Gen Patho P2

The accumulation of fluid in tissues resulting from a net movement of water into extravascular spaces

Edema

Process of blood clotting that prevents excessive bleeding after blood-vessel damage

Hemostasis

True or False: Inadequate hemostasis may result in hemmorhage

True

Inappropriate clotting (thrombosis) or migration of clots (embolism) can obstruct blood vessels, potentially causing

Ischemic cell death (infarction)

Disorders that perturb cardiovascular, renal, or hepatic function are often marked by the accumulation of______ or _______

fluid in tissues (edema), body cavities (effusions)

In normal circumstances, what balances the tendency of vascular hydrostatic pressure to push water and salts out of capillaries into the interstitial spaces?

Tendency of plasma colloid osmotic pressure to pull water and salts back into vessels

True or false: Elevated hydrostatic pressure or diminished colloid osmotic pressure disrupts the balance that results in decreased movement of fluid out of vessels

False. Keyword: decreased - increased

True or false. If the net rate of fluid movement exceeds the rate of lymphatic drainage, fluid does not accumulate

False. Fluid accumulates

Accumulation of fluid in a body cavity or space, such as a joint, pleural cavity, pericardial cavity, or peritoneal cavity.

Effusion

Accumulation of fluid in the interstitial spaces (the spaces between cells) of tissues.

Edema

True or false. Edema fluids and effusions may be inflammatory or non-inflammatory

True

True or false. Exudates are protein-poor fluids

False. Exudates are protein-rich fluids

True or false. Transudates are protein-poor fluids

True

Protein-rich exudate accumulate due to (increase, decrease) in _______ caused by inflammatory mediators

Increase in vascular permeability

Non-inflammatory edema and effusions are called

Transudates

5 Pathophysiologic Categories of Edema

Increased Hydrostatic Pressure, Reduced plasma osmotic pressure (Hypoproteinemia), Lympathic Obstruction, Sodium Retention, Inflammation

True or false. Increases in hydrostatic pressure are mainly caused by disorders that impair arterial dilation.

False. Impair venous returm

True or false. Congestive heart failure is an example of increased hydrostatic pressure

True

True or false. Deep venous thrombosis (DVT) in a lower extremity that results in edema confined to the affected part is an example of reduced plasma osmotic pressure

False. It is an example for Increased hydrostatic pressure, this is also localized

Under normal circumstances, what accounts for almost half of the total plasma protein

Albumin

Increased loss of albumin from the circulation are common causes of

Reduced plasma oncotic pressure

Where is albumin synthesized?

Liver

This is where albumin leaks into the urine through abnormally permeable glomerular capillaries

Nephrotic syndrome

True or false. Sodium and Water retention both increases hydrostatic pressure and diminished vasculuar colloid osmotic pressure

True

What hormone system activates due to congestive heart failure?

Renin-angiotensin-aldosterone axis (RAAS) - regulates blood pressure, fluid, and electrolyte balance, as well as systemic vascular resistance

Trauma, fibrosis, invasive tumors, and infectious agents can all disrupt lymphatic vessels and impair the clearance of interstitial fluid, resulting in

Lymphadema in the affected part of the body

What organism induces obstructive fibrosis of lymphatic channels and lymph nodes

Filariasis

Obstructive fibrosis of lympathic channels and lymph nodes results in edema of the external genitalia and lower limbs that is called

Elephantiasis

Where is Edema most commonly seen?

Subcutaneous tissues, lungs, and the brain

Type of Edema that can be diffuse or more conspicuous in regions with high hydrostatic pressures, being distributed by the influence of gravity

Subctunaeous edema

This is an edema that appears in the legs when standing and the sacrum when recumbent

Dependent edema

Finger pressure over markedly edematous subctuaneous tissue displaces the interstisial fluid and leaves a depression, a sign called

Pitting edema

Edema resulting from _______ often appears initially in parts of the body containing loose connective tissue, such as the eyelids; ______ is a characteristic finding in severe renal disease

Renal dysfunction, periorbital edema

Type of edema where the lungs are often two or three times their normal weight, and sectioning yields frothy, blood-tinged fluid

Pulmonary edema

Brain edema can be localized or generalized depending on the nature and extent. The swollen brain exhibits ______ and _______, which are compressed by the skull

Narrowed sulci, distended gyri

Effusions involving the pleural cavity ______, the pericardial cavity _______, or the peritoneal cavity _______

hydrothorax, hydropericardium, hydroperitoneum or ascites

True or false. Chylous effusion are protein-rich and often cloudy due to the presence of white cells

False. Chylous effusion is a type of transudative effusion; protein-poor

True or false. Exudative effusion are translucent and straw colored

False. Transudative effusion are translucent

Type of edema that signals potential underlying cardiac or renal disease

Subcutaneous edema

In pulmonary edema, what setting is it most frequently seen?

Left ventricular failure; can also occur with renal failure, acute respiratory distress syndrome, and pulmonary inflammation or infection

True or false. Edema in the pulmonary interstitium and the alveolar spaces do not impede gas exchange and also creates a favorable environment for bacterial infection.

False. Impedes gas exchange

True or false. Hyperemia and congestion both stem from decreased blood volumes within tissues

False. Stem from increased blood volumes

Is an active process in which arteriolar dilation leads to increased blood flow

Hyperemia

True or false. In hyperemia, affected tissues turn blue-red color (cyanosis) because of increased delivery of oxygenated blood

False. Affected tissues turn red (erythema)

Is a passive process resulting from reduced venous outflow of blood from a tissue; can be systemic as in cardiac failure, or localized, as in isolated venous obstruction

Congestion

True or false. Congested tissue have red color (erythema) that stems from the accumulation of deoxygenated hemoglobin in the affected area

False. Have blue-red color (cyanosis)

This is where associated chronic hypoxia may result in ischemic tissue injury and scarring

Chronic passive congestion

This is where capillary rupture can also produce small hemorrhagic foci

Chronically congested tissues

Congested tissues take on a dusky reddish-blue color (cyanosis) due to ______ and ______

red cell stasis, presence of deoxygenated hemoglobin

Type of congestion marked by engorged alveolar capillaries, alveolar septal edema, and focal intra-aveolar hemorrhage

Acute pulmonary congestion

Type of congestion that is often caused by congestive heart failure; septa are thickened and fibrotic, and the alveoli often contain numerous macrophages laden with hemosiderin (heart failure cells) derived from phagocytosed red cells

Chronic pulmonary congestion

Type of congestion where central vein and sinusoids are distended wherein cerntrilobular hepatocytes may undergo ischemic necrosis and periportal hepatocyte may only develop fatty change

Acute hepatic congestion

Type of congestion where the centrilobular regions are grossly red-brown and slightly depressed and are accentuated agains the surrounding zones of uncongested tan liver (nutmeg liver)

Chronic passive hepatic congestion

This is a process in which blood clots form at sites of vascular injury.

Hemostasis

What are the two divisions for the varying degrees in a broad range of disorders of hemostasis?

Hemorrhagic disorders, Thrombotic disorders

This is a disorder that is characterized by excessive bleeding, wherein hemostatic mechanisms are either blunted or insufficient to prevent blood loss

Hemorrhagic disorders

This is a disorder wherein blood clots form within intact blood vessels or within the chambers of the heart.

Thrombotic disorder

True or false. Hemorrhage is the most common and clinically important form of cardiovascular disease

False. Thrombosis

This is a condition wherein blood clots form throughout the small blood vessels in the body, which can lead to bleeding and organ damage.

Disseminated intravascular coagulation (DIC)

Hemostasis is a precisely orchestrated process involving _____, _____, and ____ that occurs at the _____ and culminates in the formation of a ______, which serves to _____ the extent of bleeding

Platelets, clotting factors, endothelium, site of vascular injury, prevent or limit

What is the general sequence of events that lead to hemostasis?

Arteriolar vasoconstriction, Primary hemostasis (formation of platelet plug), Secondary hemostasis (deposition of fibrin), Clot stabilization and resorption

In the sequence of normal hemostasis, what occurs immediately and markedly reduces blood flow to the injured area?

Arteriolar vasoconstriction

True or false. Endothelin, a potent endothelium-derived vasodilator, mediates the reflex neurogenic mechanisms of an artery.

False. Vasoconstrictor

In the sequence of normal hemostasis, promotion of platelet adherence and activation is evident, recruiting additional platelets that undergo aggregation to form a primary hemostatic plug

Primary hemostasis: the formation of the platelet plug

How does platelet adherence and activation promoted in primary hemostasis?

Disruption of the endothelium exposes subendothelial von Willebrand factor (vWF) and collagen

What is the purpose of the shape change of platelets from rounded to flat with spiky protrusions in their activation?

Increase surface area

In the sequence of normal hemostasis, Vascular injury exposes tissue factor at the site of injury, consolidating the initial platelet plug.

Secondary hemostasis: deposition of fibrin

This is a membrane-bound procoagulant glycoprotein that is normally expressed by subendothelial cells in the vessel wall, such as smooth muscle cells and fibroblasts.

Tissue factor

In thrombin generation, what does the tissue factor bind and activate?

Factor VII

What cleaves circulating fibrinogen into insoluble fibrin, creating a fibrin meshwork?

Thrombin

This is a potent activator of platelets, leading to additional platelet aggregation at the site of injury.

Thrombin

In the sequence of normal hemostasis, Polymerized fibrin and platelet aggregates undergo contraction to form a solid, permanent plug that prevents further hemorrhage.

Clot stabilization and resorption

What limits clotting to the site of injury that eventually lead to clot resorption and tissue repair?

Counterregulatory mechanisms (eg. tissue plasminogen activator (t-PA) made by endothelial cells

What are the central regulators of hemostasis?

Endothelial cells

What determines whether thrombus formation, propagation, or dissolution occur?

Balance between the antithrombic and prothrombic endothelium

These are factors in the normal endothelial cells that inhibit platelet aggregation and coagulation; also promotes fibrinolysis

Anticoagulant

Activation of platelets and clotting factor due to this activity

Procoagulant

The endothelium can be activated by?

Trauma, Microbial pathogens, hemodynamic forces, pro-inflammatory mediators

These forms the primary plug that initially seals vascular defects and provide a surface that binds and concentrates activated coagulation factors.

Platelets

What are the characteristics of a platelet?

Disc-shaped anucleate cell fragments shed from megakaryocytes in the bone marrow into the blood stream

What does the function of platelets depend on?

Several glycoprotein receptors, a contractile cytoskeleton, and two types of cytoplasmic granules

True or false. A-Granules contian adenosine diphosphate, adenosine triphosphate, ionized calcium, serotonin, and epinephrine.

False. B-Granules contain

True or false. B-Granules contain adhesion molecule P-selectin and proteins involved in coagulation such as fibrinogen, coagulation factor V, and vWF, among others.

False. A-Granules contain

These are the sequence of reactions that culminate in the formation of a platelet plug.

Platelet adhesion, Platelet rapidly change shape, Secretion of granule contents, Platelet aggregation

In platelet adhesion, what factors mediates largely via interactions?

Platelet surface receptor glcoprotein Ib (GpIb) and vWF in the subendothelial matrix

What receptor does platels adhere to in exposed collagen?

Platelet collagen receptor GpIa/IIa

True or false. There is a change from spiky' ‘sea urchins’ to smooth discs shape with greatly increased surface area for platelets following adhesion

False. It changes from smooth discs shape to spiky

What accompanies the conformational change in cell surface of platelets following adhesion?

Glycoprotein IIb/IIIa

True or false. Glycoprotein IIb/IIIa increase the affinity of platelets for fibrinogen and allows translocation of negatively charged phospholipids to the platelet surface.

True

What mineral does phoshpolipids bind to serve as nucleation sites for the assembly of coagulation factor complexes?

Calcium

This occurs along with changes in platelet shape; also known as platelet activation

Secretion (release reaction) of granule contents

What factors trigger platelet activation?

Coagulation factor thrombin and ADP

How does thrombin activate platelets?

Through a special G-protein-coupled receptor referred to as protease-activated receptor-1 (PAR-1)

How is PAR-1 activated?

Proteolytic cleavage by thrombin

This is a phenomenon wherein platelet activation and ADP release begets additional rounds of platelet activation

Recruitment

True or false. ADP acts by binding two G-protein-coupled receptors, P2Y1 and P2Y12

True

The activated platelet produces such wherein it is a potent inducer of platelet aggregation.

Thromboxane

This is a drug that inhibits platelet aggregation and produces a mild bleeding defect by inhibiting cyclooxygenase, a platelet enzyme required for TxA2 synthesis.

Aspirin

These are drugs used in the treatment of coronary artery disease.

Antiplatelet drugs

What follows after the activation of the platelets wherein the conformational change in glycoprotein IIb/IIIa that occurs with platelet activation allows binding of fibrinogen.

Platelet aggregation