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Pathology > Vascular > Flashcards

Vascular Flashcards

1
Q

In regards to hemostasis, healthy endothelium is…

A

Antithrombotic

Profibrinolytic

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2
Q

What is ‘activated’ endothelium

A

Damaged endothelium that releases vasoactive mediators and cytokines resulting in fluid loss or hemmorhage

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3
Q

What causes activated endothelium

A

Oxidative stress
Inflammation
Infection
Trauma

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4
Q

Which pressure is acted on a by a pump

A

Hydraulic - ie systolic BP

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5
Q

Where does hydraulic pressure in vessels push fluid

A

Out of vessels —> tissues, interstitium

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6
Q

Which pressure is acted on by large solutes

A

Colloid osmotic pressure

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7
Q

Where does colloid pressure in vessels push/pull fluid

A

Pulls fluid from tissue/interstium —> vessels

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8
Q

Which protein is more important for COP

A

Albumin

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9
Q

Which pressure keeps fluid in vascular space

A

Albumin

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10
Q

What is Starlings law

A

Change in hydraulic pressure - Change in osmotic pressure

(Pcap – Pif) – s(Ccap – Cif)

	Pcap = hydraulic pressure in capillaries (generated by heart)
	Pif = hydraulic pressure in tissues

s= reflection coefficient of proteins across capillary wall (0 = permeable, 1 = impermeable)

		Ccap = oncotic pressure of plasma (generated by plasma proteins)					      
                     Cif = oncotic pressure of ISF (generated by filtered proteins in ISF)
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11
Q

What is the pressure in tissue capillaries and what does this mean for fluid exchange

A

Capillary hydraulic and COP pressures are low (due to decreased changes in pressure)

Causes net flow of fluid to interstitium/tissue

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12
Q

What happens to fluid in tissue that is not reabsorbed by venules

A

Transported via lymphatics to circulation

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13
Q

If hydraulic pressure in vessels increases, fluid moves….

A

to tissue

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14
Q

If COP in vessels increases, fluid moves….

A

to tissue

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15
Q

What is the ‘Safe Zone’

A

No accumulation in tissues if 1) hydraulic pressure decreases and 2) COP decreases

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16
Q

Pathogenesis hypervolemia

A

1) Increased plasma volume
2) Water moves into ISF and ultimately into cell (due to hyraulic and osmotic gradients!)
3) Cells swell

17
Q

Pathogenesis hypovolemia

A

1) Decreased plasma volume
2) Water leaves ISF and cells
3) Cells shrink

18
Q

4 causes of edema

A

1) Intravascular permeability
2) Increased hydraulic pressure
3) Decreased COP
4) Decreased lymphatic pressure

19
Q

What is the accumulation of excess interstital fluid called

A

Edema

20
Q

What causes increased vascular permeability (7)

A

1) Inflammatory vasoactive substances (histamine, substance P, bradykinin, cytokines IL-1, TNF)
2) Infectious agents (virus, bacteria)
3) Immune mediated mechanisms
4) Toxins - endotoxin causes increase endothelial gaps
5) Metabolic (diabetes)
6) Type 1 hypersensitivity (histamine)
7) Clotting issues

21
Q

Ascites, hydroperitoneum, peritoneal effusion all indicate…

A

Right sided heart failure

(increased pressure gradient in portal venous system, causing increased filtration of fluid and reduced absorption into venules)

22
Q

Pulmonary hypertesnsion, pulmonary edema indicate….

A

Left-sided heart failure OR high altitude disease

increased pressure gradient in pulmonary vessels

23
Q

Generalized edema suggests….

A

Generalized heart failure

24
Q

What are some non-heart failure things that can cause increased hydraulic pressure (3)

A
  1. Localized venous obstruction (GDV, venous thromboses, intestinal twists)
  2. Fluid overload (iatrogenic, sodium retention due to renal Dz)
  3. Hyperemia
25
Q

Causes of decreased intravascular oncotic pressure (5)

A

1) Increased fluid filtration to interstitial – lack of COP holding fluid in
2) Decreased production of albumin (liver failure, malnutrition)
3) Protein losing enteropathy (parasites)
4) Protein losing nephropathy (glomerular, tubular loss of protein)
5) Burns

26
Q

Causes of decreased lymphatic drainage (3)

A

1) Obstructions, compressions (neoplasia, inflammation)
2) Lymphatic aplasia, hypoplasia
3) Lymphangitis

27
Q

Gross appearance of edema (5)

A

1) Swelling, doughy skin
2) Distended tissue
3) Not red or painful
4) Cool to touch
5) Clear, yellow tinged fluid

28
Q

Histopathological appearance of edema (3)

A

1) Separation of tissue by clear spaces
2) Fluid
3) Pink - if protein is in spaces, fluid

29
Q

Cavitary fluids (4)

A
  1. Pericardial effusion (hydropericardium)
  2. Pleural effusion (hydrothorax)
  3. Peritoneal effusion (ascites)
  4. Hydroperitoneum
30
Q

What is transudate

A

Low/high protein, low cells

31
Q

What is exudate

A

High protein, many cells

32
Q

Types of effusion

A

Biliary
Chylous
Neoplastic
Inflammatory

33
Q

Which tissues have discontinuous (sinusoidal) capillaries

A

Liver
Spleen
Bone marrow
Lymph nodes

34
Q

Which tissues have fenestrated capillaries

A 
Glomerulus
Intestinal villi
Endocrine glands
Choroid plexus
Ciliary processes of eye
35
Q

The capillary endothelium of tissues such as brain, muscle, lung, and bone is described as

A

Continuous endothelium

Pathology (8 decks)

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