Lab 7 - Hemodynamics & Coagulation

Question 1

Causes of Inflammatory Edema

Answer 1

• a swelling due to effusion of fluid in the soft parts surrounding a focus of inflammation
• due to vasodilation & immune resonse

Question 2

What is the role of lymphatics in hydrostatic edema

Answer 2

• lymphedema: edema due to lymphatic obstruction

Question 3

Edema

Answer 3

def: accumulation of excess fluid in interstitial spaces

Causes: increased Hydrostatic pressure (HTN/gravity); decreased plasma oncotic pressure, lymphatic obstruction, sodium retention, inflammation (swelling -> osmotic pressure due to inflammatory proteins)


To summarize, the four major causes of edema are:

1) increased hydrostatic pressure => transudate; edema may be localized or generalized
2) increased vascular permeability => exudate; edema may be localized or generalized
3) decreased plasma osmotic pressure => transudate; generalized edema
4) lymphatic obstruction => transudate; edema may be localized or generalized

S/S: dyspnea, LV failure, MI, Pericarditis, infections, etc

Question 4

Ascites

Answer 4

fluid accumulation on the abdomen/in peritoneal cavity

Question 5

Difference between hyperemia & congestion

Answer 5

Congestion = passive, from impaired venous return; tissue is cyanotic (pathologic - flow of blood backs up passively)

Hyperemia = active process from increased flow & arteriolar dilation (redder tissue); increased blood supply (physiological)

Question 6

Anasarca

Answer 6

generalized whole body edema

when in fetus = “hydrops”

Hypoproteinemia (fluid doesn’t get pulled back in due to decreased plasma osmotic pressure) - due to renal disorders, GI loss, malnutrition

Question 7

Transudate

Answer 7

extravascular fluid with low protein content and a low specific gravity

Question 8

Exudate

Answer 8

extravascular fluid due to vessel alteration during inflammation (increased permeability, vascular constriction then dilation). This results in an extracellular fluid of high protein content, with cell debris present and high specific gravity (>1.020).

Question 9

Pitting edema

Answer 9

• subcutaneous edema
• points to cardiac/renal disease
• suggests Right sided heart failure

Question 10

Pulmonary Edema

Answer 10

• fluid backs up into lungs due to lack of pulmonary venous return
• left ventriculat heart failure
• frothy (albumin + edema) pink (RBC) sputum

Question 11

Pulmonary HTN

Answer 11

dues to recurring microemboli in lungs

Question 12

ALT

Answer 12

• Alanine transaminase
• an enzyme found in the highest amounts in the liver that tests for the presence of liver damage
• elevated with death of hepatocytes
• evidence of liver damage

Question 13

AST

Answer 13

Aspartate Aminotransferase

• an enzyme found in high amounts in liver, heart, and muscle cells
• elevated with death of hepatocytes/heart/muscle cells
• evidence of liver damage/MI

Question 14

Nutmeg Liver

Answer 14

red brown - associated with cell loss & congestion
paler - normal unaffected hepatocytes
-seen iwth CHF & obstructed IVC/hepataic vein

Question 15

Virchow’s triad

Answer 15

1) abnormal blood flow (sluggish = venous/turbulent = art)
2) endothelial injury
3) hypercoagulable state

Question 16

Lines of Zahn

Answer 16

laminations in thrombi consisting of alternating pale (platelets
/fibrin) and dark (red blood cells) layers

Question 17

Vegetations

Answer 17

Thrombi composed of infectious agents on heart valves

-ex. endocarditis

Question 18

Thrombi - Arterial vs Venous

Answer 18

Arterial = dislodged & moved downstream - lodged in legs
Left sided heart -> brain & body

Venous = dislodged & go to lungs
Right sided heart -> lungs
-more common in veins

Causes: DVT (popliteal & below), CHF, neoplasia, pregnancy, immobilization, burns, fractures

Question 19

Thrombus vs embolus

Answer 19

Thrombus: a clot/plaque
-can embolyze, propagate, dissolve or become organized (integrated & vasculature grows around)

Embolus: DISLOGED substance that causes obstruction downstream

Question 20

Rheumatic heart disease

Answer 20

an inflammatory disease that occurs following a Strep infection

Question 21

Fat emboli

Answer 21

originate in bone marrow, presents as fatty clot

Causes: long bone fxs, burns, soft tissue trauma

Question 22

Major factors in determining the clinical/pathological outcome of infarctions:

Answer 22

1) nature of vascuclar supply (i.e liver = 2 blood supplies)
2) rate of occulsion (reorganization)
3) tissue resistance to hypoxia
4) oxygen content of blood (art/venous)

Question 23

Infarctions

Answer 23

area of ischemic necrosis caused by occlusion of the arterial supply

Anemic (pale)

• solid organs
• end arterial circulations

Hemorrhagic (red)

• venous occlusions
• loose architecture tissue
• reperfusion of ischemic zone
• dual bloods supply (lung, SI - 2nd supply isn’t enough to save necrotic tissue - jsut cause hemorrhage)

Question 24

Stroke

Answer 24

Acute onset neurologic syndrome due to vascular event

hemorrhagic - no TPA
occlusion - push TPA

extensive loss initially with very slow/no restoration

Question 25

Volvulus

Answer 25

bowel twists on its own messentary axis; can compromise the messenteric artery

Question 26

Intussusception

Answer 26

bowel telescopes into itself; can compromise the messenteric artery

Question 27

von Willebrands Disease

Answer 27

- lacking important platelet adhesion molecule that links exposed subendothelial collagen/GP1b - PT, PTT & platelet counts are normal

Question 28

Vasculitis

Answer 28

a group of disorders that destroy blood vessels by inflammation inflammation of veins = phlebitis (think phlebotomist) inflammation of arteries = arteritis

Question 29

Arteriosclerosis

Answer 29

``` arterio = artery sclerosis = thickening/hardening ``` - the thickening, hardening and loss of elasticity of the walls of arteries

Question 30

Disseminated Intravascular Coagulation (DIC)

Answer 30

- AKA "consumptive coagulopathy" - a pathological process characterized by the widespread activation of the clotting cascade that results in the formation of blood clots in the small blood vessels throughout the body - consumption of clotting factors and platelets disrupts normal clotting -> severe bleeding can occur from various sites & lead to multiple organ damage

Question 31

Atherosclerosis

Answer 31

athera = "gruel" or porridge - a specific form of arteriosclerosis caused by the buildup of fatty plaques and cholesterol in the artery