Pathology of Blood Vessels, Hemodynamic disorders and shock Flashcards
Hyperemia and congestion are both due to __
Increased blood volume in tissue
___ is an active process and involves vasodilation leading to increased vascular flow
Hyperemia
____ and ___ are examples of hypermia
Inflammation and Exercise
___ is a passive process where there is decreased blood outflow (deoxygenated blood is backing up)
Congestion
This process can be a result of a systemic (cardiac failure) problem or local issue (like blockage), and results in edema
Congestion
Vascular congestion leads to a lack of blood flow, which causes ___, leading chronic ischemia. This results in loss of parenchyma, which the body replaces with ___
Vascular congestion leads to a lack of blood flow, which causes hypoxia, leading chronic ischemia. This results in loss of parenchyma, which the body replaces with scarring/scar tissue
Typical pathological findings begin with ___ ___, leading to small hemorrhages, which are cleaned up ___ that’ll be laden with ___
Typical pathological findings begin with capillary rupture , leading to small hemorrhages, which are cleaned up by macrophages that’ll be laden with hemosiderin
What is the pathology in the image below? What are the cells in the spaces called? (aka heart failure cells)
Mitral stenosis (congestion)
Hemosiderin-laden macrophages
A patient with chronic right heart failure has “nutmeg liver”. What condition leads to this nutmeg appearance?
Chronic liver congestion
Which area of the body is referred to as the “3rd space”? (hint: holds about 28% or so of the body’s water)
The interstitium
Third spacing refers to the collection of fluid in the ___
Third spacing refers to the collection of fluid in the interstitium
An abnormal increase in interstitial fluid within tissues is known as ___
Edema
Hydrothorax is fluid accumulation in the ___
Peritoneum (lung/chest cavity)
___ is fluid accumulation in the pericardium
Hydropericardium
___ is fluid collection in the abdomen and is frequently observed with ___ failure
Ascites is fluid collection in the abdomen and is frequently observed with liver failure
___ is fluid accumulation all over, like the patient below
Anasarca
___ is protein poor fluid caused by increased hydrostatic pressure or reduced plasma protein
Transudate is protein poor fluid caused by increased hydrostatic pressure or reduced plasma protein
In heart, renal and hepatic failure as well as malnutrition and other cases of fluid overload, ypu normally see this type of fluid
Transudate
___ is protein rich, driven by increased vascular permeability, and is part of the inflammatory response
Exudate
In the diagram below, what is the pink fluid shown by the arrow?
Transudate (edema; massive fluid overload)
Edema caused by issues in the systemic circulation is known as ___ edema and is characterized by swelling of the ankles and feet (see pic below)
Edema caused by issues in the systemic circulation is known as dependent edema and is characterized by swelling of the ankles and feet
The most common cause of dependent edema is ___. You should also consider what other conditions?
The most common cause of dependent edema is heart failure. You should also consider protein-wasting conditions.
Ascites can be a result of increased hydrostatic pressure due to __ of liver. It can also result from decreased ___ in liver failure, and ___ failure.
Ascites can be a result of increased hydrostatic pressure due to fibrosis of liver. It can also result from decreased colloid pressure (decreased albumin) component in liver failure, and right heart failure
For the case below, what gives away that this is ascites due to liver failure and NOT right heart failure?
The patient’s skin is yellow-orangish, indicating jaundice, which suggests liver failure and NOT right heart failure
___ is fluid accumulation in the pleura and can cause lung compression
Pleural effusion is fluid accumulation in the pleura and can cause lung compression
Fluid accumulation in the lymphatics is called ___
Lymphedema (lymphatic obstruction)
The most common causes of fluid accumulation in the lymphatics are radiation, surgery, ___ infection, ___, cellulitis and ___ (thoracic duct obstruction)
The most common causes of fluid accumulation in the lymphatics are radiation, surgery, parisitic infection, neoplasms, cellulitis and chylothorax (thoracic duct obstruction)
___ is the formation of intravascular blood clot that may obstruct blood flow and result in hypoperfusion / infarction
Thrombosis is the formation of intravascular blood clot that may obstruct blood flow and result in hypoperfusion / infarction
Below is the sequence of thrombotic events:
Endothelial injury >>
___ (to control bleeding) >>
___ adherence and aggregation >>
Coagulation cascade (tissue factors), __ __ formation (made by platelets and endothelium) >>
Fibrinolysis / thrombosis equilibrium
Endothelial injury >>
Vasoconstriction (to control bleeding) >>
Platelet adherence and aggregation >>
Coagulation cascade (tissue factors), fibrin clot formation (made by platelets and endothelium) >>
Fibrinolysis / thrombosis equilibrium
Virchow’s triad (i.e. the 3 key factors in thrombosis) consists of:
endothelial injury, ___ and ___
endothelial injury, abnormal blood flow (aka stasis), and hypercoagulability
Endothelial injury can occur due to ___ (aka the primary evolutionary drive for hemostasis), and ___ (e.g. diabetes, hypertension, atherosclerosis)
Endothelial injury can occur due to trauma (aka the primary evolutionary drive for hemostasis), and chronic endothelial damage (e.g. diabetes, hypertension, atherosclerosis)
How did the owner of this coronary artery die suddenly?
A.Thrombosis due to stasis
B.Acute myocardial infarction due to plaque rupture
C.Rupture at an aneurysm
D.Cocaine induced coronary vasospasm
B. Acute myocardial infarction due to plaque rupture
Another word for abnormal blood flow is ___, which can happen in both veins and arteries; if it happens in arteries, it mainly happens in areas of ___. It can also occur in ___ heart chambers
Another word for abnormal blood flow is stasis, which can happen in both veins and arteries; if it happens in arteries, it mainly happens in areas of aneurysms. It can also occur in dilated heart chambers (e.g. aneurysms from healed infarcts, valve disease, cardiomyopathies)
In the image below, what is the most likely cause of thrombosis?
A.Atherosclerosis inside the ventricle
B.Coagulopathy
C.Old MI -> decreased motility -> stasis inside ventricle
D.Metastatic cancer
C.Old MI -> decreased motility -> stasis inside ventricle
For the patient below, what is the most likely outcome?
A.Diabetes
B.Coronary artery disease
C.Metabolic syndrome
D.Systemic thromboembolism
D. Systemic thromboembolism
(The problem with thrombi in the ventricles is that they can leave through the L ventricle to the systemic circulation and go lodge somewhere else)
The two types of hypercoagulable/prothombotic states are ___ and __
Primary and secondary/acquired
A primary prothrombotic state is due to __ in the coagulation cascade, whereas aquired can be due to ___, carcinomas, heparin induced thrombocytopenia, low risk: smoking, OCPs, nephrotic syndrome, and ___
A primary prothrombotic state is due to genetic errors in the coagulation cascade, whereas aquired can be due to immobilization, carcinomas, heparin induced thrombocytopenia, low risk: smoking, OCPs, nephrotic syndrome, and pregnancy
Examples of venous thrombosis syndromes include ___ (DVT), ___ (on differential for pt w/ ripping chest pain) which can be acute or chronic, ___ and ___ (Budd-Chiari syndrome)
Examples of venous thrombosis syndromes include deep venous thrombosis (DVT), pulmonary thromboembolism (on differential for pt w/ ripping chest pain) which can be acute or chronic, IVC thrombosis and Hepatic vein thrombosis (Budd-Chiari syndrome)
The movement of physiologic or foreign material within an artery or vein, that lodges elsewhere is known as an ___
Embolism
Examples of components that can embolize are __ (most common), fat, __ fluid, tumors, air and ___ materials
Examples of components that can embolize are thrombus (most common), fat, amniotic fluid, tumors, air and iatrogenic materials (medical devices/drugs left in body therapeutically or unintentionally)
The types of emboli include systemic, ___ and ___ (crosses foramen ovale to reach systemic circulation)
The types of emboli include systemic (source usually cardiac (valves, ventricles)
or Iatrogenic),pulmonary(source usually inleg veins)
and paradoxical (venous source) (involves hole in one’s heart)
Pulmonary embolisms usually come from __ veins and the biggest risk factors include ___ (I have trauma to my veins and I just had surgery so I can’t move coz I have cancer)
Pulmonary embolisms usually come from leg veins and the biggest risk factors include DVT, trauma, post-operative, immobilization, and malignancy
In the pt below, what is the most likely cause of death?
A.Budd-Chiari syndrome
B.Gunshot wound
C.Congestive heart failure
D.Paradoxical embolus
E.Saddle embolus of pulmonary trunk bifurcation
Saddle embolus of pulmonary trunk bifurcation
(Saddle emboli look like you’re sitting on a saddle between right and left)
How can you tell ante-morterm vs post-morterm saddle emboli?
Antemorterm: lines of Zahn – there’s organization which obstructs blood flow, whereas post morterm would look like chicken fat
An ___ is irreversible ischemic injury secondary to hypoxia, resulting in coagulative necrosis (except in ___, where it’s liquefactive necrosis). It’s usually the result of a thrombus or embolus.
An infarction is irreversible ischemic injury secondary to hypoxia, resulting in coagulative necrosis (except in brain, where it’s liquefactive necrosis). It’s usually the result of a thrombus or embolus.
Histologically, you can date an infarct using the scheme below:
Minutes to hours: ___
___ hours: necrosis
>1-2 days: ___
Histologically, you can date an infarct using the scheme below:
Minutes to hours: nothing
4 - 12 hours: necrosis
>1-2 days: scar
Shock is defined as __, and may be due to decreased cardiac contractility, decreased ___ (as in DIC), or decreased ___ (vasodilation)
Shock is defined as systemic hypotension resulting in tissue hypoperfusion, hypoxia + ischemia , and may be due to decreased cardiac contractility, decreased intravascular volume (as in DIC), or decreased peripheral vascular resistance (vasodilation)
The types of shock are __, hypovolemic, neurogenic, __ and ___
Cardiogenic
Hypovolemic
Neurogenic
Septic
Anaphylactic
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