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68 Cards in this Set

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What are the four non-inflammatory causes of inflammation?
1. Increased hydrostatic pressure
2. Decreased osmotic pressure
3. Lymphatic obstruction
4. Preimary retention of Na
What parasite causes the enlarged lymph node that is responsible for elephantitis
Filaris
What causes Peau d'orange?
Obstruction of superficial lymph vessels in breast cancer
What are three clinical correlations of edema?
1. Impaired wound healing and infection clearance
2. Pulmoney edema decreases gas exchange and increases infection
3. Brain edema can cause herniation through the foramen magnum or even vascular compromise
Describe hyperemia.
It is an active process that results in the increase of blood flow to a certain tissue usually as a result of a dilated arteriole.
Describe congestion.
Congestion is a passive process that involves the accumulation of static blood due to venous obstruction or pressure.
Describe the color of hyperemia and congestion.
Hyperemia is usually red while congestion is cyanotic (blue-red).
What is a wide variety of medical conditions that lead to the increased tendancy to hemorrhage?
Hemorrhagic diathesis
What are the causes for petechiae (4)?
1. Increased intravascular pressure
2. Thrombocytopenia
3. Decrease in circulating clotting factors
4. Defective platelets
What the causes for purpura(3)?
1. Trauma
2. Amalyoidsis
3. Vascular inflammation
Hemostasis and thrombosis are regulated by three components. What are they?
1. Vascular wall
2. Platelets
3. Clotting factors (coagulation cascade)
What endothelial compounds prevent the aggregation of platelets in normal situations?
1. NO
2. PGI2
3. ADPase
What are the different ways that coagulation is prevented by endothelium?
1. HLMs interact with Antithrombin III to degrade IIa (thrombin)
2. Thrombomodulin activates Protein C and that results in the cleavage of Va and VIIIa.
3. Thrombomodulin can also turn thrombin into an anticoagulant
4. TFPI - tissue factor pathway inhibitor prevents the activation of the extrinsic pathway
What anti-thrombolytic factor does endothelium secrete?
Plasmin Activating Inhibtors
Platelets contain two different types of granules. What are they and what do they contain?
1. Alpha granules - fibrinogen, fibronectin, Factors V, VIII, platelet factor 4, PDGF, TGF-Beta
2. Dense bodies/Delta granuse - ADP, ATP, calcium, histamine, seratonin and epinephrine
vW Factor acts as a bridge between what?
Platelets receptors(glycoprotein-1b) and collagen
What is a disorder of deficient vW Factor called? Glycoprotein-1b?
1. vW disease
2. Bernard Soulier Disease
What does ADP release augement besides aggregation of platelets?
The release of ADP from other platelets
Why are the phospholipid complexes on the platelets so important in clotting?
They provide a stage for the platelet, factor and cofactor to aggregate on. Calcium also stabilizes this area.
Besides ADP, what do platelets secrete to further their aggregation?
TxA2
What is it called when the platelets contract?
Viscous metamorphisis
What ADP activated substance encourages the crosslinking of platelets using fibrinogen?
GpIIb-IIIa
What disorder is a deficiency of GpIIb-IIIa?
Glanzmann thrombasthenia
Does thrombin stimulate neutrophil and monocyte adhesion?
Yes
The intrinsic clotting cascade is started with the activation of what?
Hageman (Factor XII)
The extrinsic clotting cascade is started with the actiavtion of what?
Tissue Factor
What are three natural anti-coagulants?
1. Antithrombin III
2. Protein C and S - requires K
3. Tissue Factor Pathway Inhibitor - inactivates X and VII
What three ways can plasmin be activated?
1. Hageman Factor
2. Urokinase PA
3. Tissue PA
What does free plasmin adhere to?
Alpha-2 plasmin inhibitor
What three influences make up Virchow's Triad?
1. Endotheliam Injury (most dominant)
2. Alterationa in normal blood flow
3. Hypercoagability
What is the main factor in venous thrombis formation?
Stasis
What are the four things that stasis or turbulent blood flow do to promotoe thrombis formation?
1. Disrupt laminar flow and bring the platelets to the endothelial surface
2. Prevent dilution of circulating clotting factors
3. Prevent the influx of anti-coagulant factors
4. Activates the endothelial cells
What is the aquired mutation of Factor V called and why is it hypercoagulative?
1. Leiden Mutation
2. It makes Factor V resistant to cleavage by Protein C
60% of people with DVT have what mutation?
Leiden Mutation
Elevated levels of what will lead you to be 3x more likely to get a DVT?
Prothrombin
Hyperhomocysteinemia causes what?
Decreased activity of Antithrombin III and Thrombobodulin.
When should you consider a hereditary hypercoagability disorder in a patient?
If a patient is under 50 with no aquired causes of hypercoagability.
What happens in Heparin-Induced Thrombocytopenia Syndrome?
Unfractionated heparin causes an immune reaction where antibodies against heparin + Platelet Factor 4 complexes cause thrombocytopenia
What happens in antiphospholipid antibody syndrome? What is seen in this disorder?
1. Antibodies are produced against epitopes on plasma proteins that are only exposed when bound to phospholipids(carbolipin).

2. Repeat miscarriages, valve vegetations or thrombocytopenia
What is the order in which you see predominating arterial thrombi? Are they usually occlusive?
1. Coronary
2. Cerebral
3. Femoral
4. Yes
What type of thrombis usually makes a long cast of the vessel it is in? Why?
1. Venous thrombi
2. The blood is more static that arterial blood
How can you tell the difference between post-mortem clots and red/stasis clots?
1. Red/Stasis clots are usually attached to the wall of the vessel
2. Post-mortem clots are usually red all the way through the clot
What type of endocarditis is caused by immune complexes dipositing on the valve?
Verrucous Endocarditis (Libman-Sacks)
What are the four fates of thrombi?
1. Propagation
2. Dissolution
3. Embolization
4. Recanulization
Dissolution of thrombi is only possible when?
When the thrombus is very recent
An organizaed thrombus can be reconstituted in what part of the vessel?
Sub-endothelial area
Bacterial thrombi result in what?
Mycotic anuerysm
Edema and swelling in superficial venous thrombi can cause what?
Vericose ulcers
Is there pain associated with DVT?
Not very much
What is a tumor associated disease that results in an increase in the release of procoagulant factors?
Migratory Thrombophlebitis or Trousseau Syndrome
What disease causes the dilation of the atrium due to mitral valve stenosis? What does this lead to?
1. Rheumatic heart disease
2. Stasis of the blood in the atrium and thrombi formation
What are the three main targets of arterial emboli? Why?
1. Brain
2. Spleen
3. Kideny
4. High blood flow to these organs
What is the worst type of PE?
Saddle embolism
What is it called when a PE crosses over into arterial circulation?
Paradoxical embolism
80% of systemic emboli are the result of what type of thrombis?
Intracardiac Mural Thrombi
What strange symptom is seen in 20-50% of patients with a fat embolis?
Rash
What is chronic decompression sickness called? What is the main sign of this disease?
1. Cassion disease
2. Necrosis in the heads of long bones
Amniotic fluid embolism is caused by tears in what vessel? What do the lungs show in this event?
1. Uterine veins
2. Diffuse alveloar damage
If the base of an infarct is seen near a serous cavity, what is usually seen?
Fibrous exudate
What is a difference in red a white infarcts over time?
Red infarcts do not change while white infarcts get whitter with time.
What four factors influence the development of an infarct?
1. Nature of the blood supply
2. Rate of occlusion
3. Tissue's resistance to O2 deprivation
4. O2 content of the blood
70% of septic shock is due to what?
Gram (-) bacterail LPS
Describe the interaction of LPS with the body
1. LPS binds to LPS binding protein
2. That complex binds to CD14
3. This complex is bound to TLR4
4. This activates leukocytes
What are the three phases of shock?
1. Initial non-progressive stage
2. Progressive stage
3. Irreversible stage
Why do the arterioles dilate in the progresive stage of shock?
Decreasing pH causes a depression of the vasomotor reponse
What pathological change is seen in the heart due to septic shock?
Contraction band necrosis
What pathological change is seen in the lungs as a result of septic shock?
Diffuse alveloar damage - "shock lung"
Is diffuse alveloar damage seen in hypovolemic show?
No