V- Hemodynamics

Question 1

diseases of reduced plasma oncotic P

Answer 1

1. nephrotic syndrome
2. end stage liver dz
3. malnutrition
4. gastroenteropathy aka diarrhea

anything that dec proteins (albumin)

Question 2

anascara

Answer 2

severe generalized edema from dec onctoic P
-early sign is periorbital edema

Question 3

diseases of inc hydrostatic P

Answer 3

1. CHF
2. constrictive pericarditis
3. ascities (from liver cirrhosis)
4. venous obstruction

Question 4

L heart vs R heart edema

Answer 4

CHF in L heart = complain of trouble breathing bc lungs fill with fluid
CHF in R heart = JVD, edema in legs, h/smegaly

Question 5

sodium retention causes

Answer 5

1. renin angiotensin aldosterone system
2. renal insufficiency

Question 6

causes of lymphatic obstruction

Answer 6

1. inflamm
2. neoplastic
3. surgery (removal axillary nodes)
4. postirradiation > fibrosis

Question 7

subcutaneous tissue edema

Answer 7

not serious unless have a wound healing problem
-histology may only show subtle changes like inc clear spaces b/t cells

Question 8

dependent edema

Answer 8

from inc hydrostatic P like CHF

Question 9

pitting edema from

Answer 9

transient fluid displacement

Question 10

edema in lungs symptoms

Answer 10

-dyspnea
-cyanosis
-tachypnea
-cough with copious sputum, frothy, bloody
-bounding pulse
-crackles
-hemosiderin macrophages

Question 11

lung edema shows

Answer 11

if interstitial:
-poorly defined vessels with septal lines
-thick bronchial walls

if alveolar:
-bilateral lung consolidation

Question 12

edema in the brain

generalized

Answer 12

if generalized can push brainstem into foramen magnum and impair breathing centers
-from encephalitis, hypertensive crisis, obstruction venous outflow, trauma

Question 13

edema in brain local

Answer 13

herniate into adj compartments like cerebellar
-from abcess, neoplasm, trauma

Question 14

active hyperemia from

Answer 14

-muscles during exercise, inflamm, blushing

arteriolar dilation inc oxygenated blood flow into tissues = erythematous

Question 15

passive congestion from

Answer 15

impaired outflow of deoxy blood from tissues i.e. CHF or local venous obstruction

Question 16

nutmeg liver

Answer 16

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

Question 17

causes of hemorrage

Answer 17

1. trauma
2. atherosclerosis
3. aneurysm
4. neoplasia- polyps, cancer
5. inflamm
6. fragile vessles
7. platelet dysfunctin
8. coagulation defect

Question 18

signs of hemorrhage

Answer 18

1. petechiae, smallest tiny lesions
2. purpura
3. ecchymoses

Question 19

PT

Answer 19

diagnostic measure of extrinsic coagulation pathway
-prolonged by warfarin

Question 20

PTT

Answer 20

diagnostic measurement of intrinsic coagulation pathway
-prolonged by heparin

Question 21

Bernard Soulier dz

Answer 21

mutation in GPIb (platelet formation) so very large platelets
-only mild bleeding

Question 22

Glanzmann thrombasthenia

Answer 22

mutation in GPIIb/IIIa (platelet aggregation)
-show varying amounts of bleeding

Question 23

thrombotic thrombocytopenic purpura

Answer 23

antibodies vs ADAMTS-13 (cleaves vWF)

Question 24

idiopathic thrombocytopenic purpura

Answer 24

autoimmune dz vs platelets so dangerously low
-treatment with splenectomy

Question 25

hemophilia can cause

Answer 25

-deep internal bleeding
-joint damage
-transfusion transmitted infections
-adverse rxns (immune resp)
-intracranial hemorrhage

Question 26

von willebrand dz

Answer 26

easily bruise, get nosebleeds, gingival bleeding, menorrhagia

Question 27

liver produces what for coagulation

Answer 27

1. factors II, VII, IX, X
2. protein S
3. protein C

if liver disease or vit K deficiency then all impacted

Question 28

what happens in DIC

Answer 28

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

Question 29

causes of DIC

Answer 29

infections
malignancies
obstetric complications
hypersensitivity rxns
widespread tissue damage

Question 30

virchow’s triad

Answer 30

1. hypercoagulable state
2. endothelial injury
3. circulatory stasis/abnormal blood flow

Question 31

causes of arterial thrombi

Answer 31

MI, A fib, rheumatic heart dz, atherosclerosis

Question 32

causes of venous thrombi

Answer 32

sepsis, CHF, trauma, surgery, preg, cancer, trousseau syndrome

Question 33

characteristics of arterial thrombi

Answer 33

• 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

Question 34

characteristics of venous thrombi

Answer 34

-common in LE
-made of more erythrocytes so have redder appearnce

Question 35

risk factors for hypercoag states

Answer 35

1. factor V mutations
2. prolonged immobilization
3. MI, A fib, prosthetic valves
4. tissue injury, cancer, smoking
5. DIC, heparin induced thrombocytopenia, antiphospholipid Ab syndrome, sickle cell
6. oral contraceptive use, preg
7. nephrotic syndrome

Question 36

tetrad of TTP

Answer 36

fever + thrombocytopenia + hemolytic anemia + transient neurologic defects with renal dz