Circulatory Disorders

Question 1

What role does the vascular endothelium play in hemostatic

Answer 1

Anti-thrombotic and pro-fibrinolytic in normal state

Pro-thrombin and anti-fibrinolytic during injury

Question 2

What are the roles of the vascular endothelium?

Answer 2

Role in homeostasis
Modulate perfusion
Role in inflammation

Question 3

How does the vascular endothelium modulate perfusion?

Answer 3

NO relaxes and causes vasodilation

Endothelin causes vasoconstriction

Question 4

What is the role of vascular endothelium in inflammation?

Answer 4

Regulate cellular traffic
Produce-proinflmmatory cytokines
Control angiogenesis and tissue repair

Question 5

Most body fluid is _________

Answer 5

Intracellular (40%)

Question 6

Space between tissue compartments where all metabolic products must pass between microcirculation and the cells

Answer 6

Intersitium

Question 7

What is transcellular fluid

Answer 7

Fluid present in body cavity
Eg cerebrospinal fluid
Aqueous humor of eye

Question 8

What is the extracellular max trip?

Answer 8

Composed of structural molecules (collagen, reticulin, and elastic fibers) and ground substance (glycoproteins and glycosaminoglycans)

Question 9

What two forces determine water distribution between plasma and interstitium

Answer 9

Hydrostatic pressure 
And osmotic (oncotic)  pressure

Question 10

Increased hydrostatic pressure or diminished plasma oncotic pressure can cause ________

Answer 10

Tissue edema

Question 11

What functions to remove excess volume from the intersitium and will return this fluid back to the circulation

Answer 11

Lymphatic

Question 12

What are the circulatory disorders ?

Answer 12

Edema 
Hyperemia and Congestion 
Hemostatis 
Hemorrhage 
Thrombosis and embolism 
Infarction 
Shock

Question 13

Abnormal accumulation of excess extracellular water in interstitial spaces or in body cavities

Answer 13

Edema

Question 14

What are the two classifications of edema?

Answer 14

Inflammatory -> increase vascular permeability (exudate)

non-inflammatory

Question 15

What are the 4 main causes of edema?

Answer 15

Increased body hydrostatic pressure
Decreased plasma colloidal osmotic - protein not absorbed/ not produced/ lost
Lymphatic obstruction
Increased vascular permeability

Question 16

Increased blood hydrostatic pressure can occur in ____________ which causes generalized edema

Answer 16

Right sided congestive heart failure

Eg pulmonary stenosis (narrowing) -> right ventricle cannot maintain normal output to lung -> accumulation -> back up to atrium and venous system =increased hydrostatic pressure

Question 17

Example of localized increased hydrostatic pressure

Answer 17

Tightly bandaged limb resulting in venous occlusion

Blood trapped in vein -> increased pressure ->
Fluids escapes into intersitium=> edema

Question 18

How can severe liver disease lead to edema ?

Answer 18

Proteins are not produced -> low albumin levels -> decreased osmotic pressure -> fluids not reabsorbed from interstitium

Question 19

How can renal disease result in generalized edema?

Answer 19

Glomerular disease-> loss of protein -> loss of oncotic pressure -> decreased absorption-> edema

Intrarenal proteinuria

Question 20

What type of edema is protein rich

Answer 20

Inflammatory (increased vascular permeability )

“Exudate”

Question 21

What type of edema is protein poor

Answer 21

Non-inflammatory
Eg. Liver failure
“Transudate”

Question 22

Gross appearance of edema

Answer 22

Wet
Gelatinous and heavy 
Swollen organs 
Fluid weeps from cut surface 
May be yellow

Question 23

What is the histological appearance of edema?

Answer 23

Clear(non-inflammatory)/pale eosinophilic(inflammatory) 
Spaces are distended 
Blood vessels may be filled with RBC
Lymphatic are dilated 
Collagen bundles are separated

Question 24

Type of edema, where pressure is applied to an areas resulting in a depression/dent

Answer 24

Pitting edema

Interstitial fluid is forced to adjacent areas

Question 25

Fluids in the thoracic cavity

Answer 25

Hydrothorax

Question 26

Fluid within the pericardial space

Answer 26

Pericardial effusion

Question 27

What is mulberry heart disease

Answer 27

Pericardial effusion- Inflammatory edema Fibrin strands and cloudy appearance

Question 28

Fluid within the peritoneal cavity

Answer 28

Acites/hydroperitoneum

Question 29

Generalized edema with profuse accumulation of fluid within subcutaneous tissue?

Answer 29

Anasarca

Question 30

Type of edema commonly associated with severe GI parasitism and hypoproteinemia

Answer 30

Submandibular edema (bottle jaw)

Question 31

After prolonged edema, what can occur to tissue?

Answer 31

Become firm and distorted due to increased in fiberous CT

Question 32

Sudden, diffused and direct- increase in vascular permeability in the lungs

Answer 32

Acute respiratory distress syndrome (ARDS)

Question 33

Chronic pulmonary edema is most commonly associated with what condition?

Answer 33

Cardiac failure

Question 34

What is chronic pulmonary edema?

Answer 34

Alveolar walls become thickened->fibrosis | Congestion, micro-hemorrhages-> accumulation of heart failure cells

Question 35

What is the gross appearance of pulmonary edema ?

Answer 35

Lungs enlarged in thoracic cavity ( can have rib indents) Surface is wet/moist and heaven On section of trachea -> froth/fluid in airway

Question 36

What are heart failure cells and what stain can be used to visualize them?

Answer 36

Cells in alveoli-> macrophages (aka siderophages) containing hemosiderin (iron->metabolic products of heart failure) Iron (perl's) stain

Question 37

What is the difference between hyperemia and congestion?

Answer 37

Hyperemia-> increase of arteiole-mediated engorgement (oxygenated blood) Congestion-> passive venous engorgement (deoxy blood)

Question 38

Physiological hyperemia can be due to?

Answer 38

Digestion Exercise Dissipate heat Neurovascular

Question 39

What are causes of pathological hyperemia?

Answer 39

Inflammation - > inflammatory mediators cause arteriolar dilation - > rubor, tumor, calor, pain, loss of function

Question 40

Condition of obstruction due to twisting of an the stomach

Answer 40

Gastric volvulus (torsion)

Question 41

Are torsion/volvus due to hyperemia/congestion?

Answer 41

Severe venous congestion --> ischemia and necrosis

Question 42

_______________ is usually the result of hart failure and associated with edema

Answer 42

Pulmonary congestion

Question 43

What cells will be present in pulmonary hemosiderosis?

Answer 43

Heart failure cells

Question 44

Subacute/chronic hepatic congestion is usually the result of ________

Answer 44

Right-sided CHF

Question 45

In chronic hepatic congestion you can usually see a build up of __________

Answer 45

Fiberous CT

Question 46

Chronic hepatic congestion is also called?

Answer 46

Nutmeg liver

Question 47

Nutmeg liver is due to ?

Answer 47

Increased congestion of hepatic vein

Question 48

Chronically, low grade hypoxia and increased centrolobular hepatocytes leads to ??

Answer 48

Atrophy and necrosis

Question 49

Escape of blood from the blood vessels

Answer 49

Hemorrhage | Extravasation

Question 50

What are the causes of hemorrhage?

Answer 50

Trauma Sepsis/viremeia/bactereimia/toxins Abdominal neoplasia Coagulation abnormalities

Question 51

How does hemorrhage differ from hyperemia and congestion

Answer 51

Hemorrhage - outside vessels wall | Hyperemia and congestion - within the blood vessel

Question 52

What is the most common cause of hypovolemic shock?

Answer 52

Hemorrhage

Question 53

Hemopericardium can lead to a fatal ___________

Answer 53

Cardiac tamponade (increased pressure on heart and unable to fill properly) Due to: Trauma Malignant tumor ->hemangiosarcoma rupture (common in dog)

Question 54

Blood loss due to substantial tear in the vascular wall

Answer 54

Hemorrhage by Rhexis

Question 55

________________ is a blood filled channel within the aortic wall and can result in rupture and fatal hemorrhage? What species is this usually seen?

Answer 55

Dissecting aneurysm Pig and turkey-> copper deficiency Horse -> thoracic injury Young male racing greyhounds-> coronary and renal arteries

Question 56

Hemorrhage that is due to small defect in vessel wall or RBC passing through the vessel in case of inflammation or congestion

Answer 56

Hemorrhage by diapedesis

Question 57

Increased tendency to hemorrhage from usually insignificant injury

Answer 57

Hemorrhagic diathesis

Question 58

Blood in the thoracic cavity

Answer 58

Hemothorax

Question 59

Blood in peritoneal cavity

Answer 59

Hemoperitoneum

Question 60

Blood in a joint space

Answer 60

Hemarthrosis

Question 61

Coughing up blood or blood-stains sputum from lungs or airways

Answer 61

Hemoptysis

Question 62

Bleeding from the nose

Answer 62

Epistaxis

Question 63

What is petechia

Answer 63

Hemorrhage within tissue up to 1-2mm Found on skin, mucosa, and serosal surfaces

Question 64

What is ecchymosis?

Answer 64

Larger than petechia (up to 1/ 2 cm

Question 65

What is agonal hemorrhanges?

Answer 65

Petechiae and ecchymoses associated with terminal hypoxia

Question 66

What is suffusive hemorrhage?

Answer 66

Larger than ecchymosis and contiguous.

Question 67

What is Paint-brush hemorrhage? And what tissue is it most commonly found?

Answer 67

A terrible paint job Mucosal and serosal surfaces.

Question 68

How are hematoma resolved?

Answer 68

Hemoglobin (dark red/blue) -> enzymatically converted to bilirubin (blue-green)-> hemosiderin (yellow brown)

Question 69

What is the pathological form of hemostatis in which a clot forms in a vessel

Answer 69

Thrombosis

Question 70

What is required for hemostasis to occur?

Answer 70

Vascular wall endothelium Platelets Coagulation cascade

Question 71

Describe normal hemostasis

Answer 71

Injury of arteriolar wall -> vasoconstriction -> exposure of glycoproteins Ib rector on platelets to von Willebrand factor->platelet activation -> shape change -> aggregation Factor 3 thromboplastin exposed -> activate coagulation cascade -> thrombin cleaves fibrinogen to fibrin ->further platelet recruitment ad granule release

Question 72

Describe formation of a thrombus clot

Answer 72

Polymerized fibrin and platelet aggregated Tissue plasminogen activator and thrombomodulin activated to limit side of thrombus

Question 73

Coagulation factors are produced mainly in the ?

Answer 73

Liver

Question 74

Thrombosis

Answer 74

Formation/presence of solid mass within the CV system Can result in occlusion of lumen and embolism

Question 75

What factors can lead to thrombosis formation?

Answer 75

Endothelial injury Alteration in blood flow (turbulence or stasis) Hypercoagulability (increase factors or decreased inhibitors)

Question 76

How can severe renal glomerular disease lead to thrombosis formation?

Answer 76

Protein losing neuropathy -> loss of antithrombin III

Question 77

Thrombus formation due to strongylus vulgaris infection is called?

Answer 77

Verminous thrombosis Equine - crainial mesenteric artery common

Question 78

What are the outcomes of thrombus??

Answer 78

Lysis Propagation Organization/recanalization

Question 79

What is an embolism/embolus ??

Answer 79

Piece of thrombus breaks off from original mass and lodges at a different site Embolus =mass that breaks off

Question 80

What embolism can be a complication of long bone fractures?

Answer 80

Fat embolism Eg. Secondary to CPR efforts -> bone break->bone marrow embolus -> pulmonary artery

Question 81

Thrombotic meningoencepalitis is often due to what?

Answer 81

Bacterial infection by Histophilus so nice =>vasculitis and thrombosis formation

Question 82

Pathologic, generalized activation of the blood coagulation system

Answer 82

Disseminated intravascular coagulation (DIC) Often due to : - neoplasia injury - anaphylaxis

Question 83

Localized area of ischemic necrosis in a tissue or organ caused by occlusion of arterial supply or venous drainage

Answer 83

Infarction

Question 84

how does a venous infarction differ from arterial infarction

Answer 84

Venous- intensely hemorrhagic as blood backs up into tissue Arterial- initially hemorrhagic but becomes pale and coagulation necrosis becomes evident

Question 85

___________ gives rise to systemic hypoperfusion

Answer 85

Shock Due to reduced CO or reduced effective circulating blood volume

Question 86

What are the types of shock?

Answer 86

Cardiogenic - decreased CO Hypovolemic - fluid loss Blood maldistribution - anaphylactic - neurogenic -loss of vascular tone - septic -host innate immune response to infectious organism

Question 87

What is the pathogenesis of septic shock?

Answer 87

Usually from endotoxin-producing gram negative bacilli (endotoxin shock) -> bacterial LPS -> Lipid A component -> induce injury and activate WBC -> cytokine release ->vasodilation and pro-thrombotic dathesis (DIC)