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2 Path Unit > 10/1 Edema/Congestion/Shock/Blood > Flashcards

10/1 Edema/Congestion/Shock/Blood Flashcards

1
Q

What is an embolus? Where does it always lodge?

A
  1. mass moving in the blood stream

2. ARTERY!

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2
Q

What does a venous thromboembolism always result in?

A

pulmonary embolus

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3
Q

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

A
  1. In the heart- mural thrombi or vegetations

2. A fib, MI

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4
Q

How do paradoxical thromboembolisms occur? And what are they?

A

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

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5
Q

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

A

resolution> pulmonary infarct> death> shock> pulmonary hypertension

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6
Q

Review the following types of emboli-

A
  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
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7
Q

What does a fat embolism in the lung look like?

A

small capillaries extremely distended with clear

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8
Q

What is the consequence of a vascular occlusion?

A

incr. hydrostatic pressure–> congestion and edema

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9
Q

What is the consequence of arterial occlusion?

A

Ischemia–angina, claudication, infarction

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10
Q

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

A
  1. atherosclerosis- arteries
  2. Thrombosis- arteries and veins
  3. Embolus- arteries
  4. compression- veins»arteries
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11
Q

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

A
  1. infarction

2. pale- arterial from obstruction of endarteries

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12
Q

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

A
  1. venous
  2. loose tissue
  3. Very dark—black
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13
Q

How does the hemorrage occur?

A

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

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14
Q

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

A
  1. previously infected tissue
  2. bacterial endocarditis
  3. Gangrene[look for signs of inflammation neutrophils etc.]
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15
Q

What is hyperemia? 2 main types?

A

increased blood in the microcirculation of a tissue

  1. active- hypoxic vasodilation from incr. O2 demand
  2. reactive hyperemia- post injury ischemia
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16
Q

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

A

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

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17
Q

What does congestions usually imply?

A

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

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18
Q

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

A

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

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19
Q

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

A

RBC in the sinusoids

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20
Q

What is edema?

A

increased interstitial fluid (extracellular and extravascular)

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21
Q

What is effusion?

A

fluid in a serous body cavity

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22
Q

What is pulmonary edema?

A

fluid in pulmonary alveolar spaces

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23
Q

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

A

1.020 exudate

<1.012 Transudate

24
Q

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

A

No- they are impermeable

25
Q

What are the 5 basic mechanisms of edema and effusion?

A
  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
26
Q

What are 3 causes of local edema?

A

lymphatic obst., venous obstruct, inflammation

27
Q

What are the 3 causes of generalized edema?

A

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

28
Q

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

A

pink stuff in the alveolar spaces

29
Q

What is filariasis?

A

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

30
Q

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

A
  1. ischemia
  2. aortic and mitral valve disease
  3. inadequate filling (constriction of some sort)
  4. Hypertension
31
Q

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?

A
  1. decr. CO–>renin–>aldosterone–> Na/H2O retention–> generalized edema
  2. increased preload–>incr pulmonary venous pressure–> pulmonary edema
32
Q

What are the 2 causes of right heart failure?

A
  1. left heart failure

2. cor pulmonale/pulmonary hypertension

33
Q

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

A

YES!

34
Q

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

A

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

35
Q

What is shock?

A

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

36
Q

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

A

hypovolemic shock

37
Q

What is an ineffective pump to maintain blood pressure?

A

cardiogenic shock

38
Q

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

A
  1. septic shock
  2. anaphylatic shock
  3. neurogenic shock (spinal cord injury)
39
Q

What are the 3 stages of shock?

A
  1. non-progressive- compensation/no damage
  2. progressive- hypoxic>acid>damage>reversible
  3. irreversible-damage too severe to reverse
40
Q

Tissue damage from shock is predominant in which 5 tissues?

A

brain heart kidneys gut liver

they all use tons of blood!

41
Q

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

A

associated with acute loss- decrease in Hb due to dilution

42
Q

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

A

associated with chronic loss- iron deficiency leads to this

43
Q

Review the compensation mechanisms for blood loss

A

immediate=cardiovascularhours=fluid shiftday= RBC regeneration

44
Q

What is a cc of blood?

A

cubic centimeter=milliliter

45
Q

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?

A 
>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]
46
Q

Where is chronic hemorrhage most commonly seen.

A

GI and GU tracts. less common is respiratory tract

47
Q

What hemodynamic disorders should we think with SOB?

A

left heart failure and pulmonary embolus

48
Q

What hemodynamic disorders should we think with pallor?

A

blood loss anemia, hypovolemic shock, cardiogenic shock

49
Q

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

A

blood loss, shock, infarct

50
Q

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

A

edema and congestion

51
Q

What hemodynamic disorders should we think with organomegaly?

A

venous occlusion and hear failure

52
Q

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

A

effusion from venous obstruction, cirrhosis)

53
Q

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

A

vascular occlusion with/without infarct

54
Q

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

A

pulmonary infarct or bowel infarct

55
Q

What hemodynamic disorders should we think with paralysis?

A

infarct or hemorrhage to nervous system

56
Q

What hemodynamic disorders should we think with distended neck veins?

A

right heart failure, vascular occlusion by tumor compression

2 Path Unit (14 decks)

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