Pathology 2 - Edema

Front 1

what are the fates of thrombi?

Back 1

(1) resolved by fibrinolysis (2) organized & incoporated into vessel wall (3) organized and recanalized (4) embolization; either arterial or venous

Front 2

define infarct?

Back 2

a localized area of ischemic necrosis in an organ or tissue resulting from the occulusion of either its arterial supply or venous drainage

Front 3

what are the causes of infarcts?

Back 3

(1) thrombosis and thromboemboli (2) arterial spasm (3) ligation, external pressure, strangulation

Front 4

what are the types of infarcts?

Back 4

(1) color classfication: white infarct or red infarct (2) classified by presence or absence of contaminating bacteria: septic infarct (3) by morphology

Front 5

define embolism?

Back 5

an embolus is detached intravascular undissolved material that is carried by the blood to a site distant to its point of origin

Front 6

what are the effects of embolism?

Back 6

(1)metastasis, (2) infarction,(3) acute circulartory failure (4) abscessation

Front 7

what is microsvasculature?

Back 7

small arterioles, arterial capillaries, venous capillaries, small venules

Front 8

what distrubances of the micrcirculation occur?

Back 8

edema and yperemia/congestion

Front 9

what is Starling's Law of Microvascular Equilibrium?

Back 9

(1) microvasculature consists of small arterioles, capillaries and small venules (2) forces favoring outward movement of fluid (intravascular hydrostatic pressure - 30-17 & colloidal-osmotic pressure of interstitial fluid - 10) & forces favoring inward movement of fluid (tissue hydrostatic pressure - 8 & colloidal osmotic pressure of plasma - 23-25)

Front 10

what is Starling's Equilibirum under normal conditions?

Back 10

there is net movement of fluid out of the microvasculature

Front 11

During inflammation how is Starling's Equilibrium affected?

Back 11

increased movement of fluid (and cells) out of the microvasculature due to increased vascular permeability and increased tissue colloidal osmotic pressure

Front 12

define edema?

Back 12

abnormal accumulation of fluid in the intercellular tissue spaces or body cavities

Front 13

name terms that describe edema?

Back 13

anasarca, ascites, hydrothorax, hydropericardium, dependent edema

Front 14

define anasarca?

Back 14

generalized massive edema of most tissue and organs, especially subcutaneous

Front 15

define ascites?

Back 15

edema fluid in peritoneal cavity

Front 16

define hydrothroax?

Back 16

collectiof edema fluid anywhere in thorax

Front 17

define hydropericardium?

Back 17

collection of edema fluid in bpericardial sac

Front 18

define debpendent edema?

Back 18

edema of lower legs and ventral midline (gravitational influences)

Front 19

what is transudate?

Back 19

colorless to yellow, <1500 WBC/ul, <2.5 g/dl protein, SG <1.012 (ultrafiltrate of plasma across intact endothelium)

Front 20

what is exudate?

Back 20

cloudy, flocculent, >7000 WBC/ul, >3g/dl protein, SG 1.020 (inflammatory extravascular fluid high in protein and cell debris)

Front 21

what is purulent exudate?

Back 21

exudates high in neutrophils, degenerate neutrophils, and cell debris

Front 22

what is another term for purulent exudate?

Back 22

pus

Front 23

what is another term for pus?

Back 23

purulent exudate

Front 24

what is the pathogenesis of edema?

Back 24

decreased colloidal-osmotic pressure, increased intravascular hydrostatic pressure, increased vascular permeability, lymphatic obstruction

Front 25

describe the pathogenesis of decreased colloidal-osmotic pressure?

Back 25

always generalized (transudate), decreased protein synthesis( toxin, liver disease/cirrhosis), decreased protein intake or malabsorption (agroceriosis, EPI, GI disease), protein loss (parasites, renal failure = PLN, GI disease = PLE)

Front 26

describe the pathogenesis of increased intravascular hydrostatic pressure?

Back 26

inflammation causes local arteriolar dilation, local or general (transudate), CHF is right or left (portal cypertension from liver cirrhosis)

Front 27

describe the pathogenesis of increased vascular permeability?

Back 27

always localized and distribution depends on extent of inflammation (exudate), inflammatory edema

Front 28

give a brief description of decreased plasma colloidal-osmotic pressure?

Back 28

hypoproteinemia (albumin < 1.5g/dl)

Front 29

give a brief description of increased intravascular hydrostatic pressure?

Back 29

impeded venous drainage

Front 30

give a brief description of increased vascular permeability?

Back 30

proteins/plasma escape to tissue, water pulled out due to increased tissue colloid-oncotic pressure

Front 31

describe the pathogenesis of lympatic obstruction?

Back 31

localized, transudate

Front 32

what pathogenesis of edema consist of transudate?

Back 32

decreased colloidal-osmotic pressure, increased intravascular hydrostatic pressure, lymphatic obstruction

Front 33

what pathogenesis of edema consist of exudate?

Back 33

increased vascular paermeability

Front 34

what are the clinical derangements causing generalized edema?

Back 34

hypoproteinemia, congestive heart failure, liver cirrhosis

Front 35

what does PLE stand for?

Back 35

protein losing enteropathy

Front 36

what does PLN stand for?

Back 36

protein losing nephropathy

Front 37

describe how hypoproteinemia causes generalized edema?

Back 37

PLE/PLN, malabsorption, starvation, parasitism, liver disease

Front 38

describe how congestive heart failure causes generalized edema?

Back 38

right heart results in ascites, left hear results in pulmonary edema

Front 39

describe how liver cirrhosis cause generalized edema?

Back 39

impaired synthesis of albumin (portal hypertension resulting in ascites)

Front 40

what are the clinical derangements causing localized edema?

Back 40

impaired venous drainage, inflammation/allergy, lymphatic obstruction, pulmonary edema

Front 41

describe how impaired venous drainage causes localized edema?

Back 41

thrombosis, neoplastic obstruction, bandage

Front 42

describe how inflammation/allergy causes localized edema?

Back 42

results in increased vascular permeability

Front 43

describe how lymphatic obstruction causes localized edema?

Back 43

tumor metastasis, inflammation, congenital malformation

Front 44

describe how pulmonary edema causes localized edema?

Back 44

L heart failure, hypoproteinemia, infections, toxins, hypersensitivity reactions, inhaled hot gases cause damage to endothelial/epithelial linging cells of alveolar septa

Front 45

what is the mophology of edema?

Back 45

(1) CT heavy, sowllen, rounded, pale, wet, glistening (2) tissue has fluid/doughy consistency and 'pit' with finger pressing (pitting edema) (3) cut surface oozes clear straw-colored to colorless fluid (4) edematous lungs heavy and wet, fail to collapse completely when removed from thorax (5) lungs reddended if also hyperemia or congestion of vessels (6) airways will have white stable foam (pink if alveolar hemorrhage) with fluid in interlobular septa

Front 46

what is the histology of edema?

Back 46

(1) increased clear spaces, separation of tissues (especially in CT) (2) if lots of protein in edema so interstitium may stain pale smudgy pink (eosinophilic) (3) lymphatic dilatation (4) in lung fluid collects around bronchi and interlobular septa causing alveoli to be filled with pink fluid

Front 47

what is the clinical significance of edema?

Back 47

life treathening in critical locations (brain, heart, larynx, lungs), little functional significance in subcutaneous and other viscera, and pleural effusions (hydrothorax) can lead to compression atelectasis

Front 48

what is the general definition of hyperemia/congestion?

Back 48

an increase in the volume of blood in the microvasculature of the affected part

Front 49

define hyperemia?

Back 49

an active proces, arteriole and arteriolar dilatation results increased flow into capillary beds

Front 50

define congestion?

Back 50

a passive process, impaired venous drainage impedes blood flow out of capillaries and venules

Front 51

define erythema?

Back 51

a dermatology term for abnormal redness of skin due to capillary congestion, usually localized

Front 52

what is the morphology of hyperemia?

Back 52

redness, enlarged, rounded, mushy/turgor, cut surface oozes blood

Front 53

what is the morphology of congestion?

Back 53

initial redness turns to blue-red due to increased concentration of deoxygenated hemoglobin in blood, the intensification is called cyanosis

Front 54

what is the morphology of systemic congestion?

Back 54

increased deoxygenated hemoglobin resulting in cyanosis

Front 55

what is the histology of hyperemia and congestion?

Back 55

look similar becaues the capilaries and venules dilated, filled with blood

Front 56

what are examples of clinically important hyperemia?

Back 56

usually localized due to inflammation; physiologic hyperemia is a result of activities like exercise affecting skin and muscles or eating affecting GI tract or blushing affecting skin

Front 57

what are examples of clinically important congestion?

Back 57

chronic pulmonary congestion/edema (left heart failure), torsion, nasal congestion, chronic passive congestion of liver, hypostatic congestion, shock/circulatory collapse

Front 58

what is the pathologenesis of chronic pulmonary congestion?

Back 58

alveoli contain hemosiderin-laden alveolar MPs (heart failure cells) from microhemorrhages

Front 59

what is the pathologenesis of torsion?

Back 59

congestion (testicular, GI, liver lobe)

Front 60

what is the pathogenesis of nasal congestion?

Back 60

increased vascular permeability (inflammation), later results in pus

Front 61

what is the pathogenesis of chronic passive congestion of liver?

Back 61

results from R heart failure or caudal vena cava obstruction resulting in atrophy of centrilobular region (last hepatocytes to get blood) causing the pooling of blood

Front 62

what is the morphology of chronic passive congestion of liver?

Back 62

capsule of liver is uniformly textures, the cut surface has distinctive lobular mottling with dark red centrilobular regions surrounded by yellow-brown periportal regions known as a nutmeg liver

Front 63

what is the histology of chronic passive congestion of liver?

Back 63

centrilobular hepatic cords atrophic, sinusoids dilated and blood-filled

Front 64

what may result from chrnoic passive congestion of liver?

Back 64

centrilobular fibrosis (cardia cirrhosis)

Front 65

what is the pathogenesis of hypostatic congestion?

Back 65

pooling in lower (dependent) areas because of gravity and failing circulation

Front 66

what is the morphology of hypostatic congestion?

Back 66

lower lung and kidney darker than upper and lower lung edematous, predisposed to developing hypostatic pneumonia

Front 67

what is the pathogenesis of shock/circulatory collapse?

Back 67

widespread hypoperfusion due to reduction in blood volume/CO or redistribution of blood results in inadequate effective circulating blood volume, causing systemi hypoxia triggeringa shift to anaerobic metablism causing metabolic acidosis with is reversible in early phases by correction of hemodynamics and metabolic disturbanced, but failure leads to irreversible injury and death of cells

Front 68

what does clinically important congestion depend on?

Back 68

organ affected and acute or chronic affect