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114 Cards in this Set
- Front
- Back
Hemostasis
|
series of regulated processes that keep blood in fluid, un-clotted state in normal circumstances while rapidly forming a "plug" when vascular injury occurs
(letting blood flow when it should) |
|
thrombosis |
pathogenic version when clots form within intact vessels
(letting clot where it needs to) |
|
Hemostasis
3 components |
1. vascular wall 2. platelets 3. coagulation cascade |
|
active hyperemia |
due to increase flow of arterial blood in dilated capillaries |
|
passive hyperemia |
-venous congestion -disruption of blood flow to an area -chronic -results from increase pulmonary and systematic venous pressure |
|
hyperemia |
ACTIVE increase in the volume of blood in tissues cause by arteriolar dilation |
|
hemorrhage |
extravasation of blood to exterior of body or into nonvascular body space due to rupture of blood vessels |
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epistaxis |
nose bleeds
|
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hemothorax |
collection of blood in the space between the chest wall and the lung (the pleural cavity). |
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hemoptysis |
coughing up blood from the respiratory tract. |
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hemopericardium |
to blood in the pericardial sac of the heart |
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hematemesis |
person begins to vomit blood |
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hemoperitoneum |
presence of blood in the peritoneal cavity. (peritoneal cavity contains the pelvis, stomach, spleen, gall bladder, liver and the intestines. ) |
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enterorrhagia |
Bleeding within the intestinal tract. |
|
petechiae |
Tiny purple or red spots on the skin associated with endocarditis, resulting from hemorrhages under the skin's surface. |
|
metrorrhagia |
uterine bleeding occurring at irregular intervals, and sometimes of prolonged duration. |
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purpura |
a small hemorrhage in the skin, mucous membrane, or serosal surface. |
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hematuria |
blood (erythrocytes) in the urine. |
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ecchymoses |
The medical term for a bruise. Ecchymoses may develop around the eyes following a nasal fracture. |
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ischemia |
Ischemia is an insufficient supply of blood to an organ, usually due to a blocked artery. |
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arteriosclerosis |
a group of diseases characterized by thickening and loss of elasticity of the arterial walls, occurring in three forms: atherosclerosis, monckeberg's arteriosclerosis, and arteriolosclerosis |
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atherosclerosis |
Atherosclerosis is the build up of a waxy plaque on the inside of blood vessels.
-can occur in several forms -terms means hardening of arteries |
|
risk factors of atherosclerosis |
-raised plaque is where problems develop. -thin caps with large lipid cores more risky -injury to cap and release of lipid is likely |
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atherosclerosis
atherosclerotic plaques |
-lipids contained within foam cells or in pools -collagen -ca++ deposits |
|
thrombi |
-solid mass or plug within heart/arteries/veins/capillaries from components of streaming blood
-A fibrinous clot formed in a blood vessel or in a chamber of the heart. |
|
thrombi
clotting |
activation of a protein cascade within the blood leading to the formation of thrombin, which convert fibrinogen to fibrin |
|
thrombi
thrombosis is ___ activation and ____
which occurs when... |
platelet, clotting
plaque is unstable and cap releases |
|
thrombi
thrombosis is ___ to get rid of
clotting is ___ because |
hard
easier because it can dissolve with enzymes |
|
thrombi
4 contributions of platelets to hemostasis
|
-adhere to underlying vessel walls -release pharmacologically active compounds -aggregate (platelet and platelet binding) -provide co-factors for clotting |
|
thrombi
4 contributions of platelets to hemostasis
1. Adhesion |
-bind to damaged endothelium cells -bind to glycoprotein receptors -collagen now exposed -> bind glycoprotein receptors |
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thrombi
4 contributions of platelets to hemostasis
2. Release |
-platelet adherences leads to shape change -release preformed compounds -release storage granules -release of orchidonate used in synthesis of prostaglandins that promote and prevent aggregation |
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thrombi
4 contributions of platelets to hemostasis
3.Aggregation |
-result of shape change -platelet-platelet mass body forms using fibrinogen as bridge -fib. binds using intergrin |
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thrombi
4 contributions of platelets to hemostasis
4. co-factors for clotting |
-interact with coag factors V,VIII,IX,X -serves as surface for clotting cascade -flipping phospholipids from interior to exterior |
|
thrombi
disseminated coagulation |
scattered clots |
|
thrombi
alpha granules are |
substrates involved with clotting |
|
thrombi
contents of alpha granules |
-PDGF -thrombospondin -platelet factor 4 -fibrinogen -fibrinectin -vWF |
|
thrombi
dense bodies are |
substrates that drive the reaction forwards |
|
thrombi
contents of dense bodies |
-atp, adp -gpd, gtp -serotonin -calcium -platelets contract on stimulus -actin/myosin, |
|
thrombi
name three states that will promote thrombosis |
-change in intimal surface (endothelium) -changes in blood flow -constituent changes of the blood flow (rate of movement) |
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thrombi
____ blood flow = increase chance of thrombosis |
slow |
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thrombi
what changes the endothelium surface that will promote thrombosis |
-injury -trauma -inflammation -changes in blood flow/pattern |
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thrombi
____ can lead to atrial or cardiac thrombosis |
turbulence |
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thrombi
hypercoaguable |
up regulation of vessel wall interaction in which thrombosis is favored |
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thrombi
how do platelets contribute to hypercoaguable |
-increased procoagulant factors (fibrinogen) -decreased natural anti-coagulants -increased viscosity -stasis (blocking blood flow) -increased platelet vessel interaction -atherosclerosis = most important -deep injury to plaque cap -increase platelet count/function |
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thrombi
________ is a life long thrombosis |
protein C deficiency --> autosomal dominant |
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thrombi
4 ways thrombi can be lysed |
1. plasmin: occur naturally 2. streptokinase: dissolving thrombosis 3. plasminogen activator: genetically engineered 4. embolization: collagen plug, blocks circulation no O2 = cell death |
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emboli
|
mass in blood stream (solid or gaseous) and clogs vessl |
|
emboli
name 8 materials that can cause or be incorporated into emboli |
-thrombus -thrombus/clot -air -nitrogen -fat -bone marrow -debris from base of atherosclerotic plaque -tumor cells |
|
emboli
describe/recognize contribution factors to the development of pulmonary emboli |
-venous in origin -most common/danger form (pulmonary)
|
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emboli
3 categories for a pulmonary emboli based on size and clinical impacts are |
-massive pulmonary emboli: acute right heart failure, from legs, straining (stool) -medium size: localized necrosis, infarcts necrosis secondary to ischemia, block O2 = tissue die -small size: clinically silent, multiple, hammered into vessles |
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emboli
pulmonary emboli - |
right side
venous in origin |
|
emboli
systemic emboli |
left side
transmural myocardial infraction/congestion cardiomyopathy |
|
emboli
platelet thrombi from ____ in the ____ related to ____ ____ in the ___ deposition in the ____
|
-plaques, neck -atherosclerosis plaque, neck -brain |
|
emboli
air gaseous emboli results from |
-head & neck injury -blood transfusions -hemodialysis -air into fallopian tubes -placental disruptions
|
|
emboli
how are air gaseous emboli formed |
-air can enter into right ventricle and whipped into a frothy mess -from the heart action, blook&air is turning causing proteins to break down and stick together (40mL not good / 100mL fatal) |
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emboli
mechanical theory |
bone marrow derived, fat globules enter the venous system and lodge in the pulmonary vasculature as fat emboli |
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emboli
biochemical theory |
circulation free fatty acids affect cell lining the air spaces and produces abnormalities in gas exchange |
|
emboli
_____ plaque can lead to emboli
how... |
atherosclerosis -ather. is hardening of veins (cause plaque). if clot/ulcer breaks off and reaches an opening it can't pass through, it will lead to embolization -this causes a plug -O2 blockage = cell death |
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thrombi
what contributes to the generation of thrombi because they evaluate fibrinogen & factor VIIc cencentrations |
-age -obesity -oral contraceptives -cigarette smoking -malignancy |
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ischemia & infarct
ischemia -
infarct - |
-decreased perfusion, not meeting metabolic needs of the tissue
-localized ischemia due to ischemia |
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ischemia & infarct
causes of local ischemia |
-atherosclerosis -thrombosis -emboli -arterial smooth muscle spam -pressure from within -pathological change to a vessel (drugs like heroine) |
|
ischemia & infarct
venous occlusion occurs when...
|
blood cannot bypass obstruction which leads to intense congestion |
|
ischemia & infarct
venous occlusion can also be... and decrease... |
hemorrhagic
blood flow |
|
ischemia & infarct
venous occlusion is seen in |
-extensive mesenteric venous thrombosis -strangulation of hernias: intestines drop down, twisted, which then disrupts blood flow |
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ischemia & infarct
capillary obstruction what is a physical damage that can be seen |
-frost bite due to the physical damage to capillaries |
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ischemia & infarct
capillary obstruction what kind of cells are obtained |
-abnormal red cells: sickle cell anemia |
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ischemia & infarct
capillary obstruction explain the role of fibrin |
-spread in intravascular coagulation -little dots everywhere screwing with capillaries -lead to small blood clots in body: use up platelets and coagulation, no more left = death
-cant really fix it |
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ischemia & infarct
capillary obstruction explain the role of antigen-antibody complexes
|
-interact with basement membrane -leads to inflammation -make it so blood can't circulate |
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ischemia & infarct
capillary obstruction explain role of fate gaseous emboli |
-external pressure-bed sores -must keep turning on order to prevent pressure or cut off blood supply |
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ischemia & infarct
arterial obstruction has a wide range of ____ & ____ |
- cause and effect
|
|
ischemia & infarct
arterial obstruction no effects result of good... |
-collateral (same tree but different branch) circulation or insignificant reduction of blood flow
(collateral circulation = more than one entry for arterial blood to tissue) |
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ischemia & infarct
functional evidence of ischemia |
-you're okay until stressed (demand of O2 ↑) -angina (pain in chest due to insufficient supply of blood) , intermittent claudication (weakness in legs, limping, pain), plaque build up
|
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ischemia & infarct
some ways to get rid of symptoms of ischemia
|
stop being stressed |
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ischemia & infarct
structural evidence of ischemia lost of ___ leads to ___... |
-lost tissue leads to fibrosis from necrosis |
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ischemia & infarct
if ischemia is slow...
if ischemia is sudden... |
-little damage / loss
- pulmonary emboli |
|
ischemia & infarct
what determines the degree of ischemia... |
- post-ischemia necrosis
(↓ damage, ↓ischemia) |
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ischemia & infarct
what are interacting variable of ischemia |
-metabolic needs of the tissue -speed: sudden=bad -degree of blockage -local anatomy -state of collateral coagulation |
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ischemia & infarct
ischemia there is more damage to the body when... |
the clot causing the ischemia is closer to the heart |
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ischemia & infarct
describe relationship of ischemia & infarct |
infarction: coagulative necrosis (may be bloody from congestion)
infarction is the result of ↓ arterial blood aupply aka ischemia. tissues die off the from the lack of supply of blood that surround the area of blockage |
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ischemia & infarct
given specific anatomical sites of infarct, what type of necrosis would be expected:
CNS
|
necrosis is liquefaction not coagulative (cavity formation) |
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ischemia & infarct
given specific anatomical sites of infarct, what type of necrosis would be expected:
Heart |
angia, arrhythemia's, necrosis, failure of muscular activity, deterioration of a beating heart |
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ischemia & infarct
given specific anatomical sites of infarct, what type of necrosis would be expected:
Lung |
wedge-shape (<10% emboli) due to circulatory |
|
ischemia & infarct
given specific anatomical sites of infarct, what type of necrosis would be expected:
Liver |
rare |
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ischemia & infarct
given specific anatomical sites of infarct, what type of necrosis would be expected:
Intestine |
strangulating hernia (bulge of organ thru structure) volvus, intussusception (enfolding of one segment of the intestine within another → twisted = block)
|
|
shock
define shock |
clinical syndrome characterized by systemic underprefusion (heavy to bottom, light on top) of tissues due to prolonged hypotension (low blood pressure) |
|
ischemia & infarct
2 acute myocardial infarction |
-regional
-subendocardial |
|
shock
3 types of shock |
1. hypovolemic: ↓ circulating blood vol., severe hemorrhage, major loss of body fluids 2. cardiogenic: ↓ cardiac output 3. septic shock: systemic infection, severe hypotension, system vasodilation |
|
shock
hypovolemia symptoms (3) |
-severe hemorrhage -diarrhea/vomiting -loss of skin
|
|
shock
acute myocardial even causes what kind of shock |
cardiogenic |
|
shock
systemic infection from pathogenic microorganisms cause which shock |
redistrubutive (septic shock) |
|
shock
redistrubutive (septic shock) is caused or leads to |
-DIC
- Adult Respirator Disease (ARD)
-bacterial |
|
shock
3 consequences of shock |
1. renal failure 2. acid-base imbalance 3. GI hemorrhage |
|
edema
define edema- |
Edema is a condition of abnormally large fluid volume in the circulatory system or in tissues between the body's cells (interstitial spaces). -fluid in extravascular |
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edema
hydrothorax- |
-pleural effusion contain serous fluid -accumulation of serous fluid in one or both pleural cavities -results from cardiac failure |
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edema
anasarca- |
-An accumulation of serous fluid in various tissues and cavities of the body.
-Anasarca often occurs in congestive heart failure, liver failure, or renal disease. |
|
edema
ascites- |
Ascites is an abnormal accumulation of fluid in the abdomen.
|
|
edema
pericardial effusion- |
-the escape of blood or other fluid into the pericardium.
-escape of fluid into a part; exudation/transudation |
|
edema
describe primary causes of edema |
-raised intracapillary pressure -low plasma oncotic pressure -retention of salt and water |
|
shock
explain renal failure |
hypovolemia (diminished volume of circulating blood in the body) causes body to direct blood to more vital organs |
|
shock
explain acid-base imbalance |
-lactic acidosis due to continued tissue hypoxia (reduction of oxygen supply to a tissue) |
|
shock
explain GI leakage |
due to ischemia causing infection in abdominal cavity |
|
edema
what causes fluid to leave vasculature? (2) |
1. ↑ intravascular hydrostatic pressure
2. ↑ colloid osmotic pressure in extravascular compartment |
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edema
what helps fluid remain in the vascularture? (3) |
1. osmotic pressure of plasma proteins, especially albumin 2. the selective permeability of the endothelium 3. tissue tension |
|
edema
exudates |
edema due to ↑ vascular permeability (like in inflammation)
|
|
edema
transudates |
edema due to ↑ hydrostatic pressure |
|
edema
cardiac edema |
-redistribution and retention of fluids -gravity influences the distribution - weak pumping leads ↑ venous pressure -*excess retention of Na+ and H2O by kidneys |
|
edema
renal edema: nephritic |
-associated with acute glomerulonephritis -caused by sodium retention -transudate characteristics |
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edema
renal edema: nephrotic
|
-heavy proteinuria (excess of serum proteins in the urine, as in renal disease) -hypoalbuminaemia (losing albumin faster than liver can make) -decreased plasma oncotic pressure |
|
edema
nutritional edema |
-prolonged starvation, ppl lose subcutaneous fat -surrounding tissues are looser so theres a decline in tissue tension -space fills with fluid = edema |
|
edema
chronic liver disease edema |
-causes: ↑ intracapillary pressure, ↑ hepatic lymph, ↓ albumin/plasma oncotic pressure, Na+ retention if cirrhotic
-edema presents as ascites |
|
edema
pulmonary edema |
-distribution of fluid between intravascular & extravascular compartments -balance of intracapillary hydrostatic pressure & capillary permeability (↑=edema) |
|
edema
in pulmonary edema ↑ in intracapillary pressure causes |
-IV overload -severe anemia -renal failure -↑ altitude |
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edema
in pulmonary edema ↑ in capillary permeability causes |
-ARDS -aspiration -DIC -pneumonia -severe trauma -bacteremia |
|
edema
3 disturbance in fluid distribution of local edema: |
1. ↑ hydrostatic pressure in the microcirculation: occlusive venous thrombsis 2. ↑ local vascular permeability: inflammation, type I hypersensitivity 3. lymphedema: obstruction of normal lymphatic flow due to surgery/inflammation |