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FHDT
10 - Fluid and Hemodynamics
35
Accounting
Pre-School
01/17/2013

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Term
Transudate vs exudate?
Definition
-Transudates are caused by disturbances of hydrostatic or colloid osmotic pressure, not by inflammation. They have a low protein content in comparison to exudates
-An exudate is any fluid that filters from the circulatory system into lesions or areas of inflammation. Has a high protein/cell content
-The specific gravity breaking point is greater or less that 1.015 (less than for transudate)
Term
Anasarca?
Definition
-Generalized subcutaneous accumulation of fluid, usually due to marked hypoalbuminemia (often from cirrhosis)
Term
Pitting edema?
Definition
-Pits on pressure (over shin)
Term
Filariasis?
Definition
-Parasitic disease where the lymphatics can become obstructed from fibrosis (formation of excess fibrous connective tissue) causing lymphedema
-May cause elephantiasis
Term
Renin and edema?
Definition
-When we get a drop in blood volume renin kicks in
-It stimulates aldosterone (mineralocorticoid) which in turn stimulates retention of Na+ and water leading to increased plasma volume leading to edema
-Also gives us more angiotensin, which acts to raise BP through water and salt retention
Term
Congestion?
Definition
-Passive process where there is decreased venous outflow and organs become engorged with venous blood
-Like in congestive heart failure
Term
What cells are characteristic of congestion in the lungs?
Definition
-Hemosiderin-laden macrophages (AKA heart failure cells)
-From left sided heart failure
-Causes brown color in the lungs
Term
What is active hyperemia?
Definition
-arterial vasodilation
-normal in some cases like EXERCISE, but can be pathological in acute INFLAMMATION

-Passive hyperemia is the result of obstruction and is typically venous (i.e. congestion)
Term
Passive congestion in the liver? Cause? Appearance?
Definition
-The congestion is the pathological result of pressure back up usually from right sided heart failure
-Causes a "nutmeg" appearance of liver
Term
Hemorrhage? Petechiae vs purpura vs ecchymoses?
Definition
-Leaking of blood through defect in vessel wall
-Petechiae; very small dots
-Purpura; small dots from 0.2 to 1cm
-Ecchymoses; bruise
Term
Define; Epistaxis, hematemesis, hemoptysis, & melena
Definition
-Epistaxis; nose bleed
-Hematemesis; vomiting blood
-Hemoptysis; coughing up blood
-Melena; tarry-collored, partly digested blood in stool
Term
Hematoma?
Definition
-Blood in soft tissues
Term
What errors usually cause small and large bleeds?
Definition
-Small bleeds (petechial or purpuric) are usually from platelet errors
-Large bleeds or in deeper tissues are usually from coagulation factor deficiencies
Term
What is thrombosis and what typically causes it?
Definition
-Process of thrombus formation; coagulated, solid fibrin-platelet mass (with entrapped RBCs)
-Often the result of atherosclerosis
Term
What are the two fluid flow properties predisposed to thrombus formation?
Definition
-Turbulent flow, like at bifurcations
-Stasis (slow flow), like in congestive heart failure or in immobilization (deep vein thrombosis in lower limbs)
Term
What is the most common coagulation cascade protein to mutate in hereditary hypercoagulable disorder?
Definition
-Factor V, such that protein C cannot affect it
-Deficient protein C or S and antithrombin III can also cause hypercoagulability
Term
Ante mortem thrombi? How can we tell?
Definition
-Thrombus formed before death
-We can tell because it will have lines of Zahn (layers of platelet and fibrin)
-A post mortem clot will be jelly-like
Term
How do we tell the difference between arterial and venous thrombi? What do we call venous thrombosis specifically?
Definition
-Venous will be redder and less laminated looking because there will be less fibrin and more RBCs trapped.
-Phlebothrombosis
Term
Mural thrombi?
Definition
-Formed in heart/aorta
Term
What do we call thrombi formed on heart valve surfaces?
Definition
-Vegetations
Term
What is a drug that can cause thrombosis? How?
Definition
-Oral contraceptives
-The estrogen causes a rise in Vit K dependent factors
Term
What are the four possible fates of a thrombus?
Definition
1. Propagation; eventual blocking off of blood vessel
2. Resolution; thrombolysis (the most common fate)
3. Embolization; lodging at another site
4. Organization; conversion to vascular tissue with obstruction (can be into wall or recanalized)
Term
What does fibrinolysis and what things activate it?
Definition
-Plasminogen lyses clots
-It is activated by t-PA
-Can also be activated by streptokinase and urokinase
-Both t-PA and urokinase are in turn inhibited by PAI
Term
What is the source of most arterial emboli?
Definition
-The heart (mural thrombi)
Term
What are the five signs of a lower limb embolism?
Definition
-The five P's; pain, paresthesia, pallor, pulselessness, paralysis
Term
What is Homan's sign? What can it result in?
Definition
-Calf pain when foot is dorsiflexed and knee is slightly flexed
-Sign of deep vein thrombosis
-May eventually lead to a pulmonary embolism
Term
What are the signs of pulmonary embolism? What is usually the fate of a pulmonary embolism?
Definition
-Tachycardia, dyspnea, and tachypnea (fast heart, shortness of breath, and fast breathing)
-Most dissolve, but if 70% of blood or more is cut off, it can cause sudden death (saddle embolus in main trunk)
Term
What causes a fat embolism?
Definition
-Fractured long bones
Term
What is Caisson's disease?
Definition
-The bends, basically
-Causes air embolism
Term
What is an amniotic embolism and what causes it?
Definition
-When the amniotic fluid gets into the uterine veins due to a tear
-Will have fetal epithelial cells and lanugo hair
-Most common with there is a tumultuous labor with deliver of a dead fetus
-Results in shock then DIC then death
Term
DIC?
Definition
-Disseminated intravascular coagulation
-We see this in association with septic shock (from all the LPS) and in amniotic embolism
Term
What is an infarction? What are the two types?
Definition
-Localized area of ischemic coagulative necrosis resulting from sudden reduction of blood flow
-Can be white (hard tissue like heart) or red (soft tissue like the lungs that have dual blood supply)
Term
Hypovolemic shock vs cardiogenic shock vs endotoxic shock vs anaphylactic shock vs neurogenic shock?
Definition
-From fluid loss (hemorrhage, dehydration, burns, etc.)
-From decreased cardiac output
-From LPS from gram negative bacteria causes widespread inflammation reaction (active hyperemia)
-From allergic reaction, also causes widespread active hyperemia
-Central nervous system/injury causes autonomic disturbance and widespread active hyperemia
Term
What are the signs of shock?
Definition
-HAT COAT
H - hypotension
A - acidosis
T - tachycardia
C - cold and clammy skin (warm in septic)
O - oliguria
A - apprehension
T - tachypnea
Term
What are the three stages of shock?
Definition
-Stage 1 - body compensates
-Stage 2 - decompensation (reversible damage)
-Stage 3 - irreversible damage
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