratio Mismatching is termed shunting. Results in alveoli dysfunction and poor perfusion 0.8 1:1

Know

V/Q mismatches Normal ventilation, poor perfusion would be an example of pulmonary embolus Normal perfusion, poor ventilation would be an example of aspiration.

Know

Space between the mouth and alveoli is all considered dead space. As air moves in and out it doesn’t contribute to oxygenation. A person may have a tracheostomy is to reduce the amount of dead space to increase ventilation

Know

Pleural abnormalities •pneumothorax- (spontaneous or secondary) change in negative pressure within the pleural space. It disrupts the ability for recoil and compliance of lung and chest wall. Presence of air or gas in the pleural space. Manifestations: sudden pleural chest pain Tachypnea (high RR) Dyspnea (SOB) Absent or decreased breath sounds on affected side

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Pleural abnormalities •tension pneumothorax- occurs rapidly/life threatening; air can enter but not escape. Tracheal deviation away from affected lung Hypotension Severe hypoxemia Chest tube Insertion to treat

Know

Pleural abnormalities ___ ___ is fluid in pleural space

Pleural effusion

Transudative means

Watery

Exudative means

WBC and plasma proteins

Hemothorax means

Blood

Empyema means

Pus

Manifestations of pleural effusion: Mediastinal shift Cardiovascular changes Decreased breath sounds on affected side Pleural friction rub over inflamed area Diagnose by thoracentesis (needle aspiration) to remove and identify fluid type

Know

Pleural abnormalities ___ is infected pleural effusion (pus accumulation

Empyema

Manifestations of empyema ``` Cyanosis Fever Tachycardia Cough Pleural pain Decreased breath sounds over affected area ``` Diagnosis is thoracentesis and sputum culture Treatment is antimicrobials and chest tube drainage

Know

Restrictive lung diseases ___ is a passage of fluid and solid particles into the lungs, result if swallow cough dysfunction Manifestations: sudden onset of choking, intractable cough, fever, wheezing

Aspiration

Restrictive lung diseases ___ is collapse of lung tissue- common after surgery or immobilization Production of viscous secretions and pooling in dependent areas; mismatching and shunting occurs. Manifestations: dyspnea, cough, fever, leukocytosis Treatment: deep breathing (incentive spirometer) position changes, early ambulation- promotes expansion of collapsed alveoli

Atelectasis

Restrictive lung diseases ___ is persistent abnormal dilation of the bronchi Manifestation: chronic productive cough, hemoptysis, and clubbing (chronic hypoxemia)

Bronchiectasis

Inhalation disorders ___ ___ causing respiratory dysfunction, damage to airway lining; inflammation, edema, ciliary damage, surfactant changes.

Gaseous irritants

Inhalation disorders ___ ___ is disruption in surfactant production and reduced lung compliance due to oxygen free radicals

Oxygen toxicity

Inhalation disorders ___ -dust particles of toxic substances inhaled, cause fibrosis of lung disease

Pneumoconiosis

Inhalation disorders ___-allergic, inflammatory disease from inhaling particles that imitate an auto immune hypersensitivity reaction

Pneumonitis

___ ___ is excess water* in the lung due to changes in hydrostatic and oncotic pressures and capillary permeability. Left sided heart failure =changes in fluid shifting and fluid developing in lungs Injury to capillary lining=permeability and fluid development Blocked lymphatic channels= inability to remove excess fluid

Pulmonary edema

Manifestations of pulmonary edema ``` Dyspnea Hypoxemia Increased work of breathing Inspiratory crackles Pink frothy sputum C02 retention (hypercapnia) ```

Know

______ Acute inflammation and diffuse alveolar capillary injury that results from injury or severe systemic inflammation Progressive manifestations: Dyspnea and hypoxemia despite supplemental o2 Hyperventilation (respiratory alkalosis)* Decreased tissue perfusion (metabolic acidosis) and organ dysfunction Increased work of breathing, decreased tidal volume, and hypoventilation Hypercapnia(respiratory acidosis) Respiratory failure, decreased cardiac output, hypotension=death Treatment: early detection, vent support, oxygenation, preventing inf, prevention of further complications

Acute respiratory distress syndrome (ARDS)

ARDS can cause severe pulmonary edema

Know

___ ___ ___ is narrowing of airways resulting in airway obstruction that is worse with EXPIRATION Accessory muscles of expiration required Increased work of breathing Dyspnea and wheezing

Obstructive lung disease

___ is chronic obstruction of airways. Causes bronchial hyper responsiveness, constriction of airways, and reversible airflow obstruction. Pulsus paradoxus- variation in pulse as breathing Status asthmaticus- stuck in asthma attack S/S: expiratory wheezing, dyspnea, and tachypnea Peak flow meters (to measure expiratory flow rate-EFR), corticosteroids, beta agonist inhalers, and anti inflammatory user to treat FEV- forced expiratory volume

Asthma

Asthma S/S ``` SOB difficulty breathing Dry cough Night cough Wheezing Chest pain ```

Know

____ is characterized by persistent air flow limitation It’s progressive Associated with chronic inflammatory responses Emphysema& chronic bronchitis equals This

COPD

____ ____ is hypersecretion of mucus Chronic productive cough Lasts for at least 3 months of the year and for at least 2 consecutive years Manifestations: productive thick mucous with cough, hypoventilation/difficulty breathing Bronchodilators, expectorants, chest PT used to treat

Chronic bronchitis

___ is abnormal permanent enlargement of the gas exchange airways accompanied by *destruction of alveolar walls without obvious fibrosis* Inherited deficit of A1- antitrypsin Loss of elastic recoil* Air trapping*

Emphysema

___ ___ Acute infection or inflammation of the airways or bronchi Commonly follows viral illness Production of sputum Acute bronchitis causes symptoms similar to those of pneumonia but* does not demonstrate pulmonary consolidation and chest infiltrates*

Acute bronchitis

___ is a lower respiratory tract infection (alveoli) Community acquired Streptococcus pneumoniae Influenza Healthcare acquired Ventilator associated Manifestations: preceded by upper respiratory infection (most cases) Consolidation: fever chills, dry cough, pain, dyspnea, crackles

Pneumonia

TB Progressive fatigue, Malaise Anorexia Weight loss ``` Chronic productive cough Night sweats Hemoptysis(advanced state) Pleuritic pain- chest pain Low grade temp in late afternoon ```

Know

Treatment of TB: TB med 6-12 months Decreased activity Resp isolation until negative sputum Requently out PT basis Dx: TB skin test Chest x ray Sputum studies- 3 specimens collected on different days

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___ __ is occlusion caused by an embolus | Blood clot, tissue fragment, lipids, foreign body, air bubble, amniotic fluid

Pulmonary embolism

Pulmonary emboli is commonly from the deep veins DVT in lower leg

Know

___ ___ is result of pulmonary hypertension Pulmonary hypertension creates chronic pressure overload in the right ventricle- right ventricular enlargement*

Cor pulmonale

Laryngeal cancer: Manifestations: Progressive hoarseness w no voice loss Dyspnea Cough

Know

Lung cancer Nearly 80% caused by smoking Manifestations: cough with sputum production Hemoptysis Chest pain

Know

___ is a red blood cell that carry Hgb for oxygenation of tissues. Low- anemia High- polycythemia

Erythrocytes

___ is several type of white blood cells- immune system inflammation Low- immune dysfunction Cancer- leukemias

Leukocytes

___ cells main function is immune

T cells (thymus)

__ cells main function is immune

B cells (bone)

___ form blood clots (thrombi) stop bleeding Low-bleeding High-clotting DVT

Thrombocytes

___ means there is not enough red blood cells (erythrocytes) to carry enough oxygen to cells. RBC don’t have enough hgb to carry enough oxygen. RBC don’t work right (shape/morphology)

Anemia

Anemia manifestations: Cause: reduced oxygen carrying capacity ``` Classic anemia S/S Fatigue Weakness Dyspnea Dizziness w position change ``` ``` Classic anemia signs Rapid HR Pallor Heart murmur Enlarged heart, even failure ```

Know

What triggers rbc production Low oxygen levels in the kidneys stimulate the release of ERYTHROPOIETIN, a hormone Erythropoietin stimulates the blood marrow to release RBC Sometimes immature RBC (reticulocytes) are released indicating higher production Need enough iron to make the hgb for new RBC

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2 basic causes of anemia 1. Loss of RBC 2. Diminished erythropoesis (not making RBC)

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Anemia classification by morphology By size and hgb shape and size. Identify terms that end in cytic. Hgb content- identified by terms that end in chromic Anisocytosis-red cells in various sizes Poikilocytosis- red cells in various shapes

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Anemia’s of blood loss: Acute blood loss Post hemorrhagic anemia- Normocytic-normochromic anemia (too fast to compensate, cells look normal) Effects depend on rate of hemorrhage Often due to trauma or surgery Chronic blood loss- when blood loss is greater than replacement compacity of blood marrow. Iron deficiency anemia can occur, not taking in enough iron to replace RBC Associated with slow blood loss like menstruation, colon cancer Loss due to RBC destruction too (hemolytic anemia)

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Macrocytic, normochromic anemias (big RBC) Also termed megablastic anemia’s Characterized by unusually large stem cells Result if defective DNA synthesis Nutrient deficits of folate, vitamin B 12

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___ ___ (macrocytic anemia) Cause: lack of intrinsic factor from gastric parietal cells Required for vitamin b12 absorption Results in vitamin b12 deficiency Manifestations : early symptoms nonspecific and vague When hgb at 7-8 g/dl Weakness, fatigue, difficulty walking, paresthesias, loss of appetite, abdominal pain, weight loss, sore tongue Neurologic manifestations irreversible Treatment: life long B12 replacement

Pernicious anemia

___ ___ (macrocytic anemia) Humans dependent on daily dietary intake of folate Absorption of folate occurs in the upper small intestine No neurological symptoms Common in alcohol abuse

Folate deficiency

Microcytic hypo chronic anemia- small pale RBC Red cells are abnormally small containing low hgb Related to iron deficiency Disorders of iron metabolism (rare) Chronic loss of RBC (mensuration, cancer) Poor intake or absorption of dietary iron (common)

Know

Microcytic hypochromic anemia’s: ___ ___ anemia is most common nutritional disorder worldwide Causes: dietary deficiency, impaired absorption, increased requirement, chronic blood loss

Iron deficiency

Iron deficiency anemia: Manifestations when hgb decreased to 7 or 8 per/dL Early symptoms are nonspecific: fatigued weakness, sob, pale earlobes, palms, conjunctiva. Progression of iron deficiency causes: Brittle, thin, coarsely rigid and spoon shaped nails (kolionychia) Cheilosis, stomatitis, painful ulceration in mouth Dysphasia(difficulty swallowing)

Know

Normocytic normochromic anemia Cells are normal but not enough of them Low RBC count Causes: acute blood loss or hemorrhage Hemolysis- red blood cells broken down, die too soon Chronic illness or inflammation Aplastic anemia- bone marrow can’t make any blood cell types

Know

___ ___ Normocytic normochromic anemia Cause: bone marrow depression, results in reduction all 3 hematopoietic cell lines (RBC, WBC, platelet) Manifestations- all types of blood cells missing. Low RBC- fatigue, pallor Low platelets- petechiae, bruising, bleeding gums, nose, GI. Low WBC- increased infections Why? Damaged bone marrow due to cancer, leukemia, radiation, medication/ chemo

Aplastic anemia

___ ___ Normocytic normochromic anemia’s RBC fragile, die too fast Causes: drugs, infection, genetic abnormalities of RBC (sickle cell) auto immune conditions where body attacks own RBC Added problem: getting rid of hgb breakdown product, bilirubin, leads to jaundice

Hemolytic anemia

___ ___ Normocytic normochromic anemia Cause: bone marrow depression, results in reduction of all 3 hematopoietic cell lines (RBC wbc platelets) Manifestations: all types of blood cells missing Low RBC-fatigue, pallor Low platelet- petechiae, bruising, bleeding gums, nose, GI) Low wbc- increased infections Why? Damaged bone marrow due to cancer, leukemia, radiation, medications/chemo

Aplastic anemia

Anemia of chronic disease Normocytic normochromic anemias Decreased erythropoiesis and impaired iron utilization in chronic disease or inflammation Common hospitalized patients AIDS- increased destruction of RBC by macrophages in spleen* Rheumatoid arthritis Lupus erythematosus Hepatitis Renal failure- decrease erythropoietin and decrease RBC Malignancies

Know

Anemia of chronic disease Result from erythrocytes life span Suppressed production of erythropoietin Ineffective bone marrow response Altered iron metabolism in macrophages

Know

___ is over production of RBC (erythrocytes)

Polycythemia

___ ___ is result of dehydration (less plasma) and hemoconcentration of the blood

Relative polycythemia

__ __ Primary absolute (polycythemia vera)- a cancer Secondary absolute polycythemia is defined as an absolute increase in red blood cell mass Hereditary hemochromatosis is a genetic disorder that can cause severe liver disease and other health problems.

Absolute polycythemia

___ ___ Also known as primary polycythemia Blood cancer in which bone marrow makes too many RBC, wbc, and platelets are also often increased Manifestations: due to increased red cell mass and hematocrit ``` Increased blood volume and viscosity (thickness) Hyper coagulability (blood clots too easily) ``` Cerebral thrombosis (stroke) one of the main causes of death

Polycythemia vera

___ high leukocyte count

Leukocytosis

Low leukocyte count

Leukopenia

___ (also called neutrophillia) Increase in granulocytes, mostly neutrophils Neutrophillia is normal in the first stages of infection or inflammation If the need for neutrophils increases behind the supply, immature neutrophils are released Phenomenon is termed “shift to the left” When the population returns to normal “shift to the right”

Granulocytosis

___ is reduction in circulating neutrophils Causes: prolonged severe infection Decreased production Reduced survival Abnormal neutrophil distribution Granulocytopenia (severe neutropenia) and agranulocytosis (absence of granulocytes) Chemo RESULTS IN VULNERABILITY to INFECTION

Neutropenia

___ is increase in circulating eosinophils Triggered by hypersensitivity reactions (allergic) Allergic disorders and parasitic invasions

Eosinophilia

___ is decrease in circulating eosinophils. Caused by migration of cells to inflammatory sites. Other causes: Cushing syndrome and stress

Eosinopenia

___ is increase in circulating basophils. Response to inflammation and hypersensitivity (allergic reactions) Seen in myeloproliferative disorders (overactive bone marrow)

Basophilia

___ is a decrease in circulating basophils Occurs in acute infections, hyperthyroidism, ovulation and pregnancy, long term steroid therapy

Basophilia

____ is decrease in circulating basophils Occurs in acute infections, hyperthyroidism, ovulation, and pregnancy: long term steroid therapy

Basopenia

___ is increase in circulating monocytes Often transient and not due to low monocyte production Usually occurs w neutropenia in later stages of infections when monocytes are needed to phagocytize* organisms and debris

Monocytosis

___ is decrease in circulating monocytes Very rare

Monocytopenia

____ is increase in number or proportion of lymphocytes Caused by acute viral infections * particularly caused by Epstein Barr virus

Lymphocytosis

____ is decrease in circulating lymphocytes Causes: low production due to immune deficiencies Destruction by drugs, viruses, or radiation.

Lymphocytopenia

___ ___ is a benign acute, self limiting infection of B lymphocytes transmitted by saliva through personal contact. Most common cause: EBV ``` Other viruses that cause similar symptoms: Cytomegalovirus Hepatitis Influenza HIV Rubella ```

Know

``` Infectious mononucleosis symptoms at time of diagnosis: Fever Fatigue* Sore throat Swollen cervical lymph nodes Increased lymphocyte count Atypical activated lymphocytes ``` Serious complications are rare: splenic rupture is common cause of death

Know

___ is a malignant disorder of the bone marrow and blood Excessive accumulation of leukemic cells Cells crowd bone marrow Decreased function of hematopoietic cells Pancytopenia lower-than-normal number of red and white blood cells and platelets in the blood.

Leukemia

Leukemia arise from stem like cells. A blood stem cell undergoes multiple steps to finally become a red blood cell, platelet, or wbc.

know

___ ___ leukemia has too many lymphoblasts most common leukemia in chikdhood (80%) most are b cell origin manifestations: bone marrow depression causes: fatigue, bleeding, fever, anorexia, and neurologic symptoms

acute lymphocytic ALL

__ ___ leukemia too many myleoblasts most common adult leukemia manifestations: bone marrow depression causes: fatigue, bleeding, fever, anorexia, and neurologic symptoms

Acute myelogenous leukemia

___ ___ leukemia 3 stages Philadelphia chromosome (95%) Too many blood cells made in bone marrow

Chronic myelogenous leukemia (CML)

___ __ leukemia Predominately seen in older adults (over 60) Too many immature lymphocytes and immunologically incompetent (can’t fight infections) Follows a slow chronic course

Chronic lymphocytic leukemia CLL

Manifestations of leukemia ``` Anemia Bleeding Thrombosis Hemorrhage DIC Fever/infection Weight loss Neurologic manifestations Bone pain Elevated uric acid Liver, spleen, and lymph node enlargement ```

Know

Alterations in lymphoid function: Alterations include: Lymphadenopathy (swollen lymph nodes) Malignant lymphomas (lymph node cancer) Plasma cell malignancy

Know

___ lymphoma Reed sternberg cells Not specific Derived from B cell Has not undergone successful immunoglobulin gene rearrangement Would normally undergo apoptosis

Hodgkin

Hodgkin lymphoma manifestations Fever, weight loss, night sweats, adenopathy (swollen glands) pruritis (itching, medistinal mass, splenomegaly (enlarged spleen) and abdominal mass Find a painless “rubbery” enlarged node on neck usually found on men when shaving

Know

___ ___ lymphoma- Generic term for a diverse group of lymphoid neoplasms Real classification B cell neoplasms T cell and NK cell neoplasms Risk factors include being older, male, white, plus having: Certain immune disorders, auto immune or HIV/AIDS Exposure to mutagenic chemicals Infection with certain cancer related virus Immune responses related to organ transplantation

Non Hodgkin lymphoma

____ lymphoma Most common type of non Hodgkin lymphoma in children Particularly African children Is a very fast growing tumor of the jaw and facial bones Epstein Barr virus is found in nasopharyngeal secretions or patients

Burkitts

___ ___ is a bone marrow disease with plasma cell tumors in bone Frequently the myeloma produces the bence Jones protein Bence Jones found in urine, toxic renal cells and may cause renal failure Bone pain may be first symptom Serum calcium level is high **

Multiple myeloma

___ is decrease in circulating platelet

Thrombocytopenia

____ is increase in circulating platelets

Thrombocythemia

Thrombocytopenia -defined as a platelet count less than 150k Less than 100k becomes clinically significant Less than 50k hemorrhage from minor trauma Less than 15k spontaneous bleeding* Less than 10k severe bleeding Pseudo thrombocytopenia Error in lab giving a false reading for thrombocytopenia

Know

___ ___ ___ igG antibodies target heparin platelet factor 4 complex Typically causes 50% drop in platelet count

Heparin induced thrombocytopenia

___ ___ ___ igG antibody that targets platelets Antibody coated platelets are sequestered (gathered up) and removed from circulation Acute- develops after a viral infection is one of the most common childhood bleeding disorders

Immune (idiopathic) thrombocytopenic purapura

___ ____ ___ is a thrombotic (clotting) micro angiography (small or micro vessel disease) Platelets aggregate, form microthrombi (tiny clots) and cause occlusion (blockage) of arterioles and capillaries Familial or acquired Results in low platelets so bleeding

Thrombotic thrombocytopenia purapura

___ ____ Myeloproliferative neoplasm (bone marrow cancer) involving defect in bone marrow megakaryocyte progenitor cells Megakaryocyte in the bone marrow are produced in excess Microvasculature thrombosis or hemorrhage occurs

Essential (primary) thrombocythemia

___ ___ is following a splenectomy bc platelets cannot be stored in spleen

Secondary thrombocythemia

Alterations of coagulation: Caused by problems with clotting factors 2 main problems: 1. Impaired hemostasis(unable to stop bleeding) 2. Thromboembolic disorders (forms clots when they should not)

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Impaired hemostasis Inability to coagulate blood and form stable fibrin clot Causes: vitamin K deficiency Vitamin K is needed for prothrombin * the procoagulant factors (VII, Xl,X) and proteins C and S (anticoagulants) Vitamin K is absorbed from the intestine made by gut bacteria. Consumptive coagulopathy- imbalance in clot formation and dissolving leads to tiny clots throughout the body. Platelets and clotting factor used up “consumed” so no clots formed, bleeding uncontrolled (DIC)

Liver disease Hepatic liver cells produce most factors in hemostasis Liver damage causes production of fewer clotting factors

___ ___ ___ caused by many disease processes, especially sepsis (severe inf) Manifestations: show wide variability but not involve abnormal bleeding Bleeding from venipuncture sites Bleeding from arterial lines Purapura, petechiae, and hematoma (bleeding) Symmetric cyanosis of fingers and toes Treatment is infusion of coagulation factors removing the cause

Disseminated intravascular coagulation DIC

___ is a fixed clot narrowing it blocking a blood vessel

Thrombus

___ is a floating clot that moves upstream in the blood

Embolus

Thromboembolic disorders are a complication of many illnesses, related to decreased mobility Major cause of deaths Clots lead to ischemia due to blockage of blood vessels so DVT usually in legs Stroke Myocardial infarction Pulmonary embolism (PE) blocking lung arteries Causes: virchows triad is a 3 factor that causes clots. 1. Damage to blood vessel walls due to injury 2. Slowed blood flow, due to less activity 3. Hypercoagulability from hereditary thrombophilias (leyden factor V) and acquired hypercoagulability

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