Chapter 4 Flashcards
What is cor pulmonale and what causes it
Right side heart failure, and occurs when an emboli obstructs 60% or more of the pulmonary circulation
What is the result of the parasite filariasis
Induces fibrosis of lymphatic channels and nodes leading to lymphatic obstruction
What is the general steps that decreased oncotic pressure leads to edema
1) Reduced intravascular volume
2) Renal hypoperfustion
3) Increased aldosterone secretion (secondary hyperaldosteronism)
4) Water and salt retention leads to further edema
What are the three main factors that limit blood clotting
1) Dilution of blood taking factors away
2) Requirement of negative charge phospholipids only seen on activated platelets
3) Factors expressed by healthy epithelium to restrict activation
What are the factors that are expressed by endothelial cells to prevent coagulation
1) Thrombomodulin
2) Endothelial protein C receptor
3) Heparin like molecules
4) tissue factor pathway inhibitor
What occurs following a loss of blood >20% of blood volume
Hemorrhagic (hypovolemic) shock
Which condition is the usual cause of pulmonary edema
Most commonly with left ventricular failure, but can also be with renal failure, or acute respiratory distress syndrome
What occurs immediately following injury to a blood vessel
Vasoconstriction in order to reduce blood flow to injured area
Septic shock is most commonly triggered by which pathogen
Gram positive bacteria
What will acute pulmonary congestion present with morphologically
Enlarged alveolar capillaries, alveolar septal edema, and focal intraalveolar hemorrhage
What are the most common inherited causes of hypercoagulability
1) Point mutations in factor 5 gene
2) Point mutations in Prothrombin gene
Where is the process of clotting occurring
On the negatively charged phospholipid surface of platelets
What is the role of endothelial protein C receptor
Hold protein C, so bound thrombin to thrombomodulin, can inactivated factors 5a and 8a
Of people with DVTs, what percent are associated with factor 5 Leiden mutation
60%
During platelet aggragation, what is the significance in the changes to complex 2B/3a
Allows the binding of fibrinogen, and subsequent bridging of adjacent platelets
How is the level of plasmin regulated
Alpha2-plasmin inhibitor (PAI) which bind to and inactivate free plasmin
What are the conditions that can lead to impaired venous return and subsequent increases in hydrostatic pressure
CHF, constrictive pericarditis, ascites (liver failure), venous obstruction or compression, arterial dilation
What condition with patients regularly receive a false positive for during antiphospholipid antibody Syndrome
Syphilis, due to binding to cardiolipin
What is the main enzyme responsible of for fibrinolysis
Plasmin
What is the most important activator of factor 10
9a/8a
For the PTT test, what are the materials added
Negative charged particles (beads)
Phospholipids
Calcium
What is the cause of congestion
Reduction in the outflow of blood from a tissue as in cardiac failure or venous obstruction
How will cardiac and hypovolemic shock present in clinic
Hypotension, weak but rapid pulse, tachypnea, cool but clammy skin
What is the general order of events in primary hemostasis
1) von Willebrand factor and collagen are exposed
2) Platelets adhere and activate, become spiky balls
3) Platelets degranulate and release factors
4) Platelets aggregate