i want 25 mutiple choice questions with thier model below each question that covers different aspects of all of the following information : HEMODYNAMIC DISORDERS & CIRCULATORY DISTURBANCES”
WHAT IS HOMEOSTASIS? “Homeostasis” is the process by which body maintain its balance or equilibrium. Fluid homeostasis means maintenance of vessel wall integrity and keep the intravascular pressure, and osmotic pressure within physiologic ranges. Disturbance of homeostasis results in s extravasation of fluid into the interstitium (Edema). WHAT IS HEMOSTASIS? Hemostasis means (‘‘stopping of hemorrhage’’|). It is the physiologic process designed to stop the bleeding from injured blood vessels. Thrombosis is a pathologic form of coagulation of circulating blood inside intact vascular spaces. Thrombus may cause Embolism which will obstruct blood flow to tissues and lead to cell necrosis (Infarction). Continuous blood loss after vascular injury results in Hemorrhage. More extensive hemorrhage can result in sever hypotension (Shock) and death. 1) Edema and Effusions
The movement of water and solutes between intravascular and interstitial spaces is balanced by the opposing forces of vascular hydrostatic pressure and plasma colloid osmotic pressure. Increased capillary pressure or diminished colloid osmotic pressure results in increased interstitial fluid. If the net movement of water into tissues exceeds lymphatic drainage, fluid will accumulate. Causes of edema: -Inflammatory or noninflammatory -Localized or systemic (generalized
80 Causes of Inflammatory
Characterized by protein-rich exudates
1-Acute inflammation Causes of Noninflammatory Characterized by protein-poor transudates
1-Increased hydrostatic pressure due to impaired venous return e.g., local [DVT] or systemic in congestive heart failure
2-Chronic inflammation
2-Reduced plasma osmotic pressure occurs with albumin loss e.g., nephrotic syndrome; or reduced albumin synthesis due to liver cirrhosis
3-Angioneurotic (Allergic)
3-Lymphatic obstruction blocks removal of interstitial fluid. Obstruction is usually localized. 4-Sodium and water retention causes increased hydrostatic pressure and reduced osmotic pressure.
Nomenclature *Edema: Increased interstitial fluid *Hydrothorax, Hydropericardium, or Hydroperitoneum: Fluid in the various body cavities.
* Hydrothorax: called pleural effusion * Hydropericardium: called pericardial effusion. *Hydroperitoneum: called ascites. *Anasarca: Severe systemic edema. Causes of localized edema
Causes of generalized edema Acute inflammation Hypersensitivity reactions
Obstructive edema: -venous: edema of lower limb due to pressure of a pregnant uterus on the iliac vein -lymphatic:
Cardiac edema: as in Rt. side heart failure.

Renal edema: as in nephrotic or nephritic syndromes
Nutritional edema.: as reduced albumin synthesis due to liver cirrhosis
Filariasis chronic lymphangitis and lymphadenitis
81 Morphology: *Microscopically: it manifests only as subtle cell swelling and separation of the extracellular matrix (ECM). *Edema is most easily appreciated grossly: 1-Subcutaneous edema: diffuse or occur where hydrostatic pressures are greatest (e.g., by gravity). It is called dependent edema (legs when standing, sacrum when recumbent). Finger pressure over subcutaneous edema typically leaves an imprint, socalled pitting edema (where the lymphatic system is patent not obliterated). If lymphatic system is obliterated, it is a non-pitting edema. 2-Edema resulting from hypoproteinemia: is generally more severe and diffuse; it is most evident in loose connective tissue (e.g., eyelids causing periorbital edema in nephrotic syndrome). 3-Pulmonary edema in lungs, 2 to 3 times their normal weight; sectioning reveals a frothy, blood-tinged mixture of air, edema fluid, and erythrocytes. 4-Brain edema: localized edema at sites of injury (e.g., abscess or neoplasm) or generalized (e.g., encephalitis, hypertensive crises, or obstruction to venous outflow). When generalized, the brain is grossly swollen with narrowed sulci and distended gyri flattened against the skull. 5- Edema of solid organs results in increase in size and weight. Histologically, there is only separation of parenchymal elements. Complications 1-Subcutaneous edema can impair wound healing and increase the risk of infection. 2-Pulmonary edema impedes gas exchange causing hypoxia and increases the risk of infection. 3-Brain edema within the confined space of the skull can impede cerebral blood flow and cause herniation, compromising critical medullary centers
2) Hyperemia
It is defined as increase in the blood flow to an organ because of active dilation of its arterioles and capillaries. It is called active which means change in the muscle tone of the vessels. Grossly: The affected organ is red (erythema) due to increase oxygenated blood. It is simply classified to: (1) Physiological: e.g., as during muscular exercise. (2) Pathological: e.g., as in acute inflammation. 3) Congestion
It is defined as a passive process caused by impaired outflow from a tissue; The veins, venules, and capillaries are passively dilated (passive hyperemia) Grossly: The affected tissues are blue-red (cyanosis) due to increase deoxygenated blood. It can be systemic (e.g., congestive heart failure) or local (e.g., an isolated venous obstruction). It is classified to: 1) Acute: general or local. 2) Chronic: general or local. Acute congestion: 1)Acute general congestion: As in acute heart failure. All viscera show acute congestion. It is terminal condition. 2)Acute local congestion: As in sudden complete obstruction of venous blood flow due to thrombosis, twisting of the pedicle of ovary or strangulated hernia. Chronic congestion: 1)Chronic general congestion: gradual venous congestion affecting the whole venous system, as in Rt. sided and left sided heart failure. In Rt. sided heart failure venous congestion occurs all over the body, lungs affected lately. Congested neck veins cyanosis, cardiac edema occurs. In Left sided heart failure chronic venous congestion occurs, mainly in lungs
2)Chronic local congestion: Gradual incomplete venous obstruction. It results from venous compression by a tumor, enlarged lymph node, pregnant uterus, and liver cirrhosis. Obstructed veins become dilated and congested with gradual opening of the collaterals. Morphology: Grossly: In acute congestion: Vessels are distended, organs are hyperemic; associated with interstitial edema. In chronic congestion: Capillary rupture cause focal hemorrhage; then erythrocyte breakdown results in hemosiderin-laden macrophages. Parenchymal cell atrophy or fibrosis may also be present. Tissues appear brown, contracted, and fibrotic
Lungs and liver are commonly affected. In lungs: capillary engorgement, interstitial edema, and alveolar transudates. Chronic manifestations include hemosiderin-laden macrophages (was called heart failure cells) and fibrotic septa. In liver: central vein and sinusoidal distention, with central hepatocyte degeneration. In chronic congestion the central regions of the hepatic lobules are grossly red-brown and slightly depressed (loss of cells) relative to the surrounding uncongested tan liver (so-called nutmeg liver). Microscopically, there is centrilobular necrosis, hemorrhage, and hemosiderin-laden macrophages. In chronic congestive heart failure, severe hepatic congestion results in hepatic fibrosis ("cardiac cirrhosis"). Nutmeg live