10/1 Edema/Congestion/Shock/Blood

Question 1

What is an embolus? Where does it always lodge?

Answer 1

1. mass moving in the blood stream

2. ARTERY!

Question 2

What does a venous thromboembolism always result in?

Answer 2

pulmonary embolus

Question 3

Where do 80% of arterial thromboembolisms arise? What are 2 key etiologies?

Answer 3

1. In the heart- mural thrombi or vegetations

2. A fib, MI

Question 4

How do paradoxical thromboembolisms occur? And what are they?

Answer 4

venous thromboembolus in the arterial circulation and it means there is a septal defect or patent ductus (some pathway to skip the lungs)

Question 5

What are the 5 consequences of pulmonary thromboembolism from greatest percent to least?

Answer 5

resolution> pulmonary infarct> death> shock> pulmonary hypertension

Question 6

Review the following types of emboli-

Answer 6

1. amniotic fluid embolism @birth
2. Atheromatous embolus- may see crystal like cholesterol
3. fat embolism- trauma/crush
4. Bone marrow embolism- from CPR sometime- fat and marrow in normal vessel
5. airembolism
6. Tumor embolism
   7 Foreign body embolism

Question 7

What does a fat embolism in the lung look like?

Answer 7

small capillaries extremely distended with clear

Question 8

What is the consequence of a vascular occlusion?

Answer 8

incr. hydrostatic pressure–> congestion and edema

Question 9

What is the consequence of arterial occlusion?

Answer 9

Ischemia–angina, claudication, infarction

Question 10

What are the 4 causes of vascular occlusion paired with their sites?

Answer 10

1. atherosclerosis- arteries
2. Thrombosis- arteries and veins
3. Embolus- arteries
4. compression- veins»arteries

Question 11

What is an area of ischemic necrosis resulting from occlusion of either arterial supply or venous drainage causing hypoxia? arterial color?

Answer 11

1. infarction

2. pale- arterial from obstruction of endarteries

Question 12

Are hemorrhagic infarctions usually arterial or venous? where do they occur most often? Color?

Answer 12

1. venous
2. loose tissue
3. Very dark—black

Question 13

How does the hemorrage occur?

Answer 13

Because there is a dual supply of blood. One artery is obstructed, but the unobstructed arterial pumps blood into the necrotic tissue

Question 14

What are the 3 major types/factors of septic infarction?

Answer 14

1. previously infected tissue
2. bacterial endocarditis
3. Gangrene[look for signs of inflammation neutrophils etc.]

Question 15

What is hyperemia? 2 main types?

Answer 15

increased blood in the microcirculation of a tissue

1. active- hypoxic vasodilation from incr. O2 demand
2. reactive hyperemia- post injury ischemia

Question 16

How doe hyperemia look in the picture of the small bowel.

Answer 16

Small bowel looked extremely extended, bright red, and the smalls vessels where visible

Question 17

What does congestions usually imply?

Answer 17

passive congestion- increased venous hydrostatic pressure– more blood in capillary slowing and sludging

Question 18

What does the small bowel image of intestine with congestion look like?

Answer 18

To me a lot alike the hyperemia bowel, but it is cyanotic! hints of blue in the small vessels and overall in the tissue

Question 19

In the case of congestion in the liver, what do we see a lot of?

Answer 19

RBC in the sinusoids

Question 20

What is edema?

Answer 20

increased interstitial fluid (extracellular and extravascular)

Question 21

What is effusion?

Answer 21

fluid in a serous body cavity

Question 22

What is pulmonary edema?

Answer 22

fluid in pulmonary alveolar spaces

Question 23

What is the difference in effusion protein levels between exudate and transudate?

Answer 23

1.020 exudate

<1.012 Transudate

Question 24

Can arterioles and veins help/hurt fluid homeostasis in interstitial spaces?

Answer 24

No- they are impermeable

Question 25

What are the 5 basic mechanisms of edema and effusion?

Answer 25

1. lymphatic obstruction (local) 2. Decreased osmotic pressure gradient (systemic) 3. increased hydrostatic pressure gradient (HF) 4. increased vascular perm. (inflammation) 5. excess total body fluid and electrolytes

Question 26

What are 3 causes of local edema?

Answer 26

lymphatic obst., venous obstruct, inflammation

Question 27

What are the 3 causes of generalized edema?

Answer 27

down osmotic gradient, up Na/H2O, up hydrostatic pressure from HF

Question 28

What do we see in the lungs in pulmonary edema biopsies?

Answer 28

pink stuff in the alveolar spaces

Question 29

What is filariasis?

Answer 29

Round worm lymphatic obstruction and causes huge amounts of edema in the extremity.

Question 30

What are the major causes [4] of left heart failure that leads to congestion, edema, and effusion?

Answer 30

1. ischemia 2. aortic and mitral valve disease 3. inadequate filling (constriction of some sort) 4. Hypertension

Question 31

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?

Answer 31

1. decr. CO-->renin-->aldosterone--> Na/H2O retention--> generalized edema 2. increased preload-->incr pulmonary venous pressure--> pulmonary edema

Question 32

What are the 2 causes of right heart failure?

Answer 32

1. left heart failure | 2. cor pulmonale/pulmonary hypertension

Question 33

Does right heart failure lead to the same consequence as left heart failure in regards to generalized edema through a decrease in CO?

Answer 33

YES!

Question 34

What are the consequences of increased preload in right heart failure?

Answer 34

incr. venous pressure--> hepatomegaly, peripheral edema with no pulmonary edema.

Question 35

What is shock?

Answer 35

a condition in which the blood pressure is too low to maintain an adequate supply of blood to tissues

Question 36

What is an insufficient blood or plasma volume in the vascular space?

Answer 36

hypovolemic shock

Question 37

What is an ineffective pump to maintain blood pressure?

Answer 37

cardiogenic shock

Question 38

What 3 types of shock do we think about when we see vasodilation with decreased peripheral resistance and peripheral pooling of blood?

Answer 38

1. septic shock 2. anaphylatic shock 3. neurogenic shock (spinal cord injury)

Question 39

What are the 3 stages of shock?

Answer 39

1. non-progressive- compensation/no damage 2. progressive- hypoxic>acid>damage>reversible 3. irreversible-damage too severe to reverse

Question 40

Tissue damage from shock is predominant in which 5 tissues?

Answer 40

brain heart kidneys gut liver | they all use tons of blood!

Question 41

What type of blood loss is associated with normochromic normocytic anemia?

Answer 41

associated with acute loss- decrease in Hb due to dilution

Question 42

What type if blood loss is associated with hypochromic microcytic anemia?

Answer 42

associated with chronic loss- iron deficiency leads to this

Question 43

Review the compensation mechanisms for blood loss

Answer 43

immediate=cardiovascularhours=fluid shiftday= RBC regeneration

Question 44

What is a cc of blood?

Answer 44

cubic centimeter=milliliter

Question 45

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?

Answer 45

``` >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] ```

Question 46

Where is chronic hemorrhage most commonly seen.

Answer 46

GI and GU tracts. less common is respiratory tract

Question 47

What hemodynamic disorders should we think with SOB?

Answer 47

left heart failure and pulmonary embolus

Question 48

What hemodynamic disorders should we think with pallor?

Answer 48

blood loss anemia, hypovolemic shock, cardiogenic shock

Question 49

What hemodynamic disorders should we think with light headedness or lost consciousness?

Answer 49

blood loss, shock, infarct

Question 50

What hemodynamic disorders should we think with local vs. generalized swelling with or without cyanosis?

Answer 50

edema and congestion

Question 51

What hemodynamic disorders should we think with organomegaly?

Answer 51

venous occlusion and hear failure

Question 52

What hemodynamic disorders should we think with abdominal enlargement with fluid wave?

Answer 52

effusion from venous obstruction, cirrhosis)

Question 53

What hemodynamic disorders should we think with acute onset of pain?

Answer 53

vascular occlusion with/without infarct

Question 54

What hemodynamic disorders should we think with with acute onset of pain followed by bleeding hemoptysis melena etc?

Answer 54

pulmonary infarct or bowel infarct

Question 55

What hemodynamic disorders should we think with paralysis?

Answer 55

infarct or hemorrhage to nervous system

Question 56

What hemodynamic disorders should we think with distended neck veins?

Answer 56

right heart failure, vascular occlusion by tumor compression