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Fluid and Hemodynamic Derangements
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07/25/2012

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Term
Anasarca
Definition
severe and generalized edema
Term
Causes edema by three ways:
1) increase in venous pressure
2) Increase in Na/H20
3) tissue anoxia causes increased cap perm
Definition
Cardiac failure (systemic edema)
Term
dependent edema also known as
Definition
Cardiac edema
Term
subcutanous edema most prominent in lower extremities
Definition
Cardiac edema
Term
Pitting edema seen in
Definition
Sacral edema, renal edema
Term
generalized edmea mainly seen in loose tissues like eyelids (periorbital edema)
Definition
Renal edema
Term
cells and connective tissue fibers are separated and spaces filled with fine granular precipitate
Definition
morphology of edema
Term
active hyperemia
Definition
seen during exercise
Term
Passive congestion
Definition
due to obstruction of venous drainage w/ distension of veins / caps (cyanosis)
Term
LV failure leads to
Definition
Chronic passive congestion of lungs
Term
RV failure leads to
Definition
Chronic Passive congestion of systemic orgnas
Term
IN addition to LV failure (MI, myocarditis, cardiomyopathy) these can leads to pulmonary edema
Definition
Rheumatic heart disease w/ mitral stenosis
and
Floppy MV w/ regurg
Term
heart failure cells
Definition
hemosiderin laden macrophages found in lung
Term
brown induration
Definition
found in lungs which become firmand borwn due to fibrous thickening of alveolar walls and hemosiderin pigmentation
Term
Liver becomes rapidly congested w/
Definition
RV failure (no valves between hepatic veins and RA)
Term
extreme dilation of central veins of liver lobules and central sinusoids DISTENDENT
liver dusky, red, tense, heavy: oozes blood when sectioned
Definition
Acute Liver hyperemia
Term
Centriolobular liver cell damage, peripheral portion of liver shows fatty changes.
Definition
Chronic Liver hyperemia
Term
Red blue congested centers rimmed by yellow tan parenchyma produce molted appearance of liver , found in chronic liver hyperemia
Definition
nutmeg liver
Term
cardiac sclerosis
Definition
comes from chronic congestion of liver
Term
necrosis of central hepatocytes ->centrilobular necrosis
Definition
severe congestion in liver
Term
congestive splenomegaly seen
Definition
in chronic congestion (esp w/ portla vein obstruction)
Term
Gamma Gandi Bodies
Definition
small yellow brown/rust colored foci found in spleen in pts w/ splenomegaly due to portla hypertension. Consist of fibrous tissue + hemosiderin deposits
Term
hemoptysis
Definition
expectoration of blood from hemorrhage in respiratory tract
Term
hematemesis
Definition
vomiting of blood (not from hemorrage in resp. tract)
Term
presence of dark, decomposed blood in stool
Definition
melena
Term
Intrapericardial hemorrhage leads to
Definition
Cardiac tamponade
Term
frequent cause of death in HT
Definition
rupture of artery in brain
Term
factor V, VWF, PAF, tPA INHIBITOR (tissue planminogen activator)
Definition
Thrombotic factors
Term
antihrombin III, thrombomodulin, protein C and S, prostacyclin PGI2, ADPase (inhibitors of platelet aggregation), tissue plasminogen activators (tPA)
Definition
Anithrombotic factors
Term
thrombomodulin
Definition
antithrombotic factor
Term
prostacyclin (PGI2)
Definition
antithrombotic factor
Term
inhibitor of platelet aggregation (antithrombotic factor)
Definition
ADPase
Term
tPA (tissue plasminogen activators)
Definition
fibrinolysis agonist (antithrombotic factor)
Term
thrombomodulin
Definition
antithrombotic factor
Term
thromboplastin
Definition
thrombotic factor
Term
activated platelets secrete these to augment platelet aggregation
Definition
ADP, TxA2
also produce platelet factor 3 to serve in fibrin clot formation
Term
extrinsic pathway triggeredby
Definition
tissue factor
Term
intrinsic pathway
Definition
triggered by hageman factor (XII)
Term
calicum ion is known as
Definition
factor IV
Term
thrombin in duces endothelial cell release of ____ and ____ to convert plasminogen to plasmin which degrades fibrin to FDPs inhibiting coagulation
Definition
tPA , urokinase
Term
Virchow's triad
Definition
endothelial injury, changes in blood flow, hypercoagulability of blood
Term
nephrotic syndrome leads to
Definition
antithrombin III excretion (increase likelihood of thrombus formation)
Term
non occlusive thrombus seen in cardiac chambers and aorta
Definition
Mural thrombus
Term
Occlusive thrombi seen in
Definition
arterial trees and veins
Term
usually red-blue , no lines of Zahn attached to site of origin w/ thin strands of fibrin (phlebothrombosis)
Definition
Thrombi in veins
Term
thrombi in veins known as
Definition
phlebothrombosis
Term
grey - red; pale layers of platelets/fibrin alternating w/ red layers of RBCs
Definition
Lines of Zahn
Term
Seen in thrombi of heart and arteries
Definition
Lines of Zahn
Term
verrucous endocarditis
Definition
non bacterial thrombotic endocarditis. seen as small vegetations on any valve in SLE
Term
thrombus becomes organized by invading fibroblasts and capillaries. Sometimes recanalized by through and through capillary channels
Definition
Organization
Term
encephalomalacia
Definition
form of stroke caused by arterial thrombi (in brain, blocks arteries)
Term
Big thrombus on venous side (legs espc. leads to)
Test Question
Definition
pulmonary embolism
Term
Cancer causes venous thrombosis/hypercoagulability
Definition
Trousseau phenomonenon
Term
most common cause of consumption coagulopathy (DIC)
Definition
obstetric complications
Term
Lung, Pancreas, prostate, and luekemia cancers can lead to
Definition
DIC
Term
endotoxins inhibit
Definition
protein C (leads to thrombi)
Term
bacterial endo toxins leads to endothelial injury by
Definition
activating monocytes -> IL-1 , TNF, free radical damage hurts endothelial cells
Term
Widespread MIcrothrombi causes
Definition
MAHA (microangiopathic Hemolytic Anemia)
and Tissue hypoxia (multiple infarcts)
Term
DIC in lung leads to
Definition
pulmonary edmea, ARDS
Term
DIC in kidney leads to
Definition
microinfarcts or RENAL CORTICAL NECROSIS
Term
condition that occurs in a woman who bleeds excessively after childbirth
(pituitary infarction)
Definition
Sheehan syndrome
Term
Shock, PURURA, DIC, Adrenocortical insufficiency.

Caused by N. meningitidis.
assoc w/ DIC
affects Adrenals
Definition
Waterhouse-Friderichsen Syndrome
Term
type of DIC seen in severe trauma / obstetric complications
Definition
ACUTE DIC
Term
Type of DIC seen in cancer
Definition
CHRONIC DIC
Term
renal symptom of DIC
Definition
oliguria (lack of urine production)
Term
hemolytic anemia is consequence of
Definition
DIC
Term
emboli in veins usually impact
Definition
lungs
Term
emoboli in arteries usually impact
Definition
legs, brain, viscera (systemic embolism)
Term
problem in heart causes problem in lungs
ex: CHF -> thrombi in veins
Definition
actue cor pulmonale
Term
straddles divding blood vessel (bifurcation of MPA) often lethal because prevents blood entry into lungs. typically from vein -> RA -> RV -> PUlm. art
Definition
Saddle embolus
Term
most emboli are
Definition
small
Term
acute cor pulmonale
Definition
RHF (probably due to blocking of MPA by venous thrombus)
Term
this size emboli may be clinically silent or cuase hemoptysis.
or induce infarction in pts w/ heart failure
Definition
small
Term
can sometimes cause chronic cor pulmonale -> pulmonary hypertension (PHT) and vascular sclerosis
Definition
small emboli
Term
refers to embloli travelling through arterial circulation
Definition
systemic emboli
Term
systemic emboli lodge in these sites (by order of frequency)
Definition
lower limbs, brain, viscera
Term
consists of thrombocytopenia, petechiae in skin and conjunctivate, respiratory difficulty, mental deterioration, severe cases: coma / death
Definition
Fat embolism syndrome
Term
Fat embolism syndrome morphology. Fat globulesin microvessels especially these organs
Definition
kidney, lungs, brain
Term
increases likelihood of infarction
Definition
anemia
Term
tissues most sensitive to hypoxia
Definition
neurons, mycoardial cells, renal tubular cells
Term
infarct that occurs in solid organs w/ end arteries (kidneys, spleen)
Definition
White or pale infarcts
Term
infarct that occurs in tissues that are loose (lungs), those w/ double circualation (intestines), or venous occlusion (torsion of ovary)
Definition
red
Term
infarcts replaced by scars except
Definition
encephalomalacia (infarct in brain): liqufactiv necrosis and smooth walled glia lined cavity.
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