Gen Path- Exam 2- TQs

What is the number 1 leading cause of death in the United states (as of 2016-17)

heart disease

what is the process which causes bleeding to stop? (keeps blood in a damaged blood vessel)

hemostasis

what is localized increase in blood within a particular body part, organ or tissue (caused by impaired venous return from a particular area)

congestion

what is hyperemia

normal increased blood flow

hyperemia (normal blood flow) is active or passive?

active

Erythema (redness) is present in ____________ due to arteriole dilation (TQ)

hyperemia

Is congestion active or passive? Pathological or no?

passive, pathological

Hyperemia is ______________ dilation, whereas congestion is decrease in _____________ outflow.

arteriole; venous

Reduced venous outflow and/or venous obstruction in congestion can result in _____________ (TQ)

Cyanosis

What are the two examples of congestion mentioned in class?

Congestive Heart Failure

Deep Vein Thrombosis (DVT)

Congestion leads to increased _____________ pressure.

Increase of this pressure leads to liquid blood (plasma/water) being squeezed into extracellular space. This liquid is called ____________

hydrostatic ; transudate

Transudate is protein _______, and leads to ______________ edema

poor; pitting

What is the difference between edema from a DVT as from edema from inflammation? (transudate vs exudate edema)

Transudate is pitting edema and non-inflammatory, where as exudate is non-pitting and inflammatory

When the center of a lobule (of the liver) undergoes necrosis due to congestive hepatopathy, what is this referred to? NBQ/TQ

nutmeg liver

What is abnormal accumulation of interstitial fluid?

edema

Localized edema can be seen in the peritoneal cavity, known as ______________ and in the pleural cavity known as ___________

ascites; hydrothorax

generalized edema in the subcutaneous tissue is known as what?

(hint: due to a severe protein deficiency)

anasarca

Which pressure is known as the pushing force where fluid is exerted outward from a vessel lumen towards the vessel wall? 100% TQ

Hydrostatic Pressure

Which pressure is what we know as "blood pressure"

hydrostatic pressure

increased blood pressure is due to increased _______________ pressure

hydrostatic

The "pulling force" of fluid balance within vessels that is maintained by plasma proteins is known as what type of pressure? 100% TQ

Colloid Osmotic pressure (oncotic)

What is the main plasma protein that helps maintain oncotic pressure?

albumin

DVT is considered ____________ impaired venous return and increased hydrostatic pressure, whereas congestive heart failure is considered ____________.

localized; generalized

Reduced oncotic pressure is due to too few of what plasma proteins? What is the clinical name for this?

albumin

hypoalbuminemia

What are two ways (and examples) that hypoalbuminemia could occur?

Reduced production (hepatitis, cirrhosis, liver failure)

Increased loss (nephrotic syndrome)

How does liver failure lead to edema? (TQ)

Lack of albumin/plasma proteins decreases oncotic pressure, disrupting the balance between oncotic and hydrostatic pressure.

Hydrostatic pressure increases causing edema

How does heart failure lead to edema? (TQ)

Congestion of the heart. Heart can't keep up with pumping blood.

Not getting blood out of vessels fast enough increases pressure and the blood accumulates in vascular tissues until edema occurs

How does high sodium impact water retention within a vessel?

Water follows sodium, therefore high sodium in vessel causes increase of fluid and hydrostatic pressure

An elderly patient enters your office with 2 swollen ankles. What is your first concern as their primary care provider?

Congestive Heart Failure

You patient drinks excessively and it has resulted in their liver failing. Your concered with the patients oncotic blood pressure, but why?

Liver damage can lead to decrease of albumin and plasma proteins, decreasing oncotic pressure, causing potential edema from hydrostatic pressure.

A patient enters your clinic with their right ankle swollen and red and their left ankle normal. They have NOT done anything physically to injure the ankle. You palpate the ankle and notice pitting edema. What is your first concern as their primary care doctor?

Blood clot (indicated with pitting edema)

Dependent edema is mostly seen in what areas of the body (100% TQ)

ankles or sacrum

What are examples of clinical features that cause pathologic edema? (TQ)

-inflammation

-heart failure

-renal failure

-malnutrition

Increased in intracranial pressure results in what kind of edema?

What can cause this?

100% TQ

cerebral edema

- abnormal BBB, tumors, infection, trauma, cell membrane injury

T/F: Pitting edema is non-inflammatory and caused by an increase of hydrostatic pressure.

TRUE

Edema as a result of congestive heart failure, liver failure and/or kidney failure is _____________ edema (TQ- need to know causes)

Transudate/pitting edema

Causes of Non-pitting edema include what? (TQ)

inflammation

T/F: Non-pitting edema is protein poor

FALSE: non-pitting=exudate, meaning protein rich

What ate the causes of lymphatic obstruction discussed in class (6)

- infection

-surgery

-ionizing radiation

- filariasis (parasitic infection spread by mosquitos)

-tumors

-inactivity

What is a mosquito born parasitic infection that obstructs lymphatics, causing edema to be restricted from returning from the lower extremities (elephantiasis)

Filariasis

What is an example of as surgery (discussed in class) that causes lymphatic obstruction

mastectomy

What is the term for extravasation of blood from vessels

hemmorrhage

How much blood is typically lost resulting in hypovolemic shock> TQ

rapid loss of > 20% of blood volume (1 liter of blood)

A ____________ is a large accumulation of blood within tissues and often presents as a large contusion/ecchymosis

hematoma

A unique pattern of hematoma that is 1-2 mm in size and is present in the skin and mucosa.

Caused by decreased platelets, vitamin C and K

100% TQ

petechiae

What causes petechiae (TQ)

decreased platelets, vitamin C and vitamin K

What is a unique pattern of hematoma that is 3-5 mm in size and is a result of vasculitis or fragile vessels? TQ

Purapura

what causes purpura hematoma? TQ

vitamin C deficiency

Contusion is also known as?

eccymosis

What is the color pattern of contusion/ecchymosis (100% TQ)

red/blue->green->yellow->brown

What compounds are the colors of ecchymosis/contusion caused by? (100% TQ)

hemoglobin-> bilirubin-> hemosiderin

(HBH)

What are the steps of normal hemostasis? TQ

1. Vessel injury (endothelial injury)

2. Primary Hemostasis (platelet plug)

3. Secondary Hemostasis (Coagulation Cascade)

Primary hemostasis (the second step of normal hemostasis) starts with exposure to _____________________ (vWF) that activates platelets and forms a _____________ _____. TQ

subendothelial ECM; platelet plug

Activation of platelets to form a platelet plug is which step of normal hemostasis?

Primary hemostasis (2nd step)

A cut, autoimmune, pathogen, chemicals (smoking) are all examples of ________ _________ in which step of normal hemostasis? TQ

Vessel injury

Step 1 of hemostasis

The coagulation cascade is a multiple step process that ultimately leads to the activation of ________________. This then converts ____________ to ___________ allowing clot to form. (step 3 of hemostasis)

thrombin; fibrinogen; fibrin

what is the end product of the steps of normal hemostasis (100% TQ)

fibrin.

thrombin converting fibrinogen to fibrin

T/F: normal cells in circulation should not come into contact with collagen. If they do, there is injury and the area needs clotting.

TRUE

What is an example of an antiplatelet drug?

example of anticoagulant drug?

aspirin

Coumadin (warfarin) and Heparin

What are the three parts of virchow's triad ( factors that would increase likelihood of thrombus formation)

1. Endothelial injury

2. Abnormal Blood Flow

3. Hypercoagulability

what are examples of endothelial injury that could cause thrombosis (100% TQ, need to memorize)

(7)

-atherosclerotic plaques

- inside of heart post myocardial infaction

- hypertension

- high cholesterol

- vaculitis

- septic infection

- tabaco smoke products

T/F: endothelial activation is inflammatory (TQ)

TRUE

Abnormal blood flow is caused by ___________ or ______________

turbulence or stasis

examples of abnormal blood flow that could lead to thrombosis include : (4)

- aneurysm

- arrhythmia

-immobility/sedentary people

- heart valve stenosis

abnormal blood flow promotes ____________ ______________

endothelial activation

Excessivly viscous blood results in ______, which makes the blood excessively prone to clotting.

Which two disorders discussed can cause cause this, potentially leading to thrombosis

stasis

sickle cell anemia disease; polycythemia

What is the most common mutation that leads to hypercoagulability, increasing risk of thrombosis (100% TQ)

How much greater is the increased risk of thrombosis for those with this mutation

-Factor V (factor V Leiden thrombophilia)

5x high risk

What three things discussed lead to an increase in hypercoagulability therefor increasing risk of thrombosis?

1. Mutations (ex: Factor V)

2. Lifestyle (sedentery)

3. Increased estrogen

increase in estrogen increases what? This leads to an increased risk of thrombosis

clotting factors

What are the 4 fates of a thrombus and what is the most common?

1. Dissolve (Most Common!!!)

2. Enlarge (propagate)

3. Embolize

4. Organization (reformation)

What is the difference between venous embolism and arterial embolism?

100% TQ NEED TO KNOW

venous- slower movement, more common, congestion, tenderness, pitting edema, systemic

Arterial- faster pressure, higher chance of infarction, localized, inflammation, cell injury

venous thrombi grow along ___________ venous blood flow (anterograde).

Common locations include?

with

popliteal or femoral regions

arterial thrombi grow _________ arterial blood flow (retrograde)

common locations include?

against

coronary, cerebral, femoral area

Which direction do thrombi enlarge toward, regardless or arterial or venous?

TQ

TOWARD the heart

-Thrombi with alternating layers of platelets and red blood cells that create a line pattern are what?

-what sites are these seen in?

-What do these indicate

100% TQ

Lines of Zahn

seen in sites of high blood pressure

indicate patient was ALIVE when the clot formed-autopsy

What does DIC stand for and what is it?

Disseminated intravascular Coagulation

widespread thrombosis seen from severe trauma

What types of severe trauma cause disseminated intravascular coagulation (DIC) (widespread thrombosis) TQ

-crush injuries

-sepsis

-obstetric (child birth) complications

What are the three potential forms of an emboli? give examples

1. Solid- thrombus, fat, plaque

2. Liquid- amniotic fluid,

3. Gas- nitrogen (caisson disease), needle injection

What are the warning signs of a pulmonary embolism (TQ)

- dyspnea

- tachypenea

- cough

- chest pain

- cyanosis

- possible cor pulmonale

What is cor pulmonale

right sided heart failure due to lung issue (likely pulmonary embolism)

95% of pulmonary embolisms originate from what?

DVTs

80% of pulmonary embolisms are clinically _____________

silent

Systemic thromboembolism is a clot originating in the heart and is found within the ______________ system (TQ)

arterial

Paradoxical embolism crosses from __________ to the _____________ system. TQ

venous; arterial

What three defects discussed in class can cause paradoxical embolism (crossing of emboli from venous to arterial system)

Which is most common?

1. Atrial Septal Defect

2. Ventricular Septal Defect

3. Patent Foramen Ovale ((MC)

Where would you see red( hemorrhagic) infarction?

tissues that fills back in with blood after infarct

(lungs)

Where would you see white (pale/anemic) infarction?

infarct that does NOT fill back in with blood, dense tissues

Heart, kidney, spleen

What are some clinical signs and symptoms of shock?

weak rapid pulse ***

pale clammy skin

profuse sweating

confusion/dizziness

What are the types of shock discussed in class?

- Cardiogenic

- Hypovolemic

- Septic

- Neurogenic

- Anaphylactic

What type of shock is due to heart pump failure, leading to decreased output of blood?

(heart is not pumping and blood is not getting where it needs to go)

cardiogenic shock

What type of shock is due to loss of blood/plasma volume leading to a rapid drop in blood pressure.

(caused usually by hemorrhage, burns, dehydration)

Hypovolemic shock

what type of shock is a severe systemic inflammatory response that causes massive vasodilation and vessel permeability. (rapid decrease in BP)

septic shock

What type of shock is caused by CNS trauma, spinal anesthesia or ADRs causing bradycardia and low BP?

(sudden loss of sympathetic tone)

Neurogenic shock

What type of shock is due to severe allergy causing vasodilation and bronchoconstriction?

anaphalactic shock

What two types of shock have similar vascular mechanisms? (extreme vasodilation)

septic and anaphylactic shock

How do you treat shock quickly? (TQ)

elevate legs, increase fluid volume, vasoconstrictive medication

what can cause septic shock?

severe bacterial infection

what can cause anaphylactic shock

nuts, shellfish, venom, latex, ADRs etc

what is a fast treatment for anaphylactic shock that activated Beta-2 adrenergic receptors on mast cells?

How do the mast cells respond?

Epinephrine (Epi-pen)

mast cells respond by decreasing histamine release

What are the three stages of shock?

1. Nonprogressive (compensated by SNS)

2. Progressive (acidosis from lactic acid accumulation)

3. Irreversible- membrane/issue damage (lethal)