Hemodynamic disorders

Question 1

fluid homeostasis requires:

Answer 1

• vascular wall integrity
• control of intravascular volume, pressure, protein
• normal clotting mechanisms

Question 2

Edema

Answer 2

increased fluid in tissue interstitial spaces

Question 3

Pleural effusion/hydrothorax

Answer 3

-fluid accumulation in pleural space

Question 4

ascites

Answer 4

• fluid accumulation in the abdominal cavity

- aka hydroperitoneum

Question 5

pericardial effusion

Answer 5

• hydropericardium

- edema fluid accumulation in pericardial sac

Question 6

anasarca

Answer 6

serve and generalized edema w/ diffuse involvement of all interstitial tissues and grossly evident subQ swelling

Question 7

Categories of edema

Answer 7

• increased hydrostatic pressure/impaired venous return
• decreased plasma oncotic pressure (hypoproteinemia)
• lymphatic obstruction
• sodium retention
• inflammation

Question 8

hyperemia

Answer 8

• active process
• arterioles dilate and let blood into tissue
• erythema

Question 9

congestion

Answer 9

• passive process
• decreased outflow of blood
• cyanotic (blue-ish red) color

Question 10

Hemorrhage

Answer 10

• extravasation of blood due to vessel rupture
• vascular injury
• vascular disease +/- minor trauma
• defects in clotting mechanism + minor trauma

Question 11

hematoma

Answer 11

-blood accumulation in a space or tissue (coagulates)

Question 12

petechiae

Answer 12

• small (1-2mm) punctate hemorrhages
• seen on skin or mucosal/serosal surfaces
• low platelets (thrombocytopenia)

Question 13

Purpura

Answer 13

• slightly larger (>3mm) hemorrhages
• low platelets
• small vessel vasculitis

Question 14

hemostasis

Answer 14

• rapid formation of localized plug at site of vascular disruption
• requires: vascular wall, platelets, and coagulation proteins

Question 15

events leading to hemostasis

Answer 15

• arteriolar vasoconstriction
• platelet adherence, activation, and aggregation (von wilebrand factor) (primary hemostasis)
• generation of thrombin and fibrin, w/ polymerization of fibrin and platelet aggregates (secondary hemostasis)

Question 16

thrombosis

Answer 16

-pathologic activation of hemostatic mechanism (clot occurs inside blood vessel)

Question 17

Virchow triad

Answer 17

• predispose to thrombosis
• endothelial injury
• hypercoagulability (genetic or acquired)
• abnormal blood flow (stasis or turbulence)

Question 18

potential fates of thrombus

Answer 18

• keep growing-propagate towards heart
• resolution-gets broken down
• pushed to one side
• recanalization
• pieces can break off-embolus

Question 19

embolus

Answer 19

-an intravascular solid, liquid, or gaseous mass that is detached from the vascular wall and is carried by the blood to a site distant from point of origin

Question 20

thromboembolus

Answer 20

-an embolus made up thrombosed blood (vast majority)

Question 21

pulmonary thromboembolism

Answer 21

• most common type of embolism

- over 95% of these originate in deep venous system of lower limbs (DVT)

Question 22

saddle embolus

Answer 22

obstruct entire pulmonary inflow-block both arteries-rapidly fatal

Question 23

air embolism

Answer 23

• causes: trauma, obstetrics

- generally at least 100ml necessary for clinical manifestations

Question 24

paradoxical embolism

Answer 24

-venous thromboembolism passing through an atrial or ventricular heart defect to lodge in the systemic arterial system

Question 25

infarct

Answer 25

an area of ischemic necrosis caused by occlusion of arterial supply or venous drainage -nearly all result from arterial thrombosis or thromboembolism

Question 26

hemorrhagic infarct

Answer 26

blood leaks back into tissue (dual blood supply)

Question 27

anemic infarct

Answer 27

infarcted tissue never regains blood flow (end arterial)

Question 28

factors that influence development of infarct

Answer 28

- nature of vascular supply - rate of occlusion of vascular supply - O2 content of blood - susceptibility of tissue to infarction

Question 29

shock

Answer 29

cardiovascular collapse resulting in systemic hypoperfusion

Question 30

hypovolemic shock

Answer 30

- substantial loss of intravascular volume - hemorrhage - plasma loss (burns, diarrhea, vomiting, dehydration

Question 31

cardiogenic shock

Answer 31

- failure of pump | - MI, cardiac tamponade, saddle embolus

Question 32

sepsis

Answer 32

- presence of various pus-forming or other pathogenic organisms, or their toxins, in blood or tissues - widespread infection w/ systemic inflammatory response

Question 33

disseminated intravascular coagulation

Answer 33

- widespread activation of coagulation w/in blood vessels - consumption of coagulation factors as well as widespread activation of fibrinolytic system leads to excessive bleeding - hemorrhage and thrombosis at same time

Question 34

acute respiratory distress syndrome (ARDS)

Answer 34

- shock lung - pulmonary dysfunction caused by diffuse alveolar capillary damage - endothelial damage in lungs leads to protein leakage across walls -> creates a hyaline membrane that blocks gas exchange - histologic change = diffuse alveolar damage (DAD)

Question 35

multisystem organ failure

Answer 35

- terminal complication in fatal cases of septic shock | - hypoxemia/acidosis, oliguria/anuria, and confusion, ischemic complications