pathophys ch. 13-15 test 2

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pathophys ch. 13-15 test 2
2010-01-29 14:38:09
blood 13 1415 pathophysiology pathophys oxygen test 2

Alterations in Oxygen Transport, Alterations in Hemostasis & Blood Coagulation, Alterations in Blood Flow
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  1. Shunt:
    unusual or abnormal circulatory pathway of blood
  2. Vasoconstriction—
    decrease in diameter of blood vessels
  3. Pallor—
    pale skin color, in this instance caused by decreased blood flow to skin
  4. Tachypnea—
    rapid respiratory rate
  5. Angina pectoris—
    chest pain due to heart muscle ischemia
  6. Murmur—
    abnormal heart sound caused by turbulent (abnormal) blood flow through heart
  7. Heart failure—
    inability of heart muscle to meet demand for delivery of blood
  8. Claudication—
    cramping of leg muscles caused by ischemia.
  9. Tinnitus—
    ringing in the ears
  10. Aplastic—
    incomplete, retarded, or defective development (think “Br. Davis’s brain”)
  11. Folate—
    vitamin B9; also known as folic acid
  12. Neural tube—
    the tubular “racing stripe” structure that forms along the back of the developing embryo that forms the nervous system.
  13. Hypochromic—
    low color, in this setting it means red blood cells with inadequate content of hemoglobin
  14. Glossitis—
    inflammation of the tongue
  15. Hemolysis—
    “lysis” (rupture) of red blood cells (RBCs)
  16. Sequestration—
    to gather together. Members of the Church gather for General Conference, actually…
  17. Vasooclusive—
    to occlude (block off) blood vessels
  18. Reticulocyte—
    the final cell stage in development of RBCs before the mature RBC is formed. 1% of circulating RBCs are reticulocytes under normal circumstances. If this percentage is increased (“reticulocytosis”), then hemolysis is the thing to suspect.
  19. Extramedullary erythropoiesis—
    production of RBCs (erythropoiesis) in places other than bone marrow (which lives in the medullary cavity of bone)
  20. Bilirubin—
    a waste product of hemoglobin break-down and recycling
  21. Hyperbilirubinemia—
    too high levels of blood bilirubin
  22. Viscosity—
    thickness of a liquid. Maple syrup is more viscous than water.
  23. Spurious—
    false, deceptive
  24. Hemarthrosis—
    abnormal accumulation of free blood in a joint space
  25. Factor—
    in the bloodstream usually means proteins, small hormones, etc.
  26. Hypersplenism—
    an over-active spleen (which pulls platelets and old RBCs out of circulation, so can lead to anemia & thrombocytopenia)
  27. Endothelium—
    the innermost lining of blood vessels
  28. Muscle compartments—
    groups of synergistic muscles surrounded by a layer of dense connective tissue
  29. compartment syndrome—
    an increase in pressure inside a muscle compartment high enough to prevent blood from entering the compartment, causing ischemia/necrosis/etc.
  30. Structure of large arteries:
    • i. Tunica intima—the innermost lining
    • ii. Tunica media—the thickest, muscular central layer which forms the bulk of the artery wall
    • iii. Tunica adventitia—the outermost layer in which the nerves & blood vessels that supply the artery itself run
  31. Lipoproteins—
    blood proteins that transport lipids to and from tissues
  32. Hyperemia—
    increased blood flow
  33. Paresthesia—
    symptom of abnormal sensation: numbness, “pins & needles”, etc.
  34. Venous stasis—
    blockage of the flow of venous blood
  35. General effects of anemia:
    1. reduced oxygen-carrying capacity

    2. tissue hypoxia

    • 3. compensatory mechanisms to restore tissue oxygenation
    • a. increased heart rate, cardiac output, circulatory rate, and shunting of blood flow to vital organs.
    • b. Increased erythropoietic activity
  36. aplastic anemia—
    decreased functional bone marrow, resulting in pancytopenia—reduction in all blood cells
  37. B12 deficiency is known as:
    pernicious anemia, and is associated with lack of intrinsic factor secretion by parietal cells in the stomach (often autoimmune)—without which B12 cannot be absorbed.
  38. Intrinsic factor:
    a glycoprotein produced by the parietal cells of the stomach. It is necessary for the absorption of vitamin B12
  39. iron deficiency anemia:
    the most common cause of anemia; may be due to low intake, diminished absorption, physiological increase in iron requirements (especially in pregnancy), iron loss (hemorrhage), chronic renal disease, etc.
  40. pica:
    craving for nonfood substances such as dirt, clay, ice, laundry starch, cardboard, or hair. typical to iron deficiency anemia.
  41. How much bleeding per day can cause Fe deficiency anemia?
    2-4 ml of bleeding/day can cause Fe deficiency anemia.)
  42. Thalassemia—
    abnormal red cell produced that are subject to increased hemolysis.
  43. α-Thalassemia is found primarily in people of
    Asian descent
  44. β-thalassemia is found primarily among people of
    Mediterranean descent.
  45. Sickle cell disease—homozygous individuals:
    produce ONLY hemoglobin S
  46. Sickle cell trait—
    heterozygous individuals: both normal & S chains are formed, with hemoglobin A usually exceeding amount of S.
  47. Sickle cell Sequestration crisis—
    large amounts of blood pool in liver +/or spleen. Only occurs in small children, and mortality rate is 50% or so.
  48. Sickle cell Aplastic crisis—
    sickled cells only circulate for 10-20 days (rather than 90-120 day for normal erythrocytes). This requires an increase in erythropoeisis (5-8 times normal). If the bone marrow can’t keep up, trouble occurs—acts much like aplastic anemia.
  49. Ultimate treatment for sickle cell is:
    stem cell transplantation
  50. Glucose-6-phosphate Dehydrogenase (G6PD) deficiency—
    • patients do not have anemia unless challenged by drugs or chemicals—classically by the anti-malaria drug primaquine.
    • 1. Present in 11% of African-American males and in Sephardic Jews.
    • 2. X-linked recessive
    • 3. Treatment—avoid inciting agents
  51. Polycythemia:
    excess of red cells, which can cause increased viscosity of blood
  52. Ecchymosis—blood escaped into tissues:
    • a bruise.
    • 1. If raised, called a hematoma.
    • 2. Hemarthrosis—bleeding into a joint.
  53. Hemophilia—
    the most common severe inherited coagulation disorders;

    1. X-linked recessive;

    2. abnormality in intrinsic pathway & subsequent fibrin clot;

    3. hallmark of the disease is Hemarthrosis—knees, elbows, ankles most common, leads to joint deformity.
  54. Treatment of Hemophilia:
    avoidance of anti-platelet agents, transfusion of missing coagulation factors (thankfully with recombinant DNA technology the AIDS risk is gone)
  55. Hemophilia A—
    • most common, due to factor VIII deficiency
    • 1. 85% of cases
  56. Hemophilia B—
    factor IX deficiency; also known as Christmas disease;
  57. Vitamin K deficiency in infants stats—
    i. vitamin K necessary for production of factors II, VII, IX, and X.

    • ii. Cord blood levels of these factors usually 50% of normal adult levels; occasionally will drop enough to cause bleeding.
    • iii. Treatment with vitamin K and/or fresh frozen plasma (FFP).
  58. Disseminated intravascular coagulation (DIC)—
    acquired syndrome in which both clotting & bleeding occur simultaneously.
  59. DIC Treatment—
    remove underlying cause; antifibrinolytics, heparin? (an anticoagulant—to stop further thrombus formation)
  60. Innermost arterial layer is made of:
    simple squamous epithelium, in vessels known as endothelium or the tunica intima.
  61. The middle arterial layer is made of:
    smooth muscle and elastic tissue: the tunica media.
  62. The outermost arterial layer is made of:
    connective tissue, nerves & blood vessels, the tunica adventitia.
  63. Lipid metabolism—:
    a. Lipids taken into the gut as food are digested by lipases

    b. Next, the lipid droplets are surrounded by bile salts to form michelles.

    • c. Next step: the michelles are
    • absorbed across the gut wall, are combined with proteins (to make the lipids soluble in water) to form chylomicrons.

    d. then they enter the lymphatic lacteals.

    e. Triglycerides get deposited into adipose.

    f. The rest of the lipids need to be transported in blood combined with proteins so they are soluble in water.
  64. lipoproteins:
    Lipids combined with proteins. (of which chylomicrons are one type).
  65. other important lipoproteins include:
    i. Very low-density lipoprotein (VLDL)—contains most of the lipids leaving the liver going out to body tissues

    ii. Low-density lipoprotein (LDL)—is VLDL minus the triglycerides deposited in adipose. So, LDLs are very high in cholesterol.

    iii. High-density lipoprotein (HDL)—contain excess lipids the cells don’t need, which are transported back to liver.