10/1 Edema/Congestion/Shock/Blood Flashcards
What is an embolus? Where does it always lodge?
- mass moving in the blood stream
2. ARTERY!
What does a venous thromboembolism always result in?
pulmonary embolus
Where do 80% of arterial thromboembolisms arise? What are 2 key etiologies?
- In the heart- mural thrombi or vegetations
2. A fib, MI
How do paradoxical thromboembolisms occur? And what are they?
venous thromboembolus in the arterial circulation and it means there is a septal defect or patent ductus (some pathway to skip the lungs)
What are the 5 consequences of pulmonary thromboembolism from greatest percent to least?
resolution> pulmonary infarct> death> shock> pulmonary hypertension
Review the following types of emboli-
- amniotic fluid embolism @birth
- Atheromatous embolus- may see crystal like cholesterol
- fat embolism- trauma/crush
- Bone marrow embolism- from CPR sometime- fat and marrow in normal vessel
- airembolism
- Tumor embolism
7 Foreign body embolism
What does a fat embolism in the lung look like?
small capillaries extremely distended with clear
What is the consequence of a vascular occlusion?
incr. hydrostatic pressure–> congestion and edema
What is the consequence of arterial occlusion?
Ischemia–angina, claudication, infarction
What are the 4 causes of vascular occlusion paired with their sites?
- atherosclerosis- arteries
- Thrombosis- arteries and veins
- Embolus- arteries
- compression- veins»arteries
What is an area of ischemic necrosis resulting from occlusion of either arterial supply or venous drainage causing hypoxia? arterial color?
- infarction
2. pale- arterial from obstruction of endarteries
Are hemorrhagic infarctions usually arterial or venous? where do they occur most often? Color?
- venous
- loose tissue
- Very dark—black
How does the hemorrage occur?
Because there is a dual supply of blood. One artery is obstructed, but the unobstructed arterial pumps blood into the necrotic tissue
What are the 3 major types/factors of septic infarction?
- previously infected tissue
- bacterial endocarditis
- Gangrene[look for signs of inflammation neutrophils etc.]
What is hyperemia? 2 main types?
increased blood in the microcirculation of a tissue
- active- hypoxic vasodilation from incr. O2 demand
- reactive hyperemia- post injury ischemia
How doe hyperemia look in the picture of the small bowel.
Small bowel looked extremely extended, bright red, and the smalls vessels where visible
What does congestions usually imply?
passive congestion- increased venous hydrostatic pressure– more blood in capillary slowing and sludging
What does the small bowel image of intestine with congestion look like?
To me a lot alike the hyperemia bowel, but it is cyanotic! hints of blue in the small vessels and overall in the tissue
In the case of congestion in the liver, what do we see a lot of?
RBC in the sinusoids
What is edema?
increased interstitial fluid (extracellular and extravascular)
What is effusion?
fluid in a serous body cavity
What is pulmonary edema?
fluid in pulmonary alveolar spaces
What is the difference in effusion protein levels between exudate and transudate?
1.020 exudate
<1.012 Transudate
Can arterioles and veins help/hurt fluid homeostasis in interstitial spaces?
No- they are impermeable
What are the 5 basic mechanisms of edema and effusion?
- lymphatic obstruction (local)
- Decreased osmotic pressure gradient (systemic)
- increased hydrostatic pressure gradient (HF)
- increased vascular perm. (inflammation)
- excess total body fluid and electrolytes
What are 3 causes of local edema?
lymphatic obst., venous obstruct, inflammation
What are the 3 causes of generalized edema?
down osmotic gradient, up Na/H2O, up hydrostatic pressure from HF
What do we see in the lungs in pulmonary edema biopsies?
pink stuff in the alveolar spaces
What is filariasis?
Round worm lymphatic obstruction and causes huge amounts of edema in the extremity.
What are the major causes [4] of left heart failure that leads to congestion, edema, and effusion?
- ischemia
- aortic and mitral valve disease
- inadequate filling (constriction of some sort)
- Hypertension
There are 2 main consequences of left heart failure leading to two different types of edema. What are the 2 consequences and reasons why they are different?
- decr. CO–>renin–>aldosterone–> Na/H2O retention–> generalized edema
- increased preload–>incr pulmonary venous pressure–> pulmonary edema
What are the 2 causes of right heart failure?
- left heart failure
2. cor pulmonale/pulmonary hypertension
Does right heart failure lead to the same consequence as left heart failure in regards to generalized edema through a decrease in CO?
YES!
What are the consequences of increased preload in right heart failure?
incr. venous pressure–> hepatomegaly, peripheral edema with no pulmonary edema.
What is shock?
a condition in which the blood pressure is too low to maintain an adequate supply of blood to tissues
What is an insufficient blood or plasma volume in the vascular space?
hypovolemic shock
What is an ineffective pump to maintain blood pressure?
cardiogenic shock
What 3 types of shock do we think about when we see vasodilation with decreased peripheral resistance and peripheral pooling of blood?
- septic shock
- anaphylatic shock
- neurogenic shock (spinal cord injury)
What are the 3 stages of shock?
- non-progressive- compensation/no damage
- progressive- hypoxic>acid>damage>reversible
- irreversible-damage too severe to reverse
Tissue damage from shock is predominant in which 5 tissues?
brain heart kidneys gut liver
they all use tons of blood!
What type of blood loss is associated with normochromic normocytic anemia?
associated with acute loss- decrease in Hb due to dilution
What type if blood loss is associated with hypochromic microcytic anemia?
associated with chronic loss- iron deficiency leads to this
Review the compensation mechanisms for blood loss
immediate=cardiovascularhours=fluid shiftday= RBC regeneration
What is a cc of blood?
cubic centimeter=milliliter
About how many ccs of blood needs to be lost in the gut to see the following problems: occult blood, melena, iron deficiency anemia, dilution anemia, tachycardia, shock?
>5cc in 24 hours >50 cc in 24 hours >15-200cc in 24 hours >1000cc in 24 hours >1000cc in 24hours >2000cc in 24 hours [Average male has 5000cc]
Where is chronic hemorrhage most commonly seen.
GI and GU tracts. less common is respiratory tract
What hemodynamic disorders should we think with SOB?
left heart failure and pulmonary embolus
What hemodynamic disorders should we think with pallor?
blood loss anemia, hypovolemic shock, cardiogenic shock
What hemodynamic disorders should we think with light headedness or lost consciousness?
blood loss, shock, infarct
What hemodynamic disorders should we think with local vs. generalized swelling with or without cyanosis?
edema and congestion
What hemodynamic disorders should we think with organomegaly?
venous occlusion and hear failure
What hemodynamic disorders should we think with abdominal enlargement with fluid wave?
effusion from venous obstruction, cirrhosis)
What hemodynamic disorders should we think with acute onset of pain?
vascular occlusion with/without infarct
What hemodynamic disorders should we think with with acute onset of pain followed by bleeding hemoptysis melena etc?
pulmonary infarct or bowel infarct
What hemodynamic disorders should we think with paralysis?
infarct or hemorrhage to nervous system
What hemodynamic disorders should we think with distended neck veins?
right heart failure, vascular occlusion by tumor compression
