Term
|
Definition
| intravascular mass that travels to a site distinct from its point of origin |
|
|
Term
|
Definition
| embolus composed of thrombotic material |
|
|
Term
| What are the 2 types of thromboemboli? |
|
Definition
|
|
Term
| What is the most common source of thromboemboli in the lungs? |
|
Definition
|
|
Term
| What are the 5 consequences of pulmonary thromboemboli? |
|
Definition
1) *subclinical event
2) pulmonary hemorrhage
3) pulmonary infarction
4) sudden death
5) pulmonary hypertension |
|
|
Term
| *When will a pulmonary thromboemboli have a subclinical event? |
|
Definition
| small embolus with either complete dissolution or organized into a small intimal scar or fibrous web |
|
|
Term
| When will pulmonary thromboemboli cause pulmonary hemorrhage? |
|
Definition
| medium-sized embolus in an individual with a good bronchial circulation |
|
|
Term
| When can pulmonary thromboemboli cause pulmonary infarction? |
|
Definition
| small to medium-sized embolus in a patient with poor bronchial circulation |
|
|
Term
| When can pulmonary thromboemboli cause sudden death? |
|
Definition
| either one large embolus or many small simultaneous emboli |
|
|
Term
| When can pulmonary thromboemboli cause pulmonary hypertension? |
|
Definition
| multiple organized emboli which increase pulmonary vascular resistance |
|
|
Term
| What is the most common consequence of pulmonary thromboemboli? |
|
Definition
|
|
Term
| What are the 4 most common sources of systemic thromboemboli? |
|
Definition
1) *cardiac mural thrombi (L atrium or ventricle)
2) aortic atherosclerosis w/ superimposed thrombosis (± aneurysm)
3) vegetations (L sided valves)
4) deep leg vein thrombosis => atrial or ventricular septal defect (paradoxical embolus) |
|
|
Term
| What is the consequence of systemic thromboemboli? |
|
Definition
|
|
Term
| What are the 6 special types of emboli? |
|
Definition
1) fat
2) air
3) amniotic fluid
4) cholesterol
5) tumor
6) bone marrow |
|
|
Term
| What are the 2 risk factors of a fat emboli? |
|
Definition
1) *long bone fractures
2) soft tissue injury |
|
|
Term
| What are the 2 consequences of fat emboli? |
|
Definition
1) *subclinical (vast majority)
2) fat embolism syndrome |
|
|
Term
| What causes fat embolism syndrome? |
|
Definition
| vascular obstruction & endothelial damage |
|
|
Term
|
Definition
resp. diffuculty
neurologic impairment
thrombocytopenia => petechiae
anemia |
|
|
Term
|
Definition
| frozen sections & special stains |
|
|
Term
| What are the 4 common causes of air emboli? |
|
Definition
1) sudden decrease in atmospheric pressure (decompression sickness)
2) chest trauma
3) obstetric complication
4) surgical procedures |
|
|
Term
| What causes decompression sickness? |
|
Definition
| greater quantity of nitrogen dissolved at high pressures, then with rapid depressurization, gas bubbles may form |
|
|
Term
def
bends (acute decompression sickness) |
|
Definition
| air emboli within skeletal muscle & around large joints |
|
|
Term
def
chokes (acute decompression sickness) |
|
Definition
|
|
Term
Sx
chronic decompression sickness (caisson disease) |
|
Definition
| persistent air emboli => long bone infarction |
|
|
Term
| How often is amniotic fluid emboli seen? |
|
Definition
| not common, but it does have a high mortality rate |
|
|
Term
| How does an amniotic fluid emboli occur? |
|
Definition
| amniotic fluid => uterine veins => lungs => diffuse alveolar damage & DIC |
|
|
Term
|
Definition
| squamous cells & keratin in the maternal pulmonary microvasculature |
|
|
Term
|
Definition
shock
resp. insufficiency
neurologic abnormalities |
|
|
Term
| Wherer does cholesterol emboli come from? |
|
Definition
| ulcerated atherosclerotic plaques |
|
|
Term
|
Definition
| focal region of ischemic (coagulative) necrosis |
|
|
Term
| What are the 4 causes of vascular obstruction => infarction? |
|
Definition
1) thrombosis
2) embolism
3) torsion of vessels (twisting)
4) extrinsic vascular compression |
|
|
Term
| What are the 2 major types of infarcts? |
|
Definition
|
|
Term
| What causes a pale infarct? |
|
Definition
| arterial occlusion within an end-artery system in a solid organ |
|
|
Term
| What does a pale infarct look like grossly? |
|
Definition
| soft, pale, often pyramidal-shaped region with hyperemic margin |
|
|
Term
| What does a pale infarct look like microscopically? |
|
Definition
| coagulative necrosis => acute inflammatory cell infiltrate => reparative process => scar |
|
|
Term
| What are the 3 causes of hemorrhagic infarct? |
|
Definition
1) venous obstruction
2) tissues with a dual blood supply or with numerous anastomoses
3) reperfusion of a pale infarct |
|
|
Term
| What does a hemorrhagic infarct look like grossly? |
|
Definition
| firm, red, often pyramidal-shaped region => rust-brown |
|
|
Term
| What does a hemorrhagic infarct look like microscopically? |
|
Definition
| coagulative necrosis with extensive hemorrhage => inflammation & repair, along with numerous hemosiderin-laden macrophages |
|
|
Term
| What are the 2 special types of infarcts? |
|
Definition
|
|
Term
| What is caused by cerebral infarct? |
|
Definition
|
|
Term
| What is caused by septic infacrt? |
|
Definition
|
|
Term
| What 4 things determine the likelihood of infarction? |
|
Definition
1) vascular supply
2) rate of development of the vascular occlusion
3) tissue susceptibility to hypoxia
4) adequacy of blood oxygenation |
|
|
Term
|
Definition
| systemic hypoperfusion => widespread tissue hypoxia |
|
|
Term
| What are the 5 types of shock? |
|
Definition
1) cardiogenic shock
2) hypovolemic shock
3) septic shock
4) neurogenic shock
5) anaphylactic shock |
|
|
Term
| What causes cardiogenic shock? |
|
Definition
| "forward" heart failure => decreased cardiac output |
|
|
Term
| What causes hypovolemic shock? |
|
Definition
| loss of blood or plasma volume |
|
|
Term
| What causes septic shock? |
|
Definition
| overwhelming microbial infection |
|
|
Term
| What are the 2 etiological factors of septic shock? |
|
Definition
1) microbial products
2) host immune response |
|
|
Term
| What of the host immune response contributes to the etiology of septic shock? |
|
Definition
1) inflammatory cells (esp. neutrophils & macrophages): produce cytokines & ROS
2) Complement activation: C3a/C5a (vasodilation, increased vascular permeability, chemotactic, opsonin) |
|
|
Term
| What are the 3 effects of septic shock that lead to multi-organ failure? |
|
Definition
1) widespread endothelial cell injury/activation
2) metabolic derangements
3) decreased myocardial contractility |
|
|
Term
| What widespread endothelial cell injury/activation is seen in septic shock? |
|
Definition
1) prothrombotic phenotype => DIC
2) peripheral vasodilation & increased vascular permeability => systemic hypotension & potentiation of procoagulant tendency
3) diffuse alveolar damage (ARDS-adult resp. distress syndrome) |
|
|
Term
| What metabolic derangements are seen in septic shock? |
|
Definition
1) Acute phase responses
2) increased gluconeogenesis, decreased insulin production & increased insulin resistance => hyperglycemia
3) abnormal glucocorticoid production (initial increase => eventual decrease) |
|
|
Term
| What causes neurogenic shock? |
|
Definition
| loss of vascular tone => peripheral pooling of blood |
|
|
Term
| What causes anaphylactic shock? |
|
Definition
| generalized type I hypersensitivity rxn => systemic vasodilation & increased vascular permeability |
|
|
Term
| What are the 3 stages of shock? |
|
Definition
1) nonprogressive
2) progressive
3) irreversible |
|
|
Term
| When are the stages of shock most prominently seen? |
|
Definition
| hypovolemic & cardiogenic shock |
|
|
Term
def
nonprogressive phase of shock |
|
Definition
| compensation by neuronal & hormonal mechanisms |
|
|
Term
| What occurs in the nonprogressive phase of shock to induce tacycardia & fluid retention? |
|
Definition
1) SS response/catecholamines => peripheral VC => cool clammy pale skin, tachycardia, tachypnea
2) renin-angiotensin-aldosterone system/ADH => fluid retention |
|
|
Term
def
progressive phase of shock |
|
Definition
| widespread tissue hypoperfusion/hypoxia |
|
|
Term
| What occurs in progressive phase of shock? |
|
Definition
1) anaerobic glycolysis => lactic acidosis => peripheral vasodilation => drop in cardiac output => hypotension
2) endothelial injury => DIC
3) renal hypoperfusion => oliguria & electrolyte abnormalities
4) cerebral hypoxia => confusion |
|
|
Term
def
irreversible phase of shock |
|
Definition
| system, irreversible cell injury |
|
|
Term
| What 4 organs undergo ischemic/hypoxic cell injury in shock? |
|
Definition
1) brain (red, dead neurons)
2) heart (contraction band necrosis)
3) kidneys (acute tubular necrosis)
4) intestine (=> bacteremia) |
|
|
Term
| What happens to the adrenal glands in shock? |
|
Definition
| stress rxn => decrease lipid in the cortex |
|
|
Term
| What alveolar damage is seen with septic shock? |
|
Definition
|
|
Term
| What manifestations of DIC (disseminated intravascular coagulation) are seen in shock? |
|
Definition
| microthrombi, petechiaw, hemorrhagic diathesis, etc. |
|
|
