Human Disease Ch 12

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1

thromus

intravacular blood clot

can occur within any vessel, including heart

2

virchow's triangle

slowing or stasis of blood flow

blood vessel wall damage

increased coagulability

3

embolus

a detached clot carried into pulmonary or systemic circulation

plugs vessel of smaller caliber than diameter of clot

blocks blood flow and causes necrosis

4

infarct

tissue necrosis from interruption in blood flow

5

common sites for thrombus formation

near biforcations

occurs in veins and arteries

6

venous thromosis

aka thrombophlebitis

causes- prolonged bed rest or cramped position for a long time ie long flights

leg swelling results from partial blockage of venous return

can cause pulmonary embolism if thrombus breaks off

7

pulmonary embolism

clinical manifestations depend on size of embolus and where it lodges in pulm artery

large PE may completely block main pulm artery or major branches obstructing blood flow to lungs

cyanosis and shortness of breath due to inadequate oxygenation of blood

8

large pulmonary embolism

pulm artery becomes over distended with blood

decreased return of blood to left heart

systemic blood pressure falls and patient may go into shock

9

small pulmonary embolism

small emboli may pass through main pulm artery becoming stuck in peripheral arteries supplying lower lobes of the lungs

raises pulm pressure and inadequate collateral circulation

affected lung segment undergoes necrosis ie pulmonary infarct

10

pulmonary embolism symptoms

dyspnea-shortness of breath

pleuritic chest pain

cough with blood

11

pulmonary embolism diagnosis

pulmonary angiogram

12

pulmonary embolism treatment

anticoagulants-heparin initially followed by coumadin

angioplasty ie balloon and break up

thrombectomy ie clot extraction surgery

general supportive care

13

arterial thrombosis

stasis not a factor due to rapid blood flow

main cause- injury to vessel wall from arteriosclerosis

this blocks blood flow-

coronary artery=myocardial infarct

major leg artery=gangrene

cerebral artery=stroke

14

arterial thrombosis intracardiac thrombosis

in the heart

thrombus forms

within atrial appendages=heart failure

surfaces of heart valves=valve injury

wall of left ventricle=myocardial infarct

may dislodge into systemic circulation

15

embolism

intravascular object that travels in blood stream

16

embolism sources

thrombi

atherosclerotic debris

marrow fat

air

amniotic fluid

17

air embolism

large amount of air sucked into circulation from lung injury due to a chest wound

may be accidentally injected into circulation (shots)

air carried into right heart chambers prevents filling of heart by returning venous blood

this makes the heart unable to pump blood and individual dies rapidly of circulatory failure

18

amnionic fluid embolism

fluid enters maternal circulation through a tear in fetal membrane

ie fetal cells, hair, fat, amniotic debris fluid block maternal pulm capillaries causing resperiatory distress

thromboplastic material in fluid activaes coagulation mechanism leading to disseminated intravascular coagulation syndrome

19

fat embolism

following severe bone fracture that disrupts fatty bone marrow surrounding adipose tissue

emulsified fat globules sucked into veins carried into lungs and obstruct pulm capillaires

if it reaches systemic circulation it eventually blocks small vessels in brain and other organs

20

fluid compartments of the body

intracellular-largest

extracllular

plasma-smallest

interstitial-fluid between cells=second largest

21

factors regulating fluid flow

hydrostatic pressure

capillary permeability

osmotic pressure

open lymphatic chanels

22

edema

accumulation of fluid in interstitial tissues

usually a result of an underlying condition/disease

range from mild to severe

can be fatal ie cerebral or pulmonary

23

two types of edema

exudate-high protein

transudate-pitting due to decreased osmotic pressure

24

pathogenesis of edema

increased capilary permeability

low plasma proteins

increased hydrostatic pressure

lymphatic obstruction

25

lymphedema

build up of fluid when lymphatics damaged or blocked

high protein edema

most common cause due to removal of lymph nodes

remove lymph nodes as cancer can metastasize through them

26

shock

inability of cardiovascular system to meet O2 needs of the body

27

shock can be a final stage of

severe hemorrhage

bacterial sepsis

heart attack

severe burns

anaphylaxis-type 1 hypersensitivity

28

end result of shock

often multi-organ failure and death due to lack of O2

29

types of shock

cardiogenic

hypovolemic

anaphylactic

septic

30

cardiogenic

pump failure

canno maintain perfusion pressure

heart attack is the main cause

31

hypovolemic

literally "less volume"

due to blood loss

32

anaphylactic

type 1 hypersensitivity

33

septic

systemic bacterial infection

gram negatives worse due to endotoxins

cause vasodialation, decrease myocardial contractibility, and endothelial cell damage may initiate DIC

34

stages of shock

nonprogressive

progressive

irreversible

35

irreversible shock

circulatory collapse (can't maintain BP)

marker phyoperfusion of vital organs

loss of vital functions

multiorgan failure

death

36

shock prognosis

depends on early recognition and rapid appropriate treatment ie

-drugs that promote vasoconstriction

-use of intravenous fluids or blood to restore blood volume secondary to fluid loss or hemorrhage

-treat underlying cause