Pathology - Hemodynamics

Front 1

Edema

Back 1

Accumulation of abnormal amount of fluid in intercellular space or body cavities

Front 2

Anasarca

Back 2

Generalized severe edema

Front 3

Main reasons for edema

Back 3

-Increase in intravascular hydrostatic pressure
-Fall in colloid osmotic pressure
-Impairment of lymph flow
-Renal retention of salt and water

Front 4

Edema secondary to increased hydrostatic pressure is most often seen secondary to _

Back 4

DVT in legs or CHF

Front 5

Edema secondary to reduced plasma osmotic pressure is most often seen in _

Back 5

Reduced synthesis of albumin - nephrotic syndrome or disorders of liver such as cirrhosis

Front 6

Edema from impaired lymphatic flow usually occurs due to _

Back 6

-Filariasis - causes elephantiasis
-Radical mastectomy

Front 7

Sodium and water retention can cause edema and occurs due to _

Back 7

acute renal failure

Front 8

Subcutaneous edema of lower parts of the body usually occurs because of _

Back 8

CHF, particularly right heart failure

Front 9

Both hyperemia and congestion are _

Back 9

Increased volume of blood in affected tissue or portion of body

Front 10

Hyperemia

Back 10

Active, due to increased arterial blood flow in tissue

Front 11

Congestion

Back 11

Passive, due to impaired venous drainage

Front 12

Minute hemorrhages of blood into skin, mucous membranes or serosal surfaces

Back 12

Petechiae

Front 13

Common bruise is known medically as _

Back 13

Ecchymosis

Front 14

Hemostasis

Back 14

Normal process, process of maintaining blood in normal vascular system free from blood clots and with the rapid formation of solid plug of blood to close injuries to blood vessels

Front 15

Thrombosis

Back 15

Pathologic process - formation of clotted mass of blood within vascular system

Front 16

Both hemostasis and thrombosis depend on

Back 16

1 - vascular wall
2- platelets
3- coagulation system

Front 17

Describe sequence of events in hemostasis

Back 17

-Brief period of vasoconstriction
-Injury to endothelial cell exposes subendothelial collagen to which platelets adhere and undergo activation and release ADP, serotonin, thromboxane which recruits additional platelets and forms primary hemostatic plug
3) Tissue factors and platelet factors activate plasma coagulation cascade which results in formation of thrombin that converts fibrinogen to fibrin - secondary hemostatic plug
4 - permanent plug - polymerized fibrin and platelet aggregates

Front 18

Antiplatelet effect of endothelium

Back 18

Intact endothelium insulates platelets from highly thrombogenic subendothelial collagen. Platelets normally do not adhere to endothelium. Prostacyclin and nitric oxide inhibit platelet aggregation

Front 19

Anticoagulant properties of endothelium

Back 19

Heparin like molecules increase actions of anticoagulant protein - antithrombin III which inactivates thrombin and other factors including factor Xa. Thrombomodulin binds thrombin and turns it from procoagulant to anticoagulant. This activated protein C - natural anticoagulant.

Front 20

Activated protein C does what?

Back 20

It inhibits clotting by proteolytic cleavage of factors Va and VIIIa

Front 21

Protein S

Back 21

Cofactor for protein C - anticoagulant

Front 22

Fibrinolytic properties of endothelium

Back 22

Endothelial cells synthesize tissue type plasminogen activators (t-PA) which promotes fibrinolytic and helps to clear fibrin deposits from endothelial surfaces

Front 23

What is necessary for platelet adhesion

Back 23

vWF - von-Willebrands factor

Front 24

_ necessary ion in coagulation cascade

Back 24

Ca

Front 25

3 stimuli for platelet aggregation

Back 25

Thromboxane A2
ADP
THrombin

Front 26

Main function of thrombin

Back 26

COnversion of fibrinogen to fibrin which stabilizes secondary hemostatic plug and anchors it to the site of origin

Front 27

Platelet aggregation is inhibited by _

Back 27

Endothelial derived PGI2 and nitric oxide

Front 28

Three major influences predisposing to thrombosis

Back 28

-Injury to endothelium
-Alterations in blood flow
-Alteration in blood - hypercoagulability

Front 29

Thrombi at site of acute MI are called

Back 29

Mural thrombi

Front 30

Fate of thrombus

Back 30

Propagation
Embolization
Dissolution - removed by fibrinolytic process
Organization and recanalizaiton - can induce inflammation and fibrosis and later become recanalized

Front 31

DIC

Back 31

disseminated intravascular coagulation - sudden development of fibrin thrombi in microcirculation. Followed by rapid consumption of platelets and coagulation factors followed by profuse bleeding. Not a primary disease, but complication of some disease such as obstetrical complication or advanced tumor

Front 32

Embolism

Back 32

Dislodged solid, liquid or gas which is carried by the blood to some other site

Front 33

99 % of all emboli are _

Back 33

Thromboemboli

Front 34

Almost 95 % of pulmonary emboli arise from _

Back 34

thrombi in deep veins of legs (popliteal, femoral)

Front 35

Saddle embolism

Back 35

Embolus that is impacting bifurcation of main pulmonary artery

Front 36

Paradoxical embolism

Back 36

Embolus that passes through interatrial or interventricular defect and gains access to systemic site of the circulation

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Clinical consequences of pulmonary embolism

Back 37

1) Most are silent
2) Sudden death, acute right heart failure (cor pulmonale) or cardiovascular collapse if 60 % or more is occluded
3) pulmonary infarction

Front 38

Amniotic fluid embolism

Back 38

1 per 50000, 86 % mortality rate