[03.05a] Hemodynamics, Thrombosis and Shock (Part 1) V2.3.pdf

Normal fluid homeostasis

What encompasses the maintenance of vessel wall integrity, intravascular pressure and osmolarity, and maintaining blood as liquid until injury necessitates clot formation?

Clotting

What process occurs when there is injury to the blood vessel wall?

Thrombus

What is an abnormal clot formation called?

Edema

What is defined as water extravasation into the interstitial spaces, where plasma leaks into the interstitial compartment outside blood vessels?

Thrombosis

What is clotting at inappropriate sites called, which is considered pathologic?

Hemostasis

What is the normal response to vascular injury, which is the opposite of thrombosis?

Embolism

What is the term for the migration of clots?

Ischemia

What occurs when there is obstruction in the blood flow to a particular tissue or organ, leading to a decrease in oxygen and nutrient supply?

Infarction

What is cell death due to prolonged and severe ischemic phase and obstruction of blood flow?

Myocardial infarct

What is an example of infarction in a portion of the heart muscle due to O2 and nutrient deprivation, often from coronary artery thrombosis?

Coagulative necrosis

What type of necrosis is typically observed in solid organs, such as the heart during an infarct?

Cell death

What does the term necrosis mean?

Hemorrhage

What is the inability to clot after vascular injury, leading to "pagdurugo" (bleeding)?

Increased fluid in the interstitial tissue spaces

What is the primary characteristic of edema?

Hydrothorax

What is the term for fluid collection in the thoracic cavity?

Hydropericardium

What is the term for fluid collection in the pericardium?

Hydroperitoneum (ascites)

What is the term for fluid collection in the abdominal cavity?

Anasarca

What describes severe and generalized edema with profound subcutaneous tissue swelling?

Fatty tissue

In soft tissue, what does "subcutaneous" specifically refer to?

Inflammatory Edema

What type of edema is characterized by mechanisms related to local increases in vascular permeability?

Vascular permeability

What refers to the leakiness of the blood vessel to plasma and proteins?

Protein-rich exudate, with a specific gravity >1.020

What kind of fluid is characteristic of inflammatory edema?

Non-Inflammatory Edema

What type of edema is usually due to hydrodynamic or hemodynamic derangements, such as congestive heart failure?

Protein-poor transudate, with a specific gravity <1.012

What kind of fluid is characteristic of non-inflammatory edema?

Increased hydrostatic pressure, reduced plasma osmotic or oncotic pressure, lymphatic obstruction, sodium and water retention

What are the four main pathological causes of edema?

Impaired venous outflow

What local condition can lead to increased hydrostatic pressure, as seen in deep venous thrombosis?

Congestive heart failure (CHF)

What generalized condition often results in systemic edema due to increased venous pressure?

Albumin

What specific protein is primarily responsible for plasma or oncotic pressure?

Liver

Which organ is responsible for synthesizing proteins like albumin?

Decrease in serum protein

What physiological change leads to a decrease in oncotic pressure, manifesting as edema?

Liver pathology (Cirrhosis)

What specific liver condition can cause reduced protein synthesis and decreased plasma oncotic pressure?

Hepatitis or alcoholism

What are two common causes of cirrhosis?

Hepatocytes or liver cells

Which specific cells in the liver synthesize protein?

Nephrotic syndrome

What kidney disease is characterized by proteinuria and a decrease in serum albumin (hypoalbuminemia), leading to reduced plasma osmotic pressure?

Proteinuria

What is the abnormal excretion of proteins in urine called?

Hypoalbuminemia

What is the term for decreased serum albumin?

Protein malnutrition

Besides liver and kidney diseases, what nutritional condition can cause decreased protein synthesis and edema?

Non-inflammatory edema or transudate

What type of edema would congestive heart failure typically lead to?

Localized

Impaired lymphatic drainage leading to lymphedema is usually described as being what in its distribution?

Filariasis

What parasitic infection can cause massive lymphatic and lymph node fibrosis, leading to lymphatic obstruction and edema of the external genitalia and lower limbs?

Brugia malayi and Wuchereria bancrofti

Name two specific parasites that cause filariasis.

Lymphatic obstruction due to lymphatic fibrosis

What is the underlying pathophysiology of scrotal swelling and elephantiasis in filariasis?

Elephantiasis

What term describes massive collection of fluid or edema in the lower limbs, named for the size of the extremities?

Breast carcinoma

What malignancy can cause edema of the overlying skin, leading to a "peau d’orange" appearance, due to tumor cell infiltration of superficial lymphatics?

Peau d’orange

What term describes the orange peel appearance of the skin, potentially caused by breast carcinoma due to lymphatic obstruction?

Salt retention

What dietary factor can be a primary cause of edema, often leading to water retention?

Acute reduction of renal function

Sodium and water retention may occur with any acute reduction of what bodily function?

Glomerulonephritis (GN) or Acute Renal Failure (ARF)

Name two examples of conditions involving acute reduction of renal function that can lead to edema.

Water

When excess sodium enters intracellularly, what is always accompanied by it, leading to cellular swelling?

Minimize salt intake

What dietary advice is typically given to patients with renal problems to manage edema?

Subcutaneous edema

What is fluid collection in the interstitial space, like the subcutaneous space, called?

High hydrostatic pressures

In which regions is subcutaneous edema often more conspicuous?

Dependent edema

What is the term for edema whose distribution is often influenced by gravity, appearing in the legs when standing or in the sacrum when recumbent?

Ankles

Where might edema appear in pregnant women standing for long periods?

Sacrum

In bedridden patients, where might dependent edema be observed?

Eyelids

Edema resulting from renal dysfunction often appears initially in parts of the body containing loose connective tissue, such as what?

Periorbital edema

What is a characteristic finding in severe renal disease that affects the soft tissue surrounding the eye?

Children with post-streptococcal glomerulonephritis

In what patient population might periorbital edema be an initial manifestation?

Left ventricular failure, renal failure, Acute Respiratory Distress Syndrome (ARDS), pulmonary infections, hypersensitivity reactions

List three conditions in which pulmonary edema is commonly seen.

Heavy and frothy (possibly blood-tinged)

What would the lungs grossly appear like in pulmonary edema?

Interfere with normal ventilatory function

What is a direct consequence of fluid in the alveolar spaces in pulmonary edema?

Favorable environment for infection (acts as a culture medium)

Why does edematous fluid in the lungs increase the risk of pneumonia?

Pink amorphous acellular material

What histological finding in the alveoli of a patient with congestive heart failure corresponds to pulmonary edema?

Abscess or tumor

What can cause localized brain edema?

Encephalitis

What can cause generalized brain edema?

Grossly swollen brain, with narrowed sulci and distended gyri

What is the gross appearance of the brain in brain edema?

Herniate through foramen magnum or brainstem vascular supply can be compressed

What severe consequences can brain edema lead to, potentially causing death?

Medullary centers

What critical brain structures can be injured by brain herniation, leading to death?

Large opening at the base of the skull

What is the foramen magnum?

Arteriolar dilation, inflammation, heat

List three local causes of increased hydrostatic pressure leading to edema.

Venous thrombosis, congestive heart failure, cirrhosis (ascites), postural inactivity, hypervolemia, sodium retention

List three causes of generalized increased venous pressure leading to edema.

Hypoproteinemia

What general condition causes decreased oncotic pressure leading to edema?

Nephrotic syndrome, cirrhosis, protein-losing gastroenteropathy, malnutrition

List three specific conditions causing hypoproteinemia.

Inflammation, burns, Adult Respiratory Distress Syndrome

List two causes of increased capillary permeability leading to edema.

Cancer, postsurgical lymphedema, inflammation

List two causes of lymphatic obstruction leading to edema.

Local increased volume of blood in a particular tissue

What is a common characteristic shared by both hyperemia and congestion?

Confined in the vasculature

In hyperemia and congestion, is the blood within or outside the blood vessels?

Hemorrhagic and wet

What is the gross appearance of the cut surface of an organ affected by hyperemia or congestion?

Active process

What kind of process is hyperemia?

Passive process

What kind of process is congestion?

Augmented tissue inflow due to arteriolar dilation

What is the cause of hyperemia?

Impaired outflow from a tissue

What is the cause of congestion?

Erythematous (deep or blushing red)

What is the coloration of tissues affected by hyperemia?

Cyanotic or bluish-red

What is the coloration of tissues affected by congestion?

Skeletal muscle during exercise

Give an example of hyperemia.

Cardiac failure or isolated venous obstruction

Give an example of congestion.

Increased inflow of oxygenated blood

What leads to engorgement with oxygenated blood in hyperemia?

Erythema

What is the resulting appearance of tissues in hyperemia due to increased oxygenated blood delivery?

Rubor (redness)

Which cardinal sign of inflammation is directly linked to increased blood flow, characteristic of hyperemia?

Diminished outflow of deoxygenated venous blood

What causes the capillary beds to swell in congestion?

Cyanosis or hypoxic appearance

What is the resulting appearance of tissues in congestion due to red cell stasis and deoxygenated hemoglobin?

Congestive heart failure (CHF)

What common cardiac condition is an example of congestion?

"Nutmeg liver" pattern

What gross appearance is characteristic of a liver with chronic passive congestion (CPC) due to central areas being red and slightly depressed compared to surrounding tan parenchyma?

Centrilobular necrosis with degenerating hepatocytes and hemorrhage

What is the histological finding in the central area of a liver with chronic passive congestion?

Non-viable cell (cell death)

What does necrosis mean in the context of liver histology?

Pyknosis, karyorrhexis, and karyolysis

What specific nuclear changes are seen during necrosis?

Pinkish granular material

What material replaces the cords of hepatocytes in the center of a liver with CPC histologically?

Cords of liver cells

At the periphery of a liver with CPC, what structures are still visible histologically?

Engorged alveolar capillaries, alveolar septal edema, focal intra-alveolar hemorrhage

List two features of acute pulmonary congestion.

Congestive heart failure

What often causes chronic pulmonary congestion?