V- Hemodynamics Flashcards
diseases of reduced plasma oncotic P
- nephrotic syndrome
- end stage liver dz
- malnutrition
- gastroenteropathy aka diarrhea
anything that dec proteins (albumin)
anascara
severe generalized edema from dec onctoic P
-early sign is periorbital edema
diseases of inc hydrostatic P
- CHF
- constrictive pericarditis
- ascities (from liver cirrhosis)
- venous obstruction
L heart vs R heart edema
CHF in L heart = complain of trouble breathing bc lungs fill with fluid
CHF in R heart = JVD, edema in legs, h/smegaly
sodium retention causes
- renin angiotensin aldosterone system
- renal insufficiency
causes of lymphatic obstruction
- inflamm
- neoplastic
- surgery (removal axillary nodes)
- postirradiation > fibrosis
subcutaneous tissue edema
not serious unless have a wound healing problem
-histology may only show subtle changes like inc clear spaces b/t cells
dependent edema
from inc hydrostatic P like CHF
pitting edema from
transient fluid displacement
edema in lungs symptoms
-dyspnea
-cyanosis
-tachypnea
-cough with copious sputum, frothy, bloody
-bounding pulse
-crackles
-hemosiderin macrophages
lung edema shows
if interstitial:
-poorly defined vessels with septal lines
-thick bronchial walls
if alveolar:
-bilateral lung consolidation
edema in the brain
generalized
if generalized can push brainstem into foramen magnum and impair breathing centers
-from encephalitis, hypertensive crisis, obstruction venous outflow, trauma
edema in brain local
herniate into adj compartments like cerebellar
-from abcess, neoplasm, trauma
active hyperemia from
-muscles during exercise, inflamm, blushing
arteriolar dilation inc oxygenated blood flow into tissues = erythematous
passive congestion from
impaired outflow of deoxy blood from tissues i.e. CHF or local venous obstruction
nutmeg liver
chronic hepatic congestion from R sided problem (in heart or upstream of liver)
-hepatic lobules are red/brown and depressed and necrotic around central vein of zone 3
-can lead to fibrosis
causes of hemorrage
- trauma
- atherosclerosis
- aneurysm
- neoplasia- polyps, cancer
- inflamm
- fragile vessles
- platelet dysfunctin
- coagulation defect
signs of hemorrhage
- petechiae, smallest tiny lesions
- purpura
- ecchymoses
PT
diagnostic measure of extrinsic coagulation pathway
-prolonged by warfarin
PTT
diagnostic measurement of intrinsic coagulation pathway
-prolonged by heparin
Bernard Soulier dz
mutation in GPIb (platelet formation) so very large platelets
-only mild bleeding
Glanzmann thrombasthenia
mutation in GPIIb/IIIa (platelet aggregation)
-show varying amounts of bleeding
thrombotic thrombocytopenic purpura
antibodies vs ADAMTS-13 (cleaves vWF)
idiopathic thrombocytopenic purpura
autoimmune dz vs platelets so dangerously low
-treatment with splenectomy
hemophilia can cause
-deep internal bleeding
-joint damage
-transfusion transmitted infections
-adverse rxns (immune resp)
-intracranial hemorrhage
von willebrand dz
easily bruise, get nosebleeds, gingival bleeding, menorrhagia
liver produces what for coagulation
- factors II, VII, IX, X
- protein S
- protein C
if liver disease or vit K deficiency then all impacted
what happens in DIC
tiny thrombi form throughout body esp capillaries and small vessels
-depletes platelet supply and coagulation factors so risk of bleeding and organ failure
an underlying disorder not primary
causes of DIC
infections
malignancies
obstetric complications
hypersensitivity rxns
widespread tissue damage
virchow’s triad
- hypercoagulable state
- endothelial injury
- circulatory stasis/abnormal blood flow
causes of arterial thrombi
MI, A fib, rheumatic heart dz, atherosclerosis
causes of venous thrombi
sepsis, CHF, trauma, surgery, preg, cancer, trousseau syndrome
characteristics of arterial thrombi
- at site of injury, coronary A
- made of platelets, fibrin, erythrocytes, leukocytes (layers of zahn histology)
- look grey/white and friable
- common in heart and brain
characteristics of venous thrombi
-common in LE
-made of more erythrocytes so have redder appearnce
risk factors for hypercoag states
- factor V mutations
- prolonged immobilization
- MI, A fib, prosthetic valves
- tissue injury, cancer, smoking
- DIC, heparin induced thrombocytopenia, antiphospholipid Ab syndrome, sickle cell
- oral contraceptive use, preg
- nephrotic syndrome
tetrad of TTP
fever + thrombocytopenia + hemolytic anemia + transient neurologic defects with renal dz
