Term
|
Definition
| Most abundant protein in the body, the material used for tissue repair |
|
|
Term
| What is procollagen secreted by? |
|
Definition
|
|
Term
| What is the primary phagocyte involved in debridement? |
|
Definition
|
|
Term
| What does a macrophage secrete? |
|
Definition
Fibroblast-activating factor
Angiogenesis factor
Epithelial stimulating factor |
|
|
Term
| Hypovolemia (Type of disfunctional wound healing) |
|
Definition
Vasoconstriction prevents delivery of inflammatory cells to site of injury
Reduced oxygen delivery |
|
|
Term
| Scurvy results from what? |
|
Definition
| Body does not produce enough Vitamin C |
|
|
Term
| Formation of keloids results from what? |
|
Definition
| Imbalance between collagen synthesis and collagen lysis (Synthesis is increased and lysis is decreased, so scar tissue extends beyond borders of the original wound) |
|
|
Term
| Body fluids are distributed where? |
|
Definition
| Between intracellular and extracellular compartments |
|
|
Term
|
Definition
| Force exerted upon the vessel walls by the contained fluid |
|
|
Term
|
Definition
| Created by the difference in protein concentration within the tissue and blood. |
|
|
Term
|
Definition
| Determines the movement of fluid into the tissue or into the blood. |
|
|
Term
|
Definition
| Palpable (touchable) swelling produced by an increase in interstitial fluid |
|
|
Term
| What are the causes of edema? |
|
Definition
Increased hydrostatic pressure
Decreased plasma colloid osmotic pressure
Sodium and water retention
Lymphatic obstruction
Increased vascular permeability |
|
|
Term
| Increased hydrostatic pressure |
|
Definition
| Poor venous circulation and resultant fluid accumulation |
|
|
Term
| What are the two forms of increased hydrostatic pressure? |
|
Definition
|
|
Term
| Localized hydrostatic pressure |
|
Definition
Results in impaired venous flow
Emboli
External pressure
Lower extremity inactivity |
|
|
Term
| Systemic hydrostatic pressure |
|
Definition
Results in congestive heart failure
congestive pericarditis
Ascites |
|
|
Term
| Decreased plasma colloid osmotic pressure |
|
Definition
| Protein concentration in blood is lower than the pressure in the interstitial tissue |
|
|
Term
| Most influential protein in decreased plasma colloid osmotic pressure |
|
Definition
|
|
Term
| What are the two forms of decreased plasma colloid osmotic pressure? |
|
Definition
Decreased synthesis
Increased excretion/loss |
|
|
Term
| What are the consequences of reduced plasma osmotic pressure? |
|
Definition
Fluid leaves the plasma and causes a reduced intravascular volume
Renal hyperfusion occurs |
|
|
Term
| How does the body react to reduced intravascular volume? |
|
Definition
| It reduces blood pressure( Renin causes angiotensin to convert to angiotensin I and then angiotensin I is converted to angiotensin II by angiotensin converting enzyme (ACE) (Found in the lungs)) |
|
|
Term
| Sodium and water retention |
|
Definition
Primary or secondary
Excessive salt intake with renal insufficiency
Increased tubular reabsorption of salt |
|
|
Term
| Sodium and water retention causes both what? |
|
Definition
| Increased hydrostatic pressure and diminished vascular colloid osmotic pressure |
|
|
Term
|
Definition
Lymphatic system provides a route for fluid from interstitial spaces to return to circulation
Impairs lymphatic drainage |
|
|
Term
| What are the causes of lymphatic obstruction? |
|
Definition
Inflammatory
Neoplastic
Postsurgical
Post irradiation
Infection with parasites (filariasis) |
|
|
Term
| Increased vascular permeability |
|
Definition
| Occurs due to inflammation |
|
|
Term
|
Definition
| Pressure applied to swollen area by depressing skin with thumb-indentation remains |
|
|
Term
| What is the cause of pitting edema? |
|
Definition
| Caused by displacement of fluid |
|
|
Term
| What conditions is pitting edema observed in? |
|
Definition
| Chronic heart failure and renal disease |
|
|
Term
|
Definition
| Pressure that is applied to the skin does not result in a persistent indentation |
|
|
Term
| What conditions in non-pitting edema observed in? |
|
Definition
Certain disorders of the lymphatic system
Thyroid disorders |
|
|
Term
|
Definition
Due to position
Lower extremity edema more pronounced when in the standing position
In recumbent position fluid may move up tot he sacral area |
|
|
Term
| Pressure vascular congestion |
|
Definition
Impairment in drainage of blood from the are
Anything that compresses the venules and veins that drain a tissue |
|
|
Term
| What are the causes of passive vascular congestion? |
|
Definition
Local- Isolated venous obstruction (tumor)
Systemic- Cardiac failure |
|
|
Term
| What color is the tissue observed in passive vascular congestion? |
|
Definition
|
|
Term
| What are some complications of passive vascular congestion? |
|
Definition
Development of localized or systemic cyanosis
Edema
Dilation of veins in the affected area
Varicies
Permanent tissue changes
Tissue hypoxia
Fibrosis
Rupture of varices |
|
|
Term
| Active vascular congestion |
|
Definition
| When blood flow to an area is increased and produces congestion |
|
|
Term
| What is active vascular congestion caused by? |
|
Definition
Dilation of arterioles
Ex: Acute inflammation
Delivery of blood due to increased demand |
|
|
Term
|
Definition
| Escape of blood from the cardiovascular system and accumulation in tissues or spaces of body and/or actual escaper from the body |
|
|
Term
| What is hemorrhage associated with? |
|
Definition
Chronic congestion
Hemorrhage diathesis
Vascular injury |
|
|
Term
| What are the categories of hemorrhages? |
|
Definition
Bleeding into the environment
Bleeding into tissue
Bleeding into body cavity
Hemopericardium |
|
|
Term
|
Definition
Petechiae
Pinpoint, 1-2mm hemorrhages into skin, mucous membranes and serosal surfaces |
|
|
Term
| What are hemorrhages into tissue associated with? |
|
Definition
Increased intravascular pressure
Low platelet count
Defective platelet function
Clotting factor deficiencies |
|
|
Term
|
Definition
| Appearance of red or purple dots on skin >3 mm caused by bnleeding underneath the skin secondary to vasculitis or dietary deficiency of vitamin C |
|
|
Term
| What is purpura associated with? |
|
Definition
Trauma
Vasculitis
Increased vascular fragility |
|
|
Term
|
Definition
| Bruise on the skin caused by the escape of blood into the tissues from ruptured blood vessels. >1cm |
|
|
Term
| What is an ecchymosis caused by? |
|
Definition
|
|
Term
| What do the consequences of bleeding depend on? |
|
Definition
Rate and volume of blood loss
Site of the bleeding
Loss of iron |
|
|
Term
|
Definition
|
|
Term
| Hemostasis serves what main functions? |
|
Definition
Maintains blood in the fluid state
Stops blood flow |
|
|
Term
|
Definition
Pathologic
Inappropriate activation of normal hemostatic process in uninjured vasculature
Thrombotic occlusion of blood vessel after minor injury |
|
|
Term
| Sequence of events in normal hemostasis |
|
Definition
Vascular injury
Vasoconstriction
Primary hemostasis
Secondary hemostasis
Tertiary hemostasis |
|
|
Term
| What are the influences of clot formation? |
|
Definition
Endothelial injury
Stasis or turbulence of blood flow
Blood hypercoagulability |
|
|
Term
|
Definition
Direct cause of endothelial injury
Formation of counter-current
Formation of local pockets of stasis |
|
|
Term
|
Definition
Long periods of immobility
Heart failure
Atrial fibrillation |
|
|
Term
| What are the effects of turbulence or stasis? |
|
Definition
Disruption of laminar flow
Prevent dilution of activated coagulation factors
Slow influx of clotting factor inhibitors
Continued endothelial cell activation |
|
|
Term
| What are some clinical settings that lead to turbulence or stasis? |
|
Definition
Ulcerated atherosclerotic plaque
Aneurysm
Myocardial infarction?
Mitral valve stenosis
Hyper viscosity syndromes
Sickle cell anemia |
|
|
Term
|
Definition
Abnormally heightened coagulation response to vascular injury
Can be primary or secondary |
|
|
Term
| What factor does hypercoagulability involve? |
|
Definition
Factor V Leiden
Involves mutation of factor V, it cannot be activated |
|
|
Term
| What does thrombin activate? |
|
Definition
|
|
Term
| What does thrombomodulin activate? |
|
Definition
|
|
Term
| What does activated protein C bind with? |
|
Definition
|
|
Term
| What does protein C-S complex inactivate? |
|
Definition
|
|
Term
| What does protein C-S complex inactivate that requires normal factor V? |
|
Definition
| Inactivates Va at the arginine residue at position 506 |
|
|
Term
| Secondary hypercoagulability, also known as acquires hypercoagulability causes what? |
|
Definition
| Heparin-induced thrombocytopenia |
|
|
Term
| What does a thrombus consist of? |
|
Definition
| Platelets, fibrin, RBC and WBC's |
|
|
Term
| What are the outcomes of thrombus? |
|
Definition
Dissolution
Organization and recanalization
Propagation
Embolization( portion of clot breaks off and travels down the vasculature |
|
|
Term
|
Definition
| Detached intravascular mass that is carried by blood to a site distant from the point of origin with lodgment in a new location. (Examples are dislodged thrombus, fat and air) |
|
|
Term
|
Definition
|
|
Term
| Pulmonary thromboembolism |
|
Definition
| Blockage of the main artery in the lungs caused by a mass that broke off from a leg vein. Major portion of pulmonary arterial supply occluded |
|
|
Term
| What are the effects of a pulmonary thromboembolism? |
|
Definition
Clinically asymptomatic
Sudden death (due to right heart failure) |
|
|
Term
| What are some causes of a pulmonary embolism? |
|
Definition
Age
Burns
Heart failure
Atrial fibrillation
Long-term immobility
Obesity
Pregnancy
Recent surgery |
|
|
Term
| What does a pulmonary embolism do? |
|
Definition
| Decreases synthesis of antithrombin, increases synthesis of anticoagulation factors in the circulation |
|
|
Term
|
Definition
| Blockage of the arterial circulation by a substance, originates from indacardiac mural thrombosis, aortic aneurysm, atherosclerotic plaques and fragmentation of the valvular vegetation |
|
|
Term
| Where is a systemic thromboembolism usually found? |
|
Definition
| In the lower-extremities and in the brain |
|
|
Term
| What are the effects of a systemic thromboembolism? |
|
Definition
|
|
Term
|
Definition
| Area of ischemic necrosis caused by occlusion of either arterial supply or venous drainage in the tissue |
|
|
Term
| What are the stages in acute myocardial infarction? |
|
Definition
Ischemia
Injury
Infarction
Death of myocardial cells
Scar tissue replaces dead tissue |
|
|
Term
| What are some factors that influence the development of an infarction? |
|
Definition
Nature of the vascular supply
Rate of development of occlusion
Vulnerability of tissue to hypoxia
Oxygen content of blood |
|
|
Term
|
Definition
| The arterial walls supplying areas of the extremities, brain, heart and major internal viscera thicken as a result of the accumulation of calcium and fatty materials such as cholesterol and triglycerides |
|
|
Term
|
Definition
Elevated mass of fatty material
Fibrous connective tissue
Secondary deposits of calcium salts and blood products |
|
|
Term
|
Definition
Genetics
Elevated serum cholesterol levels
Diabetes
HTN
Cigarette smoking |
|
|
Term
| What are some consequences of atheroma? |
|
Definition
Complete occlusion of an artery
Thrombosis
Aneurysm |
|
|
Term
|
Definition
| Complication of a primary disease that involves cardiovascular collapse. |
|
|
Term
| What is the definition of shock? |
|
Definition
| Systemic hypoperfusion; acute failure of the circulatory system to supply adequate blood to tissues and organs |
|
|
Term
|
Definition
Reduction in cardiac output
Reduction in effective circulating blood volumes
Cellular injury caused by inadequate delivery of nutrients and oxygen |
|
|
Term
|
Definition
|
|
Term
| What is the cellular response to shock? |
|
Definition
Na+/K+ ATPase pump function impaired
Rupture of lysosomal membranes
Cell death, release of cellular contents into extracellular space |
|
|
Term
| What are the three categories of shock? |
|
Definition
Cardiogenic
Hypovolemic
Distributive |
|
|
Term
|
Definition
| Low cardiac output due to pump failure. Involves hypotension, hypoperfusion and tissue hypoxia |
|
|
Term
| What are the causes of cardiogenic shock? |
|
Definition
Myocardial infarction
Ventricular ayyhythmias
Cardiac tamponade
Pulmonary embolism |
|
|
Term
| What are the compensatory mechanisms the body activates during cardiogenic shock? |
|
Definition
Activaion of the sympathetic nervouse system
The body promotes Na+ and H2O retention |
|
|
Term
| What are some manifestations of cardiogenic shock? |
|
Definition
Signs and symptoms are those of extreme heart failure
Cyanosis
Decreased BP due to poor SV
Decreased urine output
Neurologic changes |
|
|
Term
|
Definition
| Low cardiac output due to inadequate blood or plasma volume. |
|
|
Term
| When does hypovolemic shock occur? |
|
Definition
| It occurs when there is an cute loss of 15-20% of circulating blood volume |
|
|
Term
| What are some clinical examples of hypovolemic shock? |
|
Definition
Hemorrhage
Fluid loss
Vomiting, diarrhea
Burns
Ascites
Hemothorax |
|
|
Term
|
Definition
| Accumulation of fluid in the peritoneal cavity |
|
|
Term
| What are the compensatory mechanisms the body activates during hypovolemic shock? |
|
Definition
Sympathetic nervous system activation. Increased CO and BP, mobile blood stored in large veins of the abdomen
Reabsorption of fluid from interstitial spaces
Na+ and H2O retention
ADH release |
|
|
Term
| What are some laboratory tests that would be used to measure hypovolemic shock? |
|
Definition
Hgb and Hct
Serum lactate and arterial pH |
|
|
Term
| What is the treatment of hypovolemic shock? |
|
Definition
Restore vascular volume
Correct cause of blood loss
Oxygen administration
IV administration of fluids and blood
Plasma volume expands such as albumin |
|
|
Term
| What is another name for distributive shock? |
|
Definition
|
|
Term
|
Definition
| Vasodilation causes a state of hypovolemia |
|
|
Term
| What are the three types of distributive shock? |
|
Definition
Neurogenic
Septic
Anaphylactic |
|
|
Term
|
Definition
| Decrease in sympathetic control of blood vessel tone due to defect in vasomotor center in brainstem or sympathetic outflow to blood vessels? |
|
|
Term
| What are some causes of neurogenic shock? |
|
Definition
Spinal anesthesia
Spinal cord injury
Vasomotor center depression |
|
|
Term
| Septic shock (Most common type of distributive shock) |
|
Definition
Systemic response to a severe infection
Involves vasodilation and increased capillary permeability
Lipopolysaccharides on the surface of microorganisms stimulate endothelial production of TF |
|
|
Term
|
Definition
| Systemic inflammatory response due to bacterial endotoxins |
|
|
Term
| What are some clinical examples of septic shock? |
|
Definition
Gram-negative bacteria (MC)
Presence of endotoxins in the blood
Gram-positive septicemia
Lipoteichoic acids
Fungal sepsis |
|
|
Term
| What is the treatment of septic shock? |
|
Definition
Control of causative microorganism
Circulatory support
Administration of fluids
Norepinephrine
Recombinant human activated Protein C |
|
|
Term
|
Definition
Most severe systemic allergic reaction
Involves vasodilator substances such as histamine released into blood arterioles and venules |
|
|
Term
| Analphylactic shock involves what? |
|
Definition
Increased capillary permeability
Laryngeal edema and bronchospasm
Contraction of the GI anduterine
Urticaria |
|
|
Term
| What are some signs and symptoms of anaphylactic shock? |
|
Definition
Abdominal cramps
Apprehension
Burning sensation of skin
Itchine
Uticaria
Coughing
Choking
Wheezing
Chest tightness
Difficulty breathing |
|
|
Term
| What are the most common causes of anaphylactic shock? |
|
Definition
Medication reactions
Allergic reactions to food
Allergic reactions to insect venoms |
|
|
Term
| What are some treatments of anaphylactic shock which develops suddenly and causes death within minutes? |
|
Definition
Administration of epinephrine
Administration of oxygen. antihistamines, corticosteroids |
|
|
Term
| What are the stages of shock? |
|
Definition
Nonprogressive phase (compensatory stage)
Baroreceptor Reflexes
Sympathetic stimulation
Release of catecholamine
Renin-angiotensin-aldosterone
ADH
Perfusion of vital organs maintained
Tachycardia
Peripheral vasoconstriction |
|
|
Term
| What are two catecholamines used to treat shock? |
|
Definition
| Epinephrine and norepinephrine |
|
|
Term
| How are catecholamines released in the body? |
|
Definition
| Stimulation of sympathetic nervous system |
|
|
Term
| What do catecholamines do? |
|
Definition
| Impact heart beta receptors to increase heart rate and increase the force of contractions |
|
|
Term
| What are the effects of angiotensin II? |
|
Definition
Stabilization of BP and ECF volume
Vasoconstrictor of smooth muscle (arterioles)
Stimulates reabsorption of Na+ and H2O |
|
|
Term
| What are the effects of antidiuretic hormone, ADH? |
|
Definition
Insertion of aquaporins into the collecting duct
Water is conserved |
|
|
Term
| What are additional effects of angiotensin II? |
|
Definition
Decreased peritubular hydrostatic pressure
Efferent arterioles constrict
Allows more fluid back into peritubular capillaries
Reduces glomerular filtration rate |
|
|
Term
| What does the reduction of glomerular filtration rate do? |
|
Definition
| Causes constriction of glomerular mesangial cells, reducing the total surface volume area available for cells |
|
|
Term
| What are signs and symptoms of the compensatory stage of shock? |
|
Definition
Tachycardia, bouncing pulse
Restlessness and irritability
Tachypnea
Reduced urine output
Cool, pale skin or warm, dry skin |
|
|
Term
| When does the progressive stage of shock occur? |
|
Definition
| When the compensatory stage fails to maintain cardiac output |
|
|
Term
| Tissue hypoperfusion/hypoxia in the progressive stage of shock leads to what? |
|
Definition
Circulatory and metabolic imbalances
Acidosis
Systemic tissue hypoxia |
|
|
Term
| The progressive stage of shock promotes the release of endothelial mediators which do what? |
|
Definition
Vasodilation, leading to venous pooling
Increased capillary permeability
Sluggish blood flow, risk of DIC |
|
|
Term
| What are some signs and symptoms of the progressive stage of shock? |
|
Definition
Hypotension
Reduced SV
Weak, rapid, thread pulse
Shallow respirations
Reduced urine output
Cold, clammy skin
Cyanosis |
|
|
Term
|
Definition
Cell injury is widespread
Multiple system organ failire |
|
|
Term
| What are some signs and symptoms of the irreversible stage of shock? |
|
Definition
Unconsciousness and loss of reflexes
Rapidly falling BP
Weak pulse
Slow, shallow respirations |
|
|
Term
| What is the initial threat? |
|
Definition
|
|
Term
| What is the subsequent threat? |
|
Definition
|
|
Term
| What are some complications of shock? |
|
Definition
Pulmonary injury
Acute renal failure
Gastrointestinal ulceration
DIC
Multiple organ dysfunction syndrome (MODS) |
|
|
Term
| Disseminated Intravascular Coagulation (DIC) |
|
Definition
Complication of shock
Widespread activation of the coagulation system
Suppression of anticoagulation mechanisms |
|
|
Term
| What is a dominant influence of thrombus formation in heart and arterial circulation? |
|
Definition
|
|
Term
| What is the flow in the arterial circulation like? |
|
Definition
| High-pressure and velocity |
|
|
Term
| Arterioles have what type of walls? |
|
Definition
| Thick walls and are not easily injured |
|
|
Term
| Thrombus formation in heart and arterial circulation is due to what? |
|
Definition
| Disease in the lining and wall of the artery |
|
|
Term
| Disease in the lining and wall of the artery predisposes vascular lumen to thrombus formation by which three mechanisms? |
|
Definition
Exposure of platelets to subendothelial collagen
Release of TF
Anti-thrombotics which are depleted at the site of the injury |
|
|
Term
|
Definition
| Low pressure and velocity of blood flow. Thrombosis occurs via diminished flow of blood (stasis) |
|
|
Term
| Veins have what type of walls? |
|
Definition
|
|
