T19-20: Circulatory Disturbance

perfusion disorders

increase in blood volume in tissue

perfusion disorder examples

hyperemia, congestion, hemorrhage

hyperemia is active/passive

active

hyperemia results from

artery dilation from inflammation

hyperemia characteristic

redder tissues

hyperemia example

acne

congestion is active/passive

passive

congestion result from

impaired outflow of venous blood from heart failure

congestion characteristic

blue-red (cyanosis), enlarged organ

hemorrhage

leakage of blood vessel

hemorrhage cause

trauma, atherosclerosis

hemorrhage mechanism

low platelet counts, inflammation

hemorrhage types

hematoma, petechiae, purpura, ecchymosis

hematoma

hemorrhage in soft tissue

petechiae

small hemorrhage

purpura

slightly bigger than petechiae

ecchymosis

hemorrhage of subcutaneous (bruise)

ischemia

deficient blood supply due to blockage

ischemia can cause

hypoxia, malnourishment, waste accumulation

infarction

becoming ischemic necrosis

infarction cause

disrupted artery supply

factors influencing infarction development

anatomy of vascular supply (amount of blood vessel), rate of occlusion, vulnerability to ischemia, blood oxygen content

red (hemorrhagic) infarcts occur when

venous occlusion (congestion) in loose spongy tissue

red infarcts happen in single/dual circulation

dual (in previously congested tissues)

white (anemic) infarcts occur when

arterial occlusions in kidney, spleen, heart due to tissue density limiting blood diffusion

septic infarct

infected infarct

thrombosis

lots of coagulated blood that stick to endothelium

pro-thrombotic

clot too much

anti-thrombotic

no clot

virchow’s triad

abnormalities causing thrombosis: endothelial injury, abnormal blood flow, hypercoagulability

turbulence

blood don’t flow in center

stasis

slow blood flow

atherosclerosis increased risk of thrombosis due to

plug → turbulent and stasis

mitral valve stenosis has increased risk of thrombosis due to

heart valve narrowing → stasis

disseminated intravascular coagulation

widespread thrombosis → cause circulatory insufficiency

arterial thrombosis common causes

atherosclerosis, aneurysm

aneurysm

dilation in one spot → turbulence

main contributor of arterial thrombosis

endothelium damage → procoagulant → platelet aggregate

morphology of arterial thrombosis

lines of zahn

arterial thrombosis leads to

ischemic necrosis, myocardial infarction, embolization

what condition is depicted

arterial thrombosis

mural thrombosis is in

heart chamber, aortic lumen

vegetation

thrombi on heart valves

what is circled

thrombus

what is circled

infarct

venous thrombosis aka

phlebothrombosis

venous thrombosis is common in

deep vein of leg (DVT)

main contributor to venous thrombosis

stasis

what is depicted

venous thrombosis

venous thrombosis can lead to

congestion, edema, DVT, embolization

thrombus fates

dissolute/resolution, organization, propagation, thromboembolism, recanalization

organization

create blood vessel in thrombus

propagation

increased size due to more platelet → increased risk

recanalization

restore blood flow

embolism

embolus passage through blood vessel that can lodge and obstruct lumen

consequences of embolism

ischemic necrosis

pulmonary embolism main cause

DVT

pulmonary embolism happens in _______ patients

bed-ridden

saddle embolus

big → sudden death

systemic embolism mostly from

intracardiac mural thrombi lodged in artery

embolism in end arteries

infarction

consequences of fat and marrow embolism

respiratory failure

fat and marrow embolism cause

tissue or skeletal injury

air embolism happens due to

neck wounds or vein puncture in surgery

large air embolism

hypoxia

decompression sickness

gas expand if come up too fast

consequence of air embolism

ischemic injury

amniotic fluid embolism consequences

pulmonary emboli

capillary hydrostatic pressure

fluid → outside

plasma oncotic/osmotic pressure

inside push on wall

interstitial hydrostatic pressure

outside push in

interstitial oncotic/osmotic pressure

outside push out

net filtration formula

force favoring filtration - force oppose

positive net filtration means

fluid move out

plasma oncotic pressure is decreased when

albumin is decreased

edema

excess fluid accumulation in interstitial space

edema is caused by

too much force favoring filtration

effusion

accumulation in body cavity

causes of edema

increased hydrostatic pressure, decreased plasma oncotic pressure, lymphatic obstruction, sodium retention, inflammation

inflammation increases/decreases vascular permeability

increases

clinical symptoms of edema

swelling, pitting

what condition is depicted

pulmonary edema (alveoli shouldn’t be pink)

dehydration leads to

hypernatremia

shock

systemic hypoperfusion from decreased cardiac output by ineffective circulating blood

cardiogenic shock

heart failure

hypovolemic

decreased intravascular volume

septic shock

infection

septic infection leads to

DIC, hypoperfusion, organ disfunction

shock consequences

decrease blood volume, increased vasodilation, increased permeability