KINE 427: EXAM 2
57 Cards in this Set
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Jv
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filtration/absorption flow
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Fc / v
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filtration constant (inc. by histamine)
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S
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surface area (in skeletal muscle, S inc. 7x in exercise)
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Pc / v
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capillary / venule hydrostatic (pushing) pressure (mmHg)
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Pi
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interstitial hydrostatic (pushing) pressure (mmHg)
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PL
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lymphatic hydrostatic pressure (mmHg)
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Pie c / v
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capillary / venule oncotic (sucking) pressure (mmHg)
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Pie i
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interstitial oncotic (sucking) pressure (mmHg)
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Jv lymph
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lymphatic flow rate (ml / min / 100 grams of tissue)
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C3a
C4a
C5a
subtypes
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inc vascular permeability
activate mast cells
histamine and heparin release
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C3b
C4b
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Opsonization (mark foreign particles for phagocytosis)
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C5a
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functions in chemotaxis
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C5b
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production of membrane attack complexes using C6-C9
membranes of antigen cells compromised = lysis (rupture of cell wall or membrane)
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Mediators of inflammation
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Compliment system
Histamine
Serotonin
Bradykinin
Eicosanoids
Free radicals
Cytokines
Nitric Oxide
Platelets
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Histamine
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-Primary mediator in early inflammation
-Synthesized in liver (in plasma when inactive)
-in mast cells(just below epithelial and around blood vessels), platelets, and basophils
-causes pain, vasodilation, bronchile constriction, secretion of gastric HCL, inc. capillary permeability, ed…
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Serotonin
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-neurotransmitter
-known as 5-HT
-appetite, anger, aggression, mood, sleep, sexuality, ansxiety, and depression
-secreted by mast cells, GI mucosa, and PAF stimulated platelets
-excites pain recptors, inc. vasoconstriction, inc vascular platelet aggregation
-arachodonic acid product…
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Bradykinin
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-polypeptide in bld (inc vascular permeability)
-most powerful stimulator of pain receptors (most potent nociceptor agent) ex. bee venom
-Hageman factor (clotting factor XII), inc kallikrein, inc kininogen, inc bradykinin
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eicosanoids
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-products of arachadonic acid cascade
-prostaglandins
-prostacyclin
-leukotrienes
-thromboxanes
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prostaglandins
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-arachidonic acid metabolite
-released by damaged cells and macrophages
-dilation of bld vessels, leakage of fluid into surrounding tissue
-excites and enhances sensitivity of pain receptors
-slow suffering pain with tissue injury
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prostacyclin
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-arachidonic acid metabolite
-relaxes bld vessels and bronchial tubes
-prevents platelet aggregation
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leukotrienes
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-arachidonic acid metabolite; released by neutrophils
-causes chemotaxis (summoning) of neutrophils
-inc. vascular permeability
-potent bronchoconstrictor and vasodilator (anaphylaxis)
-Asthma: inc bronchoconstrict., inc. mucous, inc. airway inflammation
-rheumatoid, psoriasis, infl…
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thromboxane
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-vasoconstriction
-inc platelet aggreagation
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Free radicals
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-oxidizing agent
-removes electrons from substances (hydrogen peroxide, hydroxyl radical, superoxide anion)
-produced in metabolism
-produced by phagocytic cell (especially neutrophils) to kill antigens
-released in excess by macrophages in chronic inflammation
-normal by antioxidan…
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Antioxidants
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endogenous
-gluthione peroxidase
-superoxide dismutase
-alphalipoic acid
-CoQ10
nutrient
-Vitamins C and D
-selenium
-bioflavinoids
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Cytokines
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polypeptide produced by macrophages
-Tumor necrosis factor
-interlukins
-platelet derived growth factor
-interferons
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TNF
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released by macrophages
-pyrogen
-activates macrophages
-causes vascular endothelial cell retraction (inc vascular permeability = exudate)
- contributes to rheumation and others
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Interlukins
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stimulates and enhances immune function
-inc monocyte activation/production and chemotaxis of neutrophils and lymphocytes
-causes vascular endothelial cell retraction (inc permeability) and is a pyrogen
-autoimmune diseases
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platelet derived growth factor
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inc fibroblasts in area
inc angiogenesis
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inteferons
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virus fighters
fight certain cancers
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Nitric Oxide (NO)
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EDFR
locally synthesized in endothelium and macrophages
-inc vascular dilation and permeability
-killing harmful bacteria
-product in coronary arteries as result of nitroglycerin
-E2 loss in menopause dec. amounts of endogenous NO = risk for CAD
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Platelets
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activated release...
-lysozomes: contain digestive enzymes
-ADP, ATP, Serotonin, histamine
-Fibrinogen, thrombin, and clotting factor V
-Von willebrand factor (platelets bind to collagen)
-PAF and phospholipase A2 = thromboxane A2
-activate other platelets
-cytokines and chemokine…
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Platelet activation
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contact with
-collagen
-thrombin
-thromboxane A2
-ADP
-and each other
-adhere together by INTEGRINS
-adhere to endothelial cells in vessel walls
-form arms called pseudopods
-& fibrin form PLATELET PLUG and repair in damaged vessel wall
-contain myosin and actin to contract t…
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Acute inflammation resolved
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1. healing process takes place and tissue regenerates (rare) or scar forms (likely)
2. inflammation progresses and suppurative (pus) forming process starts
3. inflammation becomes chronic (subsides and returns)
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Suppuartive process
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-toxins secreted from bacteria, neutrophils and macrophages + tissue ischemia
-excessive tissue destruction and necrosis
-when bacteria and immune cells die near dead tissue, pus forms (abscess: prevent antigens from spreading via fibrin, fibrnogen, and thrombin pocket)
-abscess may d…
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Chronic inflammation
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Initiated by:
-excessive microtrauma to muscle or connective tissue
-asbestos and other non-living foreign material that cannot be dissolved by body
-bacteria and viruses that avoid and resist host defense (TB, mycobacteria, fungi)
-altered tissues or tissue displacement in or around…
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Bleeding outside the body
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- 10-15% bld loss can be tolerated (bld donation=8-10%)
-Positive feedback: desanguination = hypovulemic shock
- blding = dec BP = activate barorecpetors = inc HR =inc bleeding
-hematoma (bld confined to limited tissue)
- bld under skin: subcutaneous hemmorage
- limit bld loss from i…
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Bleeding inside the body
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Cause
-GI lesions: colon, rectal, or stomach cancer
-tissue malformation or dissection: aortic aneurysms, arteriovenous malformations
-ulcers
-Trauma
-head trauma
-extra-axial (outside brain; epidural, subdural, subarachnoid) vs. intra-axial (inside brain; c. hemorrhage or stroke)
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ulcers
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cause
-helicobacter pylori bacteria
-genetic predisposition
-overuse of NSAIDs
-stress
*smoking delays healing
Symptoms
-upper abdominal pain (relieved by eating, milk, antiacids)
-nause/vomiting of bld
-pain worse 2 hours after meal or when stomach is empty (middle of night)
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Cessation of blood flow
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1. Vascular spasm
2. Formation of platelet plug
3. Coagulation
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1. vascular spasm
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Vessel rupture = vessel constriction due to...
-reflexes
-myogenic response: stretch = inc Ca in smooth muscle =vasoconstriction
-platelets release thromboxane A2 (vasoconstrict. and platelet aggregator)
-2 endothelial surfaces causes them to stick together
more cross-sectional area…
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2. Formation of platelet plug
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-seal small breaks in small vessels that occur hundreds of time/day
-exposed collagen has (-) charge : (+) platelets attracted
-Von willebrand factor helps bind platelets to collagen = platelet adhesion
-adhered platelets become activated = swell and form irradiating processes
-platel…
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3. Coagulation
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initiated by
-trauma to vascular wall and adjacent tissue (extrinsic)
-traumitized tissue releases thromboplastin = coagulation initiated
-exposed collagen (endothelium damage) - (intrinsic)
- activation of Hageman factor = coagulation initiated
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Extrinsic pathway
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begins with substances extrinsic to the blood (completed in 15 seconds)
-damaged tissue releases tissue thromboplastin (tissue factor)
-thromboplastin activates Factor X
-Factor X + platelet phospholipids form prothrombinase
-Prothrombinase activates prothrombin to form thrombin
-thr…
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Intrinsic pathway
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injury (collagen exposure) within vessel (completed in 3-6 minutes)
-hageman factor comes in contact with collagen and activates Factor X
-factor X + platelet phospholipids form prothrombinase
-Prothrombinase activates prothrombin to form thrombin
-thrombin causes fibrinogen to form l…
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clotting factors and fibrinogen
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formed by liver
hepatitis, cirrhosis, etc = inc bleeding and bruising
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Vitamin K
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necessary for formation of 5 of the clotting factors
deficiency = inc blding and bruising
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Clot contraction
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within 20-60 mins, clots undergo syneresis (pulling wound together)
-actomyosin protein complex contracts like skeletal muscle
-pull created on fibrin strands = edges of injury drawn together
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Clot lysis
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after healing, clot is lysed
-injured tissue releases PLASMINOGEN and TISSUE PLASMINOGEN ACTIVATOR (TPA)
-those are in the clot and activated after days
-TPA converts plasminogen to plasmin (proteolytic enzyme that dissolves clot)
-TPA (& steptokinase) can be used to dissolve clots i…
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Coagulation time
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time required for capillary tube of blood to clot
-tube of bld broken off at 30 second intervals
-bld coagulated when fibrin threads appear at broken tube ends
-normal = 6-10 mins
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thrombus
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bld clot in cardiovascular system
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embolus
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circulating plug (solid, liquid, or gas) composed of thrombus or other material that may occlude a bld vessel
-Thromboemolic conditions...
roughened endothelial surface = collagen exposed to bld = coagultation
dec. bld flow = excess thrombin not eliminated by liver = coagulation
stagn…
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prothrombin time (PT time or pro time)
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coagulation time for mixture of thromboplastin (tissue facctor), calcium, and decalcified plasma
-PT time mean = 12-15 seconds
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International Normalized Ratio (INR)
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PT time ratio which normalizes for different thromboplastin reagents and equipment
-INR mean = 2-3
-used to monitor effect of anticoagulant drugs (Heparin, Coumadin) to ensure nominal anticoagulation
-used to prevent thromboembolic conditions (stroke, MI, TIA) or keep IV patent
- heap…
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Haparin
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inactivates factor X
inhibits conversion of prothrombin to thrombin
-LOVONOX=low molecular weight heparin
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Coumadin
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depresses clotting factor formation in liver (especially with vitamin K related factors)
-results in 50% reduction in coagulation activity after 12 hrs, 80% after 24 hrs
*drug of choice
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Rivaroxaban
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inhibits Factor Xa
no monitoring required
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dabigatran
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inhibits thrombin
no monitoring required
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Kine 427 Exam 2