USCSOM: Pathology: Hemodynamic Disorders
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| What is transudate? | protein-poor edema that enters interstitial tissue
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| What are the 5 etiologies of edema? | increased hydrostatic pressure; reduced plasma oncotic pressure; lymphatic obstruction; sodium retention; inflammation
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| What is the most likely cause of generalized increase in hydrostatic pressure? | Congestive Heart Failure
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| What is the likely cause of reduced plasma oncotic pressure? | loss or reduced synthesis of albumin
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| What is a likely cause of sodium and water retention? | renal failure
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| What is hydrothorax? | fliud in pleural space
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| What is ascites? | fliud in peritoneal space
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| What is anasarca? | severe generalized edema
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| What are the clinically important sites of edema? | lung and brain
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| What are the clinical manefestations of pulmonary edema? | dyspnea, cough, tachycardia, crackles, neck veins
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| What are the localized causes of brain edema? | abscess, neoplasm, trauma
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| What are the generalized causes of brain edema? | encephalitis, hypertensive crisis, trauma, obstruction of venous outflow
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| What is hyperemia? | arteriolar dilation resulting in increased flow of blood to tissue
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| What results in chronic passive congestion? | cellular degeneration or death; capillary rupture, small foci; hemosiderin laden macrophages
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| What is nutmeg liver? | hepatocellular death and hemorrhage with hemosiderin laden macrophages
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| What are the three classifications of hemorrhage from smallest to largest? | petachiae, purpura, ecchymosis
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| What is hemostasis? | the balance of clotting and fluid state of blood
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| What are the three main general components to hemostasis? | vascular wall, platelets, coagulation cascade
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| What is the first reaction to vascular injury? | vasoconstriction
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| What are antithrombotic mechanisms of endothelium? | barrier to subendothelium, prostacycling (PGI2) and NO, ADPase, heparin, thrombomodulin, tPA
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| What are prothrombotic mechanisms of the endothelium? | vonWillebrand factor, makes tissue factor, tPA inhibitor
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| What two things do von Willebrand factor link? | subendothelium to glycoprotein Ib receptors
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| What factors are secreted after platelet adherence? | Calcium, ADP and thromboxane, Platelet factor 4
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| What does platelet factor 4 do? | binds heparin inactivating it
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| What links platelets via GPIIb-IIIa? | fibrinogen
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| What are the two main fxns of tissue factor? | activate X and Xa, XI and XIa
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| What cements the platelets together into a clot? | fibrin
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| What converts fibrinogen to fibrin? | thrombin
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| What coagulation factors are clinically significant? | V,VII,VIII,IX,X,XI, prothrombin, fibrinogen
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| What is prothrombin time? | aka PT; extrinsic clotting cascade
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| What coagulation factors are involved in extrinsic clotting cascade? | VII, X, V, II, fibrinogen; all require vit K
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| What is partial thromboplastin time? | PTT; intrinsic clotting cascade
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| What factors are involved in the intrinsic clotting cascade? | all except VII, XIII
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| What is Hageman factor? | Factor XII in clotting cascade
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| What initiates the external clotting cascade? | Tissue factor (thromboplastin)
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| What are the main anticoagulants? | antithrombin, protein c, protein s, plasmin
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| What is the action of antithrombin? | inactivates IXa, Xa, XIa, XIIa
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| What is the action of Protein C and Protein S? | inactivate Va and VIIIa
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| What is the action of plasmin? | breaks down fibrin
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| What substances can activate plasminogen? | urokinase, tPA, streptokinase
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| What substances restric plasmin activity:? | alpha-2 antiplasmin (free plasmin); plasmin activator inhibitor (PAI) inhibits tPA
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| What is DIC? | disseminated Intravascular Coagulation
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| How is DIC measured? | D-DIMER; plasmin-cleaved insoluble cross-linked fibrin
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| What is Virchow's Triad? | factors favoring thrombosis; endothelial cell dmg, hypercoagulability, stasis
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| What is the most common genetic hypercoagulable state? | factor V Leiden
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| What is Factor V Leiden? | glut substitute for Arg; makes V resistant to degradation by protein C
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| What is coumarin Necrosis? | a hypercoagulable state induced by giving coumarin to patients with low protein C
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| What is Heparin-induced Thrombocytopenia? | giving heparin induces release of IV resulting in a prothrombotic state
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| Antiphospholipid antibody syndrome? | serum Ab against anionic phospholipids; hypercoagulable state; recurrent thrombi, miscarriages
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| What is Bernard-Soulier Disease? | defect of platelet adhesion; Glycoprotein Ib
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| What is Glanzmann's Thrombasthenia? | defect of platelet aggregation; glycoprotein IIb/IIIa
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| What is thrombotic thrombocytopenic Purpura | Abs for von Willebrand factor cleaving protease
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| What is Hemophilia A? | factor VIII deficiency
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| What is Hemophilia B? | Factor IX deficiency
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| What is the most common bleeding disorder? | von Willebrand's disease
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| What are lines of Zahn:? | alternating bands of mostly fibrin and mostly RBC
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| What are characteristics of arterial thrombi? | usually occlusive; grey-white and friable
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| What are some risk factors for venous thrombosis? | CHF, trauma, Sx, Pregnancy, cancer
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| What is an embolism? | detached intravascular solid,liq,gas; originate from a dislodged thrombus
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| What is a mural thrombi? | arterial thrombosis in cardiac chambers from MI, plaque, anuerysmal dilation
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| What is a paradoxical embolism? | emobolous originating in veins passes to systemic circulation
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| What causes fat embolism? | sever skeletal injury; burns, long bone fractures, soft tissue trauma
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| What are the bends and the chokes? | decompression sickness; gas bubbles in tissue and gas emboli in lungs
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| What is amniotic fluid embolism? | fetal amniotic fluid in maternal circulation; high mortality rate
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| Describe a Red Infarct. | venous occlusions; dual circulation tissue; tissues with previously sluggish flow
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| Describe a white infarct. | arterial occlusions in solid organs; limitation of blood flow; ischemic necrosis
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| What is the dominant histologic characteristic of post-infarction healing pattern? | ischemic coagulative necrosis
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| What is a septic infarct? | origin of embolus is infected tissue; usually from growth on heart valves
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| What are the five classifications of shock? | cardiogenic, hypovolemic, septic, neurogenic, anaphylactic
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| What are the five unifying features of shock? | high intracellular Ca, intracellular H+, cellular and interstial edema, catabolic metabolism, inflammation
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| What are the stages of shock? | nonprogressive stage, progressive stage, irreversible stage
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| What happens in the nonprogressive stage of shock? | maintain BP and CO; reflexes are making up for deficit
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| Describ ethe progessive stage of shock. | widespread tissue hypoxia, lactic acidosis, decreased urinary output
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| Describe the irreversible stage of shock. | lysosomal enzyme leakage, decreased contractility, renal failure
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| What is cardiogenic shock? | decreased CO with adequate volume; loss of 40% myocardium
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| How do you approach cardiogenic shock? | give fluids, ionotrope, manage infarct
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| Describe hemorrhagic shock. | extreme hypotension due to loss of volume
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| What are rosen's empiric criteria for dx of shock? | ill appearance; HR>100; RR>22; base deficit <-5; urine output <.5 mL/kg/hr; hypotension>20min
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| What are some treatments for hemmorhagic shock? | colloids, controlled fluid resuscitation
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| What are the clincal manifestation of SIRS? | elevated temp, elevated HR, elevated RR, elevated WBC
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| What is the clincical signs of neurogenic shock? | hypotension and bradycardia
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