Hemodynamics I Flashcards
(96 cards)
1
Q
What is edema?
A
Swelling of tissue due to increased fluid in interstitial spaces.
2
Q
What is ascites?
A
Fluid in the abdominal cavity.
3
Q
What is anasarca?
A
Generalized edema.
4
Q
What is hyperemia?
A
Erythema; an active increase in arterial blood flow.
5
Q
What is congestion?
A
Passive decrease in venous outflow.
6
Q
What is hemorrhage?
A
Extravasation of blood due to blood vessel rupture.
7
Q
What is hematoma?
A
Hemorrhage enclosed within tissue.
8
Q
What is petechia?
A
Tiny (1-2 mm) hemorrhage due to platelet deficiency.
9
Q
What is hemostasis?
A
- The maintenance of blood in a free-flowing liquid state in normal blood vessels
- The formation of a blood clot at a site of vascular injury
10
Q
What are platelets?
A
Anucleate cellular components of blood.
11
Q
What are platelets important in?
A
In initiation and propagation of clotting.
12
Q
Do platelets have granules?
A
Yes, but no nucleus.
13
Q
What is thrombosis?
A
Inappropriate formation of blood clot in a blood vessel; usually occlusive.
14
Q
What is hypercoagulability?
A
Abnormal tendency to form blood clots.
15
Q
What is coagulopathy?
A
Abnormal tendency to bleed.
16
Q
What is an embolus?
A
Detached intravascular solid, liquid, or gaseous mass carried by blood to a site distant from its point of origin.
17
Q
What is an infarction?
A
Area of ischemic necrosis.
18
Q
Generalized edema due to renal failure initially appears where?
A
Tissues with loose connective tissue matrix i.e. periorbital edema.
19
Q
What is pitting edema?
A
Transient pit forms in the skin at site of finger pressure.
20
Q
What are the 5 pathophysiologic categories of edema?
A
- Increased hydrostatic pressure
- Decreased plasma osmotic pressure
- Sodium retention
- Inflammation
- Lymphatic obstruction
21
Q
What are the 4 most common causes of edema?
A
- Increased hydrostatic pressure
- Decreased plasma osmotic pressure
- Sodium retention
- Inflammation
22
Q
What are 3 examples of edema due to increased hydrostatic pressure?
A
- Lungs: due to left heart failure
- Lower body: due to right heart failure
- Leg: due to deep venous thrombosis
23
Q
What is dependent edema?
A
Edema due to increased hydrostatic pressure is worse in legs when standing and sacrum when lying down.
24
Q
What are 2 example of edema due to decreased plasma osmotic pressure?
A
- Nephrotic syndrome: due to protein loss.
- Hepatic cirrhosis: due to increased hydrostatic pressure in portal venous system and decreased plasma osmotic pressure due to protein loss into ascites and deficient hepatic protein synthesis
25
T or F. Edema due to sodium retention is always generalized with increased hydrostatic pressure.
T.
26
What are 2 types of edema due to inflammation?
1. Localized: at site of infection
| 2. Generalized: with SIRS or sepsis
27
What is edema due to lymphatic obstruction called?
Lymphedema.
28
Lymphedema can be caused by what 5 things?
1. Tumor
2. Inflammation
3. Surgery
4. Radiation
5. Scar
29
Is lympedema usually localized or generalized?
Localized.
30
What is peau d' orange?
Lymphedema from breast cancer causes skin over tumor to resemble the skin of an orange.
31
What is the most common cause of pulmonary edema?
Left heart failure. Others: ARDS, hypersensitivity reaction, pneumonia, and renal failure.
32
What kind of fluid is found in pulmonary edema?
Frothy fluid. Pink too if blood present.
33
What is the symptom of pulmondary edema?
Dyspnea.
34
What is the sign of pulmonary edema?
Pulmonary crackles.
35
Airspaces in pulmonary alveolar edema are filled with what?
Pink, proteinaceous fluid.
36
Localized cerebral edema is caused by what 2 things?
1. Abscess
| 2. Tumor
37
Generalized cerebral edema is caused by what?
Encephalitis.
38
What does the brain look like with generalized cerebral edema?
Swollen gyri and narrowed sulci.
39
How can cerebral edema be fatal?
Herniation of cerebellar tonsils into foramen magnum compressing the brainstem's respiratory center.
40
When congestion is due to heart failure, what happens to the liver? Lung?
Nutmeg liver. Hemophages in alveoli.
41
What is nutmeg liver?
Alternating red centrilobular and tan peripherilobular tissue.
42
What is a purpura?
Medium (3-10 mm) bleed due to vasculitis, vessel fragility, etc.
43
What is an ecchymosis?
Larger (over 1 cm) subcutaneous hemorrhage. Often called a bruise.
44
Why do ecchymoses go from red-blue to blue-green to gold-brown?
Color change due to progression of hemoglobin break down.
45
What is hemothorax?
Hemorrhage into a pleural cavity.
46
What are the 4 stages of hemostasis at site of vascular injury?
1. Vasoconstriction
2. Primary hemostasis
3. Secondary hemostasis
4. Thrombus and antithrombotic events
47
Describe the first stage of hemostasis: vasoconstriction.
Brief arteriolar vasoconstriction mediated by reflex neurogenic mechanisms. Increased by local secretion of vasoconstrictors.
48
What is endothelin?
A potent endothelium-derived vasoconstrictor.
49
Describe the second stage of hemostasis: primary hemostasis.
Platelet adhesion to thrombogenic ECM-activation-shape change-GpIIb/IIIa binds fibrinogen-aggregation-release of ADP and TXA2-platelet recruitment and aggregation.
50
Describe the third stage of hemostasis: secondary hemostasis.
Coagulation cascade activated by tissue factor and platelet factors. Results in activated thrombin.
51
What does activated thrombin do?
Cleaves fibrinogen to fibrin to solidify primary hemostatic plug.
52
Describe the fourth stage of hemostasis: thrombus maturation and antithrombotic events.
Formation of solid permanent plug of aggregated platelets that are polymerized by fibrin. Counter-regulatory mechanisms contain the hemostatic plug to the site of injury.
53
What are the 3 predisposing factors to thrombosis?
1. Endothelial injury
2. Abnormal blood flow
3. Hypercoagulability
54
Thrombosis is more common in what but more serious in what?
More common in veins. More serious in arteries.
55
What is the most important factor predisposing to thrombosis?
Endothelial injury.
56
What are 3 ways endothelial injury can occur, other than trauma?
1. Hemodynamic stress of HTN
2. Toxicity of hypercholesterolemia
3. Smoking: absorbed tobacco products can increase EC procoagulant factors and decrease anticoagulant factors
57
What 2 states of abnormal blood flow predispose to thrombosis?
1. Turbulence: over ulcerated atherosclerotic plaques
| 2. Stasis: in arterial aneurysms
58
What are the 2 forms of hypercoagulability?
1. Primary: congenital/genetic
| 2. Secondary: acquired
59
What are 6 examples of primary hypercoagulability diseases?
1. Factor V Leiden mutation
2. Prothrombin G20210A mutation
3. Methylenetetrahydrofolate reductase homozygous C677T mutation
4. Anti-thrombin-3 deficiency
5. Protein C deficiency
6. Protein S deficiency
60
What are 7 way to get a secondary hypercoagulability disease?
1. Surgery
2. Cancer
3. Trauma
4. Bed-ridden state
5. Disseminated intravascular coagulation
6. Heparin-induced thrombocytopenia
7. Antiphospholipid antibody syndrome
61
T or F. Surgery inevitably creates a hypercoagulable state in the patient but anticoag therapy risks bleeding in the surgical site.
T.
62
T or F. Surgery to treat morbidity causes morbidity including hypercoag, adhesions, and other conditions.
T.
63
What is a white thrombi and where is it found?
Rich in platelets. Arterial.
64
What is a red thrombi and where is it found?
Rich in erythrocytes. Venous.
65
Where does a mural thrombi form?
On the wall of the heart.
66
Thrombi on heart valves are called what?
Vegetations.
67
What are some examples of vegetations?
Non-bacterial thrombotic endocarditis and Libman-Sacks endocarditis in SLE.
68
What are the 4 fates of a thrombus?
1. Dissolution
2. Propagation
3. Embolization
4. Organization (and recanalization)
69
What happens in the organization of a thrombus?
Fibroblasts convert it to fibrous tissue with ingrowth of new capillaries which can recanalize an occluded vessel.
70
What is the danger of catheters?
Clots form around EVERY catheter which can lead to embolization and infection of the clot.
71
What are 6 types of emboli?
1. Thrombus (most common)
2. Atheromatous debri
3. Fat
4. Air
5. Amniotic fluid
6. Tumor fragments
72
T or F. Most pulmonary thromboembolisms are clinically silent.
T.
73
What do most pulmonary thromboembolisms form in the legs?
Deep vein thrombosis.
74
What can medium sized pulmonary thromboembolisms cause?
Hemorrhagic infarction if bronchial arterial portion of the lung's dual blood supply is impaired.
75
What can large sized pulmonary thromboembolisms cause?
Acute cor pulmonale (right heart failure) and sudden death.
76
Where are saddle emboli found?
Pulmonary trunk.
77
What are paradoxical emboli?
Emboli that pass through patent foramen ovale or atrial septal defect to go to organs besides lungs.
78
T or F. Numerous small emboli can cause pulmonary HTN.
T.
79
Systemic thromboembolisms most commonly come from where and go to where?
Come from heart. Go to legs or brain.
80
Fat emboli are most commonly from what?
Long bone fractures.
81
T or F. Most fat emboli are clinically silent.
T.
82
Fat emboli can cause a syndrome consisting of what features?
Sudden onset dyspnea, tachypnea, tachycardia, irritability, restlessness, anemia, and thrombocytopenia.
83
How big must an air embolism be to have a clinical effect?
More than 100 mL.
84
Can air emboli be fatal?
Yes.
85
What are 4 causes of air emboli?
1. Getting air into IV infusion
2. Sudden change in atmospheric pressure
3. Chest wall injury
4. Back surgery in prone position
86
What is an amniotic fluid embolism caused by?
Tear in placental membrane.
87
What 4 things get into pulmonary circulation with amniotic fluid emboli?
1. Fetal squamous cells
2. Lanugo hair
3. Vernix caseosa fat
4. Mucin
88
In gross morphology, what is indicative of an infarct?
Wedge-shaped necrosis.
89
What are white anemic infarcts?
Increased density of tissue prevents RBCs from diffusing through necrotic tissue.
90
Where are white anemic infarcts found?
In solid organs with end-arterial circulation i.e. heart, spleen, kidney.
91
What are red hemorrhagic infarcts?
Loose-textured tissue allows RBCs to diffuse through necrotic tissue.
92
Where are red hemorrhagic infarcts found?
Typical with venous occlusion, dual or anastomosing blood supply organs, or reperfusion.
93
Coagulative necrosis is apparent how many hours after insult?
12-18 hours.
94
In coagulative necrosis, the acute inflammatory response peaks when and is then followed by infiltration of what cell types?
1-2 days. Macrophages and fibroblasts.
95
The likelihood of an infarction taking place is determined by what 4 things?
1. Vulnerability to hypoxia
2. Rate of development of occlusion
3. Nature of blood supply
4. Oxygen content of blood
96
How long can neurons survive without oxygen? Heart?
3 minutes. 20 minutes.
