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TEST #3

Patho

QuestionAnswer
involuntary sudden movement or muscular contraction that results from irritation or trauma Spasm
when platelets adhere to each other and the edges of vessels Platelet Plug
cascade of responses, each depending on the other; when the blood is clumping together to form a clot Blood Coagulation
occurs when blood is drawn without contamination by tissue factor. It is triggered when blood is exposed to a foreign surface and factor XII is activated. The process is accelerated by high-molecular weight Intrinsic Pathway
requires the blood to be exposed to a subendothelial tissue factor originating outside the blood. This factor begins a complex series of chemical reactions Extrinsic Pathway
a cluster or coming together of substances; attraction Aggregation
a holding together or uniting; sticking together Adhesion
an agent that prevents or delays blood coagulation Anticoagulants
a parental anticoagulant drug; It is composed of polysaccharides that inhibit coagulation by forming an antithrombin that prevents conversion of prothrombin to thrombin and by preventing liberation of throboplastin from plateletsi Heparin
What is Heparin's antidote? Protamine Sulfate
a drug that inhibits blood clotting by antagonizing the biosynthesis of vitamin K- dependent coagulation factors in the liver; taken to prevent future blood clots Warfarin (Coumadin)
What is Warfarin (Coumadin's) antidote? Vitamin K
INCREASED PLT FUNCTION; an increase in the number of platelets; PLT count >1,000,000; increases PLT adhesion, formation of a PLT or blood clot, and disturbances of blood flow. Causes: arthrosclerosis, high PLT levels Thrombocytosis
PLT count >1,000,000 Thrombocytosis
any rash in which blood cells leak into the skin or mucous membrane, usually at multiple sites. They are often associated with coagulation disorders or thrombosis Purpura
pin point purpura; hemorrhagic spots on the skin that appear in patients with platelet deficiencies Petechiae
a swelling comprising a mass of extravasated blood confined to an organ, tissue, or space and caused by a break in a blood vessel; blood blister Hematoma
an abnormal decrease in the number of platelets Thrombocytopenia
PLT antibodies form increasing destruction; PLT count < 20,000 ITP- Idiopathic Thrombocytopenia Purpura
combination of thrombocytopenia, hemolytic anemia, vascular occlusion, fever, and neurological abnormalities; abrupt onset; may be fatal TTP- Thrombotic Thrombocytopenic Purpura
deficient function of platelets Thrombocytopathia
urine acid in the blood because of unhealthy kidneys Uremia
deficiency of factor VIII; X-linked Hemophilia A
most common hereditary bleeding disorder; autosomal; decreased PLT adhesion and reduction of factor VIII; most are mild and untreated Von Willebrad Disease
paradox in hemostatic sequence; widespread intravascular coagulation followed by massive bleeding d/t the depletion of clotting factors (clot, clot, clot, bleed, bleed, bleed over reaction of clotting cascade) DIC- Disseminated Intravascular Coagulation
bleeding from small vessels d/t structurally weak walls, damage d/t inflammation or immune response; PLT counts and bleeding studies will be normal; may also occur in DIC Vascular Disorders
is caused by excessive production of adrenoncorticotropic hormone in the body; occurs with vascular disorders Cushing's Disease
purpura due to old age Senile Purpura
production of RBC; occurs in bone marrow Erythropoiesis
What are 2 problems with Hemostasis? inappropriate clotting and the failure of blood to clot
What do both the intrinsic and extrinsic pathways result in? (3) the activation of factor X, the conversion of prothrombin to thrombin, and the conversion of fibrinogen to fibrin
where are almost all factors of blood coagulation synthesized? the liver
___ is nessary for synthesis of prothrombin, factor VII, IX, X, and Protein C Vitamin K
What are 4 natural anticoagulants? antithrombin III, protein C, protein S, and plasmin
What can one do to get Vit K in their diet? eat green leafy veggies
What lab test is used for Heparin? PTT
What lab test is used for Coumadin? PT
Which anticoagulant is used to prevent future clots? Coumadin
What anticoagulant is used to slow down growth of present clots? Heparin
What are some causes of Thrombocytosis? Causes-artherosclerosis, DM, smoking, high cholesterol, high plt levels
What are 2 hypercoagulability states? > PLT function (thrombocytosis) and > clotting activity
What are some causes of > clotting activity? Causes-pregnancy, oral contraceptives, post op, immobility, congestive heart failure, and malignancy
What are some TX for > clotting activity? TX-prophylaxis; stop smoking w/ birth control meds, coumadin, ASA, and heparin
At what level are the PLT when bleeding occurs? <20,000
What is the normal PLT count? 150,000- 400,000
What are the S/S of a PLT deficit? S/S-hemorrhage, bruising, petechiae, purpura, hematoma, bleeding of the mucous membranes
What is the PLT count for Thrombocytopenia? <100,000
What are the causes of Thrombocytopenia? Causes-decreased production, increased plt pooling in spleen, or deceased plt survival
What are some drugs that are culprits of thrombocytopenia? quinine, quinidine, and aome sulfa drugs
shape that > surface for O2 and allows the cell to change shape biconcave disk
must have ____ for hgb synthesis Fe- iron
low levels of ____ indicate the need for oral supplement of iron ferritin
production of RBC; regulated by erthytopoietin; occurs in bone marrow erythropoiesis
what is a RBC average life span? 120 days
What is a RBC facilitated by? (3) spleen, live, and bone marrow
during destruction of RBC _____ prodction > causing jaundice bilirubin
what is the RBC count for men? 4.2-5.4
What is the RBC count for women? 3.6-5.0
What is the hgb count for men? 14-16.5
what is the hgb count for women? 12-15
what is the hematocrit (hct) count for men? 40-50
what is the hematocrit (hct) count for women? 37-47
abnormally high RBC, which makes the heart work overly hard to move blood polycythemia
what is the HCT for men and women with polycythemia? men- >54.....women- >51
what are the 3 types of polycythemia? relative, primary, secondary
the hct rises b/c of a loss of plasma volume w/o corresponding decrease in RBCs relative polycythemia
a proliferative disease of the pluriplotent cells; overall increase in RBCs, WBCs, and PLTs primary polycythemia
what is another term for primary polycythemia? polycythemia vera
physiological increase in erythropoietin secondary polycythemia
what are the causes of relative polycythemia? Causes- r/t water deprivation, excessive diuretic use, or GI loss
what is the TX for relative polycythemia? fluid volume replacement
what is the common ages to see primary polycythemia? 40-60
what are the S/S of primary polycythemia? S/S-HA, dizziness, difficulty hearing, HTN, venous stasis, itching & painful fingers & toes, night sweats & wt loss
what is the TX for primary polycythemia? TX-phlebotomy, chemo, & radiation
Commonly associated w/ hypoxia (high altitudes, chronic heart failure, lung disease, & smoking) secondary polycythemia
what is the TX for secondary polycythemia? TX-relieve hypoxia (O2 adm, breathing tx, ect)
what is a common cause of jaundice in an infant and is harmless and self-limiting? hyperbilirubinemia in the newborn
what is the TX for hyperbilirubinemia in the newborn? bilirubin lights or sun exposure
what are the causes of hyperbilirubinemia in the newborn? May be caused by hypoxia, breast feeding, hemolytic disease, bowel or biliary obstruction, liver disease...Prematurity, Asian ancestry, & maternal diabetes increase risk
what is hemolytic DX of the newborn? erythroblastosis fetalis (rh incompatibility: mom Rh-, baby Rh+)
transports blood thru the lungs for gas exchange pulmonary (central)
transports blood thru the body systemic (peripheral)
Includes R. side of the heart, pulmonary artery, pulmonary capillaries, & pulmonary vein pulmonary (central)
Includes L. side of the heart, aorta, arteries, capillaries, veins, and vena cavas systemic (peripheral)
____ vein is the only vein that carries oxygenated blood Pulmonary vein
low pressure system pulmonary (central)
high pressure system systemic (peripheral)
____ are closer the the heart, therefore have higher ____ arteries....pressure
_____ function for cellular exchange capillaries
principals governing pressure, flow, and resistance in the circulatory system Hemodynamics
thick walled; transports blood away from the heart; has more stretch; pulsates arteries
thin walled; transports blood back to the heart; valves aid in pushing the blood against gravity; low pressure system veins
includes capillaries, venules, and arteriole Microcirculation
single-cell thick; connect the venules and arterioles Capillaries
increase in blood flow to meet needs like in exercise (functional); when blood flow has been occluded and then restored, local blood flow increase (reactive) Hyperemia
what are 4 substances that effect blood flow? histamine, serotonin, kinins, prostaglandins
b/t the blood and the vascular smooth muscle; serves as a physical barrier for those vasoactive substances; plays a role in cellular exchange Endothelium
compensatory mechanism to deal w/ a blood flow occlusion; slow, gradual process Collateral circulation
what are 2 things that play apart in the endothelial control of the blood flow? Nitric oxide and Angiotension II
speeds things up; Epinephrine and norepinephrine sympathetic
slows things down; vagal stimulation; Acetylcholine parasympathetic
increases BP dopamine
impairment can lead to ischemia and infarction arterial circulation
CHF congestive heart failure
BCP birth control pills
stationary blood clot thrombosis
what are some causes of thrombosis? Causes-polycythemia, dehydration, plt aggregation, CHF, shock, dysrhythmias (Afib), trauma, surgery, anesthesia, BCP, smoking, arteriosclerosis/atherosclerosis, immobilization
ateries are ____ in color and are ____ with no pulse pale blue....cold
veins are _____ in color and are ____ with a large pulse and are swollen red...warm
thrombosis in the aterials results in___ blood not getting to an area
thrombosis in the venous results in ___ blood not getting out of an area and back to the heart
what are some TX options for Thromobosis? TX-prevention, anticoagulants (coumadin & heparin), anti plt aggregregates (ASA, plavix)
traveling clot embolism
What are the causes of embolism? the same as thrombosis= Causes-polycythemia, dehydration, plt aggregation, CHF, shock, dysrhythmias (Afib), trauma, surgery, anesthesia, BCP, smoking, arteriosclerosis/atherosclerosis, immobilization
what are some complication of embolism? CVA (stroke), PE (pulmonary empolis), MI (Heart attack)
what is the TX for embolism? TX-embolectomy, filters
sudden constriction of an artery vasospasm
what can a vasospasm cause? hypoxia or even necrosis
what are the causes of vasospasms? Causes-unknown, cold, hormones, food, and stress
vascular disorders that cause inflammatory injury of the blood vessels of any type and origin; classified by vessel size Vasculitides
what are the S/S of vasculitides? S/S-fever, myalgia, arthralgia, and malaise
what are the causes of vasculitides? Causes-direct injury, infectious agents, immune process (SLE), physical agents (cold, irradiation, mechanical injury, and toxins)
algia pain
5 p's pain, pulse, pallor, paratisea, and paralisis
pressure in the muscle fascia impairing circulation; can lead to permanent loss of function; may be caused by a tight cast or dressing, thermal injury, trauma, infiltration of IV fluids, postischemic swelling, & venous obstruction compartment syndrome
what are the S/S of compartment syndrome? S/S-unrelenting, deep, throbbing pain; tenseness and tenderness; taunt skin; parasthesia; muscle weakness
what is the DX for compartment syndrome? DX-early ID is critical; assessment including the 5 P’s; Doppler; direct pressure measurements of the compartment
what is the TX for compartment syndrome? TX-pressures > 30mmHg; remove pressure, fasciotomy
fractures commonly result in ___ compartment syndrome
HRT hormone replacement therapy
type of arteriosclerosis or hardening of the arteries; fatty lesions on the artery wall Atherosclerosis
Risk factors-men>45, women>55 or premature menopause w/o HRT, family hx of premature CAD, smoking, HTN, low HDL, hyperlipidemia, DM, maybe chlamydia, pneumoniae, herpes, and CMV Atherosclerosis
what are 3 types of Atherosclerosis? fatty streaks, fibrous athermatous plague, complicated lesions
what are some complication of Atherosclerosis? vessel occlusion-necrosis....thrombus-MI, PE,stroke
what are the S/S of Atherosclerosis? S/S-depends on the location; s/s of impaired tissue perfusion
abnormal dilatation of a blood vessel, usually arteries; most commonly the aorta Aneurysms
small spherical dilatation of a blood vessel junction; common in the circle of Willis in the brain Berry
involves the entire circumference of the vessel; characterized by a gradual and progressive dilatation of the vessel Fusiform
extends over a part of the circumference of the vessel and appears sac-like Saccular
false aneurysm; usually progressive; acute, life-threatening; occurs w/ a previous vessel dilatation Aortic dissection
Causes-conditions that weaken or degenerative changes in the vessel wall; congenital defects (Marfan’s, aortic valve defects, aortic coarctation), trauma, infections, and atherosclerosis3 Aortic dissection
What are the S/S of an aortic dissection? S/S-sudden presence of excruciating pain at site of dissection, syncope, hemiplegia, paralysis, heart failure (when valves are involved)
What are some complication of an aortic dissection? Complications-untx=rupture; death
What is the DX for an aortic dissection? DX-H & P, aortic angiogram, TEE, CT, MRI
what is the TX for an aortic dissection? TX-surgical repair; medical-control HTN, meds to lessen systolic force
what are 3 types of aneurysms? berry, fusiform, saccular
what are 2 types of aortic aneurysms? dissection and an aortic aneurysm
any part of the thoracic or abdominal aorta aortic aneurysms
Causes-athersclerosis & degeneration of the vessel media (most common); many also have HTN aortic aneurysms
What are the S/S of an aortic aneurysms? S/S-most are asymptomatic; a pulsating mass may be indicative; abd-may compress the lumbar nerve causing lower back pain radiating down the legs; may obstruct the renal, iliac, mesenteric, or vertebral arteries; clots may form; thoracic-substernal, etc
what is the DX for aortic aneurysm? DX-routine exam or vessel rupture; CT, MRI
what is the TX for aortic aneurysm? TX-surgical intervention w/ Dacron
These disorders are similar to those of coronary and cerebral arteries; they produce pain, ischemia, impair function, and may cause infarcts and necrosis PVD: Arterial Disorders of the Extremities
sudden event that interrupts arterial blood flow to tissue or an organ; usually caused by a clot, but may be trauma or arterial spasms Acute arterial occlusion
- Occlusion of the blood in the lower extremities...usually involves the popliteal and femoral arteries Atherosclerosis occlusive disease (Ateriosclerosis Obliterans)
Most common in men 60-70; Smoking and DM worsens Atherosclerosis occlusive disease (Ateriosclerosis Obliterans)
What are the S/S for Atherosclerosis occlusive disease (Ateriosclerosis Obliterans)? S/S-intermittent claudication; numbness; thinning of the skin & less subq tissue and hair; brittle nails; ft often cool w/ weak pulses; limb blanches w/ elevation & becomes deep red when in dependent positions; progressing to ischemic pain at rest; ulcera
What are the DX for Atherosclerosis occlusive disease (Ateriosclerosis Obliterans)? DX-skin inspection, Doppler, extremity BPs, nuclear imaging, & contrast angiogram
What is the TX for Atherosclerosis occlusive disease (Ateriosclerosis Obliterans)? TX-maintain skin integrity, slow walking will encourage collateral, fempop bypass, thromboenderectomy, PTCA
Vasculitis of the medium size arteries of the lower extremities; Inflammatory component that involves Thromboangitis obliterans-AKA Burger’s disease
Mostly men 25-40; Smoking increases risk Thromboangitis obliterans-AKA Burger’s disease
What are the S/S for Thromboangitis obliterans-AKA Burger’s disease? S/S-pain distal to the occlusion; in severe cases is may be present at rest; increased sensitivity to cold; decreased/absent distal pulses; cyanosis; thin, shiny skin; thick, malformed nails; progressing to ulceration & gangrene
What is teh DX for Thromboangitis obliterans-AKA Burger’s disease? DX-skin inspection, Doppler, extremity BPs, nuclear imaging, & contrast angiogram
What is the TX for Thromboangitis obliterans-AKA Burger’s disease? TX-stop smoking; must achieve vasodilatation & prevent injury; surgical intervention
Functional disorder caused by intense vasospasms of the arteries & arterioles in the fingers & occasionally the toes; Disease occurs w/o a cause & phenomena is a result of another cause Raynaud’s
Occurs in usually otherwise healthy women; It is brought on by cold or extreme emotions Raynaud’s
what is the cause of Raynaud’s? Cause is unknown; may be r/t an overactive sympathetic nervous system
Associated w/ previous vessel injury-frostbite, vibration, extreme temp, occupational trauma, collagen diseases, neurological disorders, & chronic arterial occlusive disorders Raynaud’s
Often the 1st s/s of a collagen disorder like scleraderma & SLE Raynaud’s
What are the S/S of Raynaud’s? S/S-pallor to cyanosis; a sensation of cold, changes of sensory perception, hyperemia after episode, may affect the entire hand of just a portion, nails become brittle, arthritis may develop, ulceration & gangrene is rare
What is the DX for Raynaud’s? DX-hx of vasospasmic episodes w/o presence of other disorders; laser-Doppler velocimetery, & CT
What is teh TX for Raynaud’s? TX-elimination of triggers (cold, emotional stress, vasoconstrictors), no smoking, vasodilators, surgical interruption of sympathetic pathways
dilated, tortuous veins of the lower extremities; usually associated w/ venous insufficiency Varicose Veins
More common after 50, in the obese, & women; usually have a family hx, prolonged standing & increased intra-abdominal pressure (lifting) Primary Varicose Veins
saphenous veins Primary Varicose Veins
What are the S/S of Varicose Veins? S/S-aches, edema, unsightly enlarge veins
What is teh DX for Varicose Veins? DX-inspection, Doppler ultrasonic flow probe, angiogram
What is the TX for Varicose Veins? TX-little can be done to restore venous tone and function; avoid activities that worsen, AED hose, sclerotherapy; surgery in severe cases
results from impaired flow to the deep veins; most common cause is DVT, but also congenital or acquire AV fistulas, congenital venous malformation, and pressure on the abd veins (pregnancy and tumors) Secondary Varicose Veins
maybe caused by DVT, valvular incompetence, or both Chronic venous insufficiency
What are the S/S of Chronic venous insufficiency? S/S-venous congestion, edema, necrosis of subq fat, brown pigmentation of skin in the lower extremities, lymphatic insufficiency, stasis dermatitis, stasis ulcers, stiffening of the ankle jt, and loss of muscle mass and strength
What are the S/S for DVT? S/S-edema, pain, ?Homan’s sign
venous obstruction caused by a clot usually in the deep veins of the lower extremities DVT
What are the TX for DVT? TX-DO NOT MASSAGE, anticoagulant therapy, embolectomy
caused by obstruction of lymph (removal or destruction of nodes) Lymphedema
What are the S/S of Lymphedema? S/S- brawny edema, skin changes (thick, rough skin)
What is the TX for Lymphedema? TX-pneumatic compression, massage, diuretics will not help much
the work part of BP systolic (100-140)
the rest part of BP diastolic (60-90)
difference b/t the systolic and the diastolic? pulse pressure (~40)
average pressure in the arterial system during ventricular contraction and relaxation mean arterial pressure (90-100)
BP= ___X___ Cardiac Output (OP) X Peripheral Vascular Resistance (PVR)
ejection of blood into the aorta Systolic BP
The variability is controlled by the amount of blood that is ejected & the elasticity of the aorta Systolic BP
Rises w/ large blood volume & rigid aortas Systolic BP
Maintained by the energy that has been stored in the aorta during systole Diastolic BP
Depends on the elasticity of the aorta & large arteries, ability to store energy, microcirculation blood flow control, & function of the aortic valve. Diastolic BP
Increased PVR & sympathetic stimulation increases diastolic Diastolic BP
______ of blood in the aortic valve decreases diastolic Regurgitation
Represents the difference b/t the blood volume ejected into aorta and arterial system pulse pressure (~40)
It rises with increased blood volume and vise versa pulse pressure (~40)
1/3 of the pulse pressure Mean arterial pressure
Indicator of tissue perfusion Mean arterial pressure
Meant to correct temporary imbalances-exercise and position changes Short-Term BP Regulation
Survival mechanism Short-Term BP Regulation
2 mechanisms of Short-Term BP Regulation Neural and Humoral
Control center located in the reticular formation of the lower pons and the medulla; major site for the autonomic nervous system; cardiac center Neural Short-Term BP Regulation
Transmit parasympathetic and sympathetic impulses Neural Short-Term BP Regulation
What is Neural Short-Term BP Regulation mediated through? (3) Intrinsic Reflexes, extrinsic reflexes, and chemoreceptors
baroreceptors are pressure sensitive & are located in the vessel walls and the heart; regulate BP by sending messages to the brain stem Baroreflex- Neural Short-Term BP Regulation (intrinsic mediator)
what are the 2 intrinsic mediators of Neural Short-Term BP Regulation? baroreflex and chemoreceptor
What are the 4 things associated with extrinsic neural mediators? 1. factors associated with pain and cold...2. spread out and inconsistant...3. processed thru the hypothalmus...4. responses to mood and emotion
sensitive to changes in O2, CO2, and H in the blood...Located in the carotid bodies (in the junction of two common carotids) & the aortic bodies...Can induce vasoconstriction Arterial chemoreceptors (Neural Short-Term BP Regulation)
an enzyme that is synthesis, stored, and released in the kidneys in response to an increase in sympathetic nervous system activity or decreased BP, extracellular fluid volume, or extracellular Na Renin
Released from the pituitary gland in response to decreased blood volume and blood pressure, increased osmolality of body fluids, & other stimuli; Vasoconstrictor Antidiuretic hormone (vasopressin)
In HTN, this mechanism gets out of control Renin-angiotension-aldosterone
what 2 hormones deal with humoral short-term BP regulation? Antidiuretic hormone (vasopressin) and Renin-angiotension-aldosterone
Kicks in to compensate d/t the short-term mechanisms inability to maintain changes over time. Long-term BP regulation
Makes changes by adjusting fluid excretion in the kidneys Long-term BP regulation
Fall in BP= ________ decreased water excretion and vise versa
Too much fluid in tissue=__________ vasoconstriction to prevent more fluid entering the space and vise versa
Created by: TayBay15