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DHYG 305: Pathology > 6. Fluid and Hemodynamic Disorders > Flashcards

6. Fluid and Hemodynamic Disorders Flashcards

1
Q

Water makes up ____% of total body weight.

A

60%

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2
Q

What are the components/compartments of body fluid water along with relative % of body weight?

A
  1. Plasma water (~5%)
  2. Extracellular or interstitial (~20%)
  3. Intracellular (~35%)
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3
Q

What can happen when the boundaries of normal physiologic variations are exceeded for plasma volume (about 3.5 L in a 70-kg man or 5% of total body weight)?

(I.e. Just like most body systems, plasma volume has a narrow range of homeostasis within which it can expand or reduce without causing harm to the body. What can happen when this homeostasis is disturbed?)

A

Mainly:

  1. Pathologic overhydration (I.e. Too much water)
  2. Pathologic dehydration (I.e. Too much little water)

Also:

  1. Redistribution of body fluids (I.e. Body water going to places it shouldn’t be in).
  2. Loss of fluids secondary to bleeding, sweating, or diarrhea.
  3. Retention of fluids because of inadequate renal excretion (I.e. The body keeping too much water due to lack of enough urination).
  4. Disruption of the circulation of fluids in tissues and vessels (I.e. Body fluids not flowing normally).
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4
Q

What is the scientific name for red blood cell (RBC)?

A

erythrocyte

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5
Q

What is the scientific name for white blood cell (WBC)?

A

leukocyte

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6
Q

What makes up blood?

A
  1. Plasma (the “water portion”) ~55%
  2. Erythrocytes (red blood cells) ~45%
  3. Leukocytes (white blood cells, proteins, platelets, ions, etc.) ~1%
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7
Q

Define: oncotic pressure

What is another name for it?

A

Osmotic pressure = Oncotic pressure = Outside-toward-inside direction of water flow caused by pressure (I.e. from Outside, interstitial space, to inside, blood vessel)

** Remember the “O-O-O”: (Osmotic, Oncotic, Outside) for easy memorization as you picture Fig. 6.2 in your head.

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8
Q

Define: hydrostatic pressure

What are two alternative names for it?

A

Hydrostatic pressure = Inside-toward-outside direction of water flow caused by pressure

Hydrostatic pressure = Arterial pressure = Venous pressure

** Memory tip: There’s WATER/FLUID (i.e. “HYDRO”) flowing in your “ARTERIES” and “VEINS” (I.e. ARTERIAL & VENOUS).

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9
Q

Define: Edema

A

Edema = An EXCESS OF FLUID in the INTERSTITIAL SPACES and/or the BODY CAVITIES. Can be “localized” (in only parts of the body) or “generalized” (all over the body).

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10
Q

Cerebral edema = ?

A

CEREBRAL edema = Edema in the BRAIN region

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11
Q

Pulmonary edema = ?

A

PULMONARY edema = Edema in the LUNG region

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12
Q

Periorbital edema = ?

A

Periorbital edema = Edema around (=peri) eye region (=orbital)

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13
Q

Ascites or hydroperitoneum = ?

A

Ascites or hydroperitoneum = Edema in the abdominal cavity (literally, “water in peritoneum”)

** Memory tip: Ascites = Abdominal (Both start with “A”)

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14
Q

Hydrothorax = ?

A

Hydrothorax = Edema in the pleural cavity (literally, “water in the thorax”)

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15
Q

Hydropericardium = ?

A

Hydropericardium = Edema in the pericardial cavity (literally, “water=hydro” “around=peri” “heart=cardium”)

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16
Q

How do the names of fluids change inside the blood vessels, inside the interstitial space, and inside the lymphatics?

A

Fluid inside the BLOOD vessel = BLOOD
Fluid inside the INTERSTITIAL space = INTERSTITIAL FLUID
Fluid inside the LYMPHATICS = LYMPH

** Remember that the fluid portion in the BLOOD is called PLASMA. When this gets filtered/drained into the INTERSTITIAL space, we now call it INTERSTITIAL FLUID. This fluid will eventually get drained out through the LYMPHATICS, at which time we now call it LYMPH. Basically, it’s DIFFERENT NAMES for the SAME FLUID in different parts of the body.

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17
Q

Define: Exudate

A

Exudate = Fluid in “edematous tissues” (i.e. tissues with edema) that is RICH in PROTEIN and BLOOD CELLS and is TYPICAL OF INFLAMMATION.

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18
Q

Define: Transudate

A

Transudate = Fluid in “edematous tissues” (i.e. tissues with edema) that has LESS PROTEIN and FEWER CELLS than EXUDATE.

** Basically, EXUDATE = thick fluid, TRANSUDATE = thinner fluid

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19
Q

Name the 4 most important pathogenetic factors of edema (i.e. 4 factors that cause edema).

** Note: Visualize Fig. 6-2

A

** All 4 conditions cause the fluids to “build up” within the INTERSTITIAL SPACE. The first 3 “squeeze out” more fluid into this space. The last 1 “prevents” fluids from “draining out” of this space:

  1. INCREASED VENOUS pressure (i.e. The pressure that “squeezes” fluids from INSIDE of blood vessel to the OUTSIDE: INTERSTITIAL SPACE).
    * * The greater this pressure, the more fluid that “squeezes out” into the INTERSTITIAL SPACE. ** Note that INCREASED ARTERIAL pressure (a.k.a. INCREASED HYDROSTATIC pressure) causes the exact same result! This is nothing more than a symptom of HYPERTENSION!
    * * Know that this results in the HYDROSTATIC EDEMA (1 of 5 types)!
  2. INCREASED PERMEABILITY of the vessel wall.
    * * The GREATER the “size of holes” in the vessel membrane, the MORE EASILY fluids can “squeeze out” INTO the INTERSTITIAL SPACE.
    * * This leads to tissue swelling (i.e. INFLAMMATION) and causes INFLAMMATORY EDEMA (2 of 5 types).
  3. DECREASED ONCOTIC pressure (i.e. lower OUTSIDE toward INSIDE flow of fluid)
    * * Remember that FLUIDS are attracted TOWARD areas with LOTS OF “STUFF” (I.e. cells, molecules, ions like sodium ion, or proteins like albumin).
    * * The MORE “stuff” there is inside the blood vessels, the greater the INCREASE in ONCOTIC pressure.
    * * The LESS “stuff” there is inside the blood vessels, the greater the DECREASE in ONCOTIC pressure.
    * * So you can DECREASE ONCOTIC pressure if you have LESS PROTEINS (I.e. Hypoproteinemia) or LESS SODIUM IONS inside the blood vessel.
    - -> You can cause HYPOPROTEINEMIA by having INCREASED PROTEIN LOSS (e.g. through peeing out proteins = PROTEINURIA) or DECREASED PROTEIN SYNTHESIS (e.g. through liver disease such as CIRRHOSIS). Know that the most commonly deficient protein is ALBUMIN (causes HYPOALBUMINEMIA). Either way, both conditions cause ONCOTIC EDEMA (3 of 5 types).
    - -> You can cause DECREASED SODIUM IONS inside the blood vessels by having the KIDNEY “keep” EXTRA SODIUM IONS (I.e. RETENTION OF SODIUM through HYPERALDOSTERONISM) and FAIL TO RETURN them to blood vessels. This causes HYPERVOLEMIC (or “Great volume”) EDEMA (4 of 5 types).
  4. OBSTRUCTION OF LYMPHATICS (i.e. “Clogged” drainage system).
    * * This rarely happens.
    * * A TUMOR blocking the lymphatics (i.e. lymphatic blockade) can “clog/OBSTRUCT the drain.” This forces the INTERSTITIAL FLUID to build up in the INTERSTITIAL SPACE and causes OBSTRUCTIVE EDEMA (5 of 5 types).
    * * Chronic inflammation such as ELEPHANTIASIS can also cause this type of edema.
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20
Q

Name the 5 forms of Edema.

** You should memorize Table 6-1.

A
  1. Inflammatory edema
  2. Hydrostatic edema
  3. Oncotic edema
  4. Obstructive edema
  5. Hypervolemic edema
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21
Q

Explain “Pitting edema.”

A

“Pitting edema” is caused by heart failure and results in swelling in the lower extremities (i.e. legs).

Heart failure = Heart can’t pump blood well. = Blood pools up in the legs as gravity pulls it downward, but there’s not enough pressure to push it back up towards the heart. This results in swelling of the legs.

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22
Q

Define: Hyperemia

A

Hyperemia = Too much (“hyper”) blood (“eremia” from “erythrocyte”) = Accumulation of blood in the peripheral circulation

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23
Q

What are the different types of Hyperemia?

A
  1. Active hyperemia
  2. Passive hyperemia
  3. Acute (short-term) hyperemia
  4. Chronic (long-term) hyperemia
24
Q

Explain: Active hyperemia

A

There are round, smooth muscles (i.e. muscles you can’t control) that surround blood vessels such as arterioles; they’re called PRE-CAPILLARY SPHINCTERS.

Depending on how hard or soft these sphincters squeeze the vessel, the vessel can become narrow (i.e. vasoconstrict) or wide (i.e. vasodilate), respectively.

When you blush or exercise (i.e. due to being “ACTIVE”), these sphincters relax and dilate the vessels, causing more blood to rush into the vessels. More blood = Hyperemia.

Since this hyperemia is caused by being “ACTIVE,” it’s called ACTIVE HYPEREMIA.

25
Q

Define: Cyanosis

A

Cyan = bluish color

Cyanosis = bluish coloring of a tissue due to deoxygenated blood lingering around

26
Q

What is another name for “Passive hyperemia?”

A

Passive hyperemia = Congestion

27
Q

Explain: Passive hyperemia

A

Passive hyperemia = Excess pooling of blood in tissues usually due to heart failure. It’s called “passive” because it’s not caused by anything the person has “actively” done.

Heart failure = Heart can’t pump blood well. = bluish, deoxygenated blood sticks around and pools up in tissues as a result, causing cyanosis.

Chronic passive hyperemia (or congestion) in the lungs often leads to edema.

28
Q

Name 5 types of: Hemorrhage

Not to be confused with “Hemorrhoid.”

A
  1. Cardiac Hemorrhage
  2. Aortic Hemorrhage
  3. Arterial Hemorrhage
  4. Capillary Hemorrhage
  5. Venous Hemorrhage
29
Q

Define: Hemorrhage

A

Hemorrhage = Extravasation (i.e. “forcing outward”) of blood = Bleeding

30
Q

Explain: Cardiac hemorrhage

A

Cardiac hemorrhage = Bleeding of the heart

  • Might result from gunshot or stabbing; often fatal
  • Could also result from softening and rupturing of heart muscle from myocardial infarct (“MI” or “heart attack”)
31
Q

Define: myocardial infarct/infarction

A 
Myo = Muscle
Cardial = Heart
Infarct = Blockage

=> Myocardial infarct/infarction = “Blockage of heart muscle” = Heart attack

32
Q

Define: Aneurysm

A

Aneurysm = Weakening of blood vessel walls

33
Q

Explain: Aortic hemorrhage

A

Aortic hemorrhage = Massive bleeding due to weakening and rupturing of the aortic walls. Often happens due to trauma such as from a car accident.

34
Q

Explain: Arterial hemorrhage

A

Arterial hemorrhage = Rapid bleeding due to torn arteries. Since arteries have high pressure and contain bright red, oxygenated blood, blood can “SQUIRTS OUT” in “PULSES” (since it shoots out with each heartbeat), and the person can quickly bleed to death. Often happens due to bullet or knife wounds.

35
Q

Explain: Capillary hemorrhage

A

Capillary hemorrhage = Usually identified by “pinpoint droplets of blood” (i.e. “dotted” or “spotty” appearance) on the skin surface. Usually caused by trauma or weakening of capitulary walls due to vitamin C deficiency.

36
Q

Explain: Venous hemorrhage

A

Venous hemorrhage = Bleeding caused by trauma. The blood is dark red or bluish since it’s deoxygenated. Since veins have low pressure, the blood DOES NOT “shoot out” in “pulses” as with arterial hemorrhage.

37
Q

Hemorrhages are classified as:

A
  1. External hemorrhage

2. Internal hemorrhage

38
Q

Explain: External hemorrhage

A

External hemorrhage = Blood flows out of the body = “Exsanguination” = Causes reduction in blood VOLUME (i.e. Hypovolemia)

39
Q

Explain: Internal hemorrhage

A

Internal hemorrhage = Blood fills body cavities. Forms “HEMATOMAS” (i.e. “BLOOD TUMORS”).

** e.g. Hemothorax, hemoperitoneum, hemopericardium

    • Small hemorrhage = Petechiae (“Petty”)
    • Medium hemorrhage = Purpura (“Purple”)
    • Large hemorrhage = Ecchymoses
    • Hemoptysis = Respiratory tract bleeding with expectoration (i.e. coughing up blood)
    • Hematemesis = Vomiting blood
    • Hematochezia = Anorectal bleeding (Bloody butthole)
    • Melena = Black/bloody stool/poop (Remember Melanin is “black pigment,” so “black poop”)
    • Hemauria = Bloody urine
    • Metrorrhagia = ABNORMAL bleeding from uterus/vagina
    • Menorrhagia = NORMAL bleeding due to menstruation
40
Q

How much blood can a normal adult lose?

A

An adult can lose 500 mL of blood without bad consequences (as in blood donations).

Loss of 1000-1500 mL can cause shocks.

Loss of more than 1500 mL can be fatal.

41
Q

Define: Thrombosis

A

Thrombosis = Clotting = Blood transforming from fluid to solid mixture of blood cells and fibrin.

42
Q

What 3 factors interact to cause intravascular coagulation (i.e. Clotting of blood “inside the blood vessels)?

A
  1. Coagulation proteins
  2. Endothelial cells (i.e. epithelial cells lining the inside of the blood vessels)
  3. Platelets
43
Q

Explain the role of COAGULATION PROTEINS in blood coagulation.

A

Various coagulation factors interact to form THROMBIN, which promotes polymerization (i.e. polymer formation) of FIBRIN. The fibrin network, along with all the blood cells and various plasma proteins are collectively called a CLOT.

44
Q

Explain the role of ENDOTHELIAL CELLS in blood coagulation.

A

Normally, endothelial cells produce substances that oppose blood coagulation.

When there is inflammation or injury, endothelial cells can become activated and switch its behavior toward initiating blood coagulation or thrombosis.

45
Q

Explain the role of PLATELETS in blood coagulation.

A

Platelets help blood clotting by neutralizing heparin (a chemical that prevents coagulation) or other anticoagulation factors. They also stimulate the coagulation process with THROMBOXANE.

46
Q

What is a PATHOLOGIC THROMBUS?

A

Pathologic thrombus = Thrombus big enough to cause serious medical problems

47
Q

What is the VIRCHOW’S TRIAD?

A

Virchow’s Triad = 3 conditions that can lead to the formation of PATHOLOGIC THROMBI

  1. Endothelial cell injury
  2. Hemodynamic changes (those that DISTURB or SLOW blood flow)
  3. Hypercoagulability of the blood
48
Q

THROMBI are classified based on their LOCATION as:

A
  1. Intramural thrombi
  2. Valvular thrombi
  3. Arterial thrombi
  4. Venous thrombi
  5. Microvascular thrombi
49
Q

What are some things that THROMBI may do?

A
  1. Occlude (or “block”) the lumen (or hole) of the blood vessel
  2. Narrow the lumen (or hole) of blood vessels and reduce blood flow
  3. Serve as a source of emboli
50
Q

Define: Embolus

A

Embolus = A freely movable, intravascular mass that is carried from one site to another by circulating blood.

51
Q

Name 4 forms of EMBOLI.

A
  1. Thromboemboli - broken-off fragments of thrombi carried by blood.
  2. Liquid emboli - emboli made of fat after bone fracture or amniotic fluid entering into uterine veins during delivery.
  3. Gaseous emboli (air emboli) - injection of air into veins or formation of air bubbles in veins under decreased pressure such as diving (e.g. “The bends”).
  4. Solid particle emboli - Cholesterol crystals, bone marrow from fracture, or tumor cells that break off into the blood stream.
52
Q

Define: Infarction

A

Infarction = Sudden lack of blood supply that causes an area of ischemic necrosis (i.e. “tissue death due to lack of oxygen”).

53
Q

Name 2 types of INFARCTION.

A
  1. WHITE (or Pale) infarcts - Pale or white areas because of ARTERIAL occlusion (i.e. blockage of artery, which blocks blood flow due solid organs like HEART, KIDNEY, or SPLEEN.
  2. RED infarcts - Usually due to VENOUS obstruction involving intestines or testis. May happen due to twisting of the organ around its supporting structure. Typically found in organs with DUAL BLOOD SUPPLY like LUNG or LIVER.
54
Q

Define: Shock

A

Shock = State of hypoperfusion (i.e. reduced blood flow) of tissues.

55
Q

Name 3 causes of SHOCK

A
  1. Pikachu (J/K)
  2. Fork in an outlet (J/K)
  3. Pump failure of the heart (CARDIOGENIC or “originating from heart” shock) - typically from heart attack or heart disease
  4. Loss of fluid from circulation (HYPOVOLEMIC or “low blood volume” shock) - typically from massive hemorrhage
  5. Pooling of blood in dilated peripheral blood vessels (HYPOTONIC or DISTRIBUTIVE shock) - typically from anaphylactic shock (i.e. allergic reaction)
56
Q

Define: Disseminated intravascular coagulation (DIC)

A
  • Easy way to remember: DIC = “Death Is Coming.”
  • Disseminated = “spread-out”
  • Intravascular = “inside blood vessels”
  • Coagulation = “blood clotting”

= Massive blood clotting all over the place inside blood vessels.

** This is a very dangerous condition that can be fatal.

57
Q

Name the 3 stages of SHOCK.

A
  1. EARLY/COMPENSATED shock - symptoms:
    - Tachycardia
    - Vasoconstriction of peripheral arterioles (i.e. whitening of skin)
    - Reduced urine
    * * When you’re “shocked,” your heart rate rises, your face whitens, and peeing’s the last thing you’d think about.
  2. DECOMPENSATED but REVERSIBLE shock - symptoms:
    - Hypotension
    - Tachypnea and shortness of breath
    - Oliguria (decreased urine)
    - Acidosis
  3. IRREVERSIBLE shock - symptoms:
    - Circulatory collapse
    - Significant hypoperfusion (i.e. reduced blood flow) to vital organs
    - Loss of vital functions

DHYG 305: Pathology (23 decks)

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