Keywords: Chapter 7, Hemodynamic Disorders

anasarca

Anasarca refers to generalized edema, in its most severe form. There is an accumulation of fluid in subcutaneous tissues, internal organs, and body cavities. It typically occurs during the course of nephrotic syndrome, but severe cardiac failure could result in anasarca.
cardiac tamponade
Cardiac tamponade results from accumulation of fluid (transudate, exudate, or blood) in the pericardial sac. Since the fluid occupies the pericardial space, compressing the heart, the ventricles and atria cannot fill during diastole. Acutely, 100-200 cc may be enough to cause death. If the fluid accumulates slowly, the pericardium will expand, and perhaps 1 liter would be necessary to cause death.
decompression illness
Seen most commonly in sport and commercial diving, or in construction workers breathing compressed air in caissons. Under increased pressure during diving, nitrogen gas becomes dissolved in tissues, and forms bubbles in the circulatory system upon ascent, if done too rapidly. These gas bubbles are one form of embolism, and may occlude vessels, leading to ischemia, pain, neurologic symptoms, and perhaps death.

Reference: The Physiology of Decompression Illness. Moon, RE, Vann, RD, and Bennett, PB. Scientific American, August 1995.
disseminated intravascular coagulation (DIC)
A form of coagulopathy where the intrinsic or extrinsic coagulation pathway is activated within the confines of the vascular system. This leads to the formation of microthrombi throughout the body, and the consumption of platelets and fibrinogen. This depletion of clotting factors has lead to the synonym for DIC of consumption coagulopathy. Ironically, the consumption of platelets and fibrinogen in microthrombi ultimately leads to uncontrolled hemorrhage (see pg 572-573, Figure 20-17).
ecchymosis
Ecchymosis is the clinical term for a bruise. An ecchymosis involves a larger area of skin than purpura (>1 cm).
edema (non-inflammatory)
Noninflammatory edema can be understood in terms of Starling's hypothesis or law: hydrostatic outflow of fluid from the circulation is nearly balanced by the osmotic attraction of (oncotic pressure created by) circulating plasma proteins, which cannot leave the circulation under normal conditions. Knowing only this principle, it is possible to deduce the pathogenesis of pulmonary edema secondary to left ventricular cardiac failure (increased hydrostatic pressure).
embolism
Passage through the venous or arterial system of any object capable of lodging in a vessel downstream and obstructing the flow of blood.
embolus
air embolus
The movement of air (gas) through the circulatory system is usually seen in decompression sickness (the bends, caisson disease).
amniotic fluid embolus
The movement of a bolus of amniotic fluid containing desquamated fetal epithelial cells (squames) through the maternal circulatory system most often occurs during traumatic vaginal deliveries. It has dire consequences, for amniotic fluid has high thromboplastin activity, and often leads to a coagulopathy (disseminated intravascular coagulation, or DIC).
bone marrow embolus
Bone marrow emboli are often seen at autopsy, following CPR. They are occasionally seen following trauma of the pelvis.
fat embolus
Fracture of the pelvis or long bones may lead to embolism of marrow fat into the circulatory system. Symptoms typically occur 1-3 days post-trauma, manifested by respiratory distress, mental changes, thrombocytopenia, and petechial hemorrhage.
foreign body embolus
A foreign body may occasionally embolize; i.e., a retained bullet may work its way into the circulatory system and lodge somewhere downstream, creating ischemia and infarction.
paradoxical embolus
In patients with a patent foramen ovale or atrial septal defect, emboli may arise on the venous side of the body, but are able to gain access to the left side of the heart via the septal opening and thus give rise to arterial emboli and subsequent infarction.
thromboembolus
This is the most common type of embolus. The usual source is the deep veins of the leg, which have suffered deep venous thrombosis (DVT).
hemarthrosis
The collection of blood in a joint space.
hematoma
A collection of blood within soft tissue that results in swelling (tumor). The suffix -oma is added to denote the fact that the collection of blood can mimic a neoplasm.
hemopericardium
Collection of blood within the pericardial sac.
hemorrhage
Bleeding into an extravascular space, which could include the exterior of the body or a body cavity.
hemothorax
Collection of blood within the pleural space.
hypercoagulable state
Any condition with increased risk thrombosis. A hypercoagulable state may be associated with neoplasia, sickle cell disease, pregnancy, smoking, and oral contraceptives, to name a few.
hyperemia (active and passive)
An excess amount of blood in an organ.

active hyperemia
Increased blood supply to an organ, usually for physiologic reasons (exercise).
passive hyperemia
Engorgement of an organ with venous blood, usually the result of inadequate circulation (heart failure).
infarct
Occlusion of an artery produces an area of coagulative necrosis downstream. This area of coagulative necrosis is known as an infarct.
nephrotic syndrome
The nephrotic syndrome is caused by a massive loss of protein in the urine, due to an abnormality of the glomerulus (see page 456, Rubin). The losss of protein, particularly albumin, leads to a decreased oncotic pressure of plasma, and subsequent non-inflammatory edema. The edema is usually generalized, and effusions may also occur.
petechia
Pinpoint hemorrhage into the skin, usually around hair follicles. Often associated with coagulopathies, thrombocytopenia, or vasculitis.
phlebothrombosis
Thrombosis of veins, unassociated with inflammation. It is a very common condition, usually occuring in the deep veins of the legs, associated with age, sickle cell disease, injury, stasis, and hypercoagulable states. Now usually referred to as deep venous thrombosis (DVT) (See page 165, Rubin).
purpura
Superficial hemorrhage into the skin, up to 1 cm in diameter.
shock
A profound disturbance of the circulation and metabolism, leading to inadequate perfusion of vital organs, necessary to maintain homeostasis (see Figure 7-16, page 177, Rubin).

cardiogenic shock
Shock due to pump (heart) failure, usually the result of myocardial infarction, cardiac tamponade, or myocarditis.
hypovolemic shock
Shock due to a decreased blood volume, usually due to hemorrhage, decreased fluid intake, diarrhea, excess urination, or excess perspiration.
septic shock
Vascular collapse due to Gram-negative bacteremia (see Figure 7-17, page 178, Rubin)
thrombophlebitis
Thrombosis of veins, associated with inflammation (usually leg veins). Phlebitis refers to inflammation of veins. If the patient has significant pain (inflammation), then this term may be appropriate, however, the current practice is to use the term deep venous thrombosis (DVT).
thrombosis
Thrombosis refers to the formation of a thrombus within the vascular space.
thrombus
A thrombus is an aggregate of a network of fibrin, platelets, and blood elements trapped by the fibrin net. The book makes a big deal out of the difference between a clot and a thrombus, but most physicians and laymen use them synonymously.
Trousseau syndrome
A para-neoplastic syndrome due to a hypercoagulable state. Typically, the patient experiences migrating thrombophlebitis. It is classically associated with pancreatic cancer (which Dr. Trousseau diagnosed in himself), but other tumors, particularly adenocarcinomas, can cause it.