Ch 4 - Hemodynamic disorders Flashcards
Name the 3 body fluid compartments?
intracellular, interstitial, intravascular.
How much fluid is taken in a day?
2.5 liters.
How much fluid is let out in a day and how?
2.5 liters. 0.1 in stool, 0.9 in respiration/sweat, 1.5 in urine.
What are the 2 forms of edema?
- Exudate. 2. Transudate.
Which type of edema is typical of inflammation?
Exudate.
What is exudate rich in?
Protein and blood cells.
Transudate contains less proteins and fewer cells and is typical of what?
Hydrostatic or osmotic pressure pathology.
What is transudate?
An ultra-filtrate of plasma fluid.
4 factors of pathogenesis of edema?
- Increased hydrostatic pressure. 2. Increased wall permeability. 3. decreased oncotic pressure. 4. Lymphatic obstruction.
What is hydrostatic pressure?
Blood pressure pushing fluid OUT of capillaries.
What is oncotic pressure?
Plasma proteins that are in capillaries want to be diluted - pull fluid back INTO the capillary.
Transudate vs exudate - hypocellular/cellular?
Transudate - hypocellular Exudate - cellular
Transudate vs exudate - protein rich?
Transudate - protein POOR Exudate - protein RICH
Transudate edema - specific gravity higher or lower than 1.012?
Lower.
Exudate edema - specific gravity higher or lower than 1.020?
Higher
What causes transudate edema?
Increased hydrostatic pressure, incresed oncotic pressure, Na retention.
What causes exudate edema?
Lymphatic obstruction, INFLAMMATION
Hydrostatic pressure causes edema and is caused by what 2 things?
hypertension (increased arterial pressure), heart failure (increased venous backpressure).
Oncotic pressure, when low, causes edema and is caused by what?
decreased protein synthesis, proteinuria (loss of proteins in urine).
Obstructions that cause edema are usually caused by what?
Tumors or chronic inflammation, also parasites like filaria which causes elephantiasis.
What is hypervolemic?
High levels of blood.
Hypervolemia causes edema - what causes it?
Na and H2O retention.
What is anasarca?
Extreme generalized edema.
What are hydrothorax, hydropericardium, and hydroperitoneum?
Clincal forms of edema that are in cavities.
Low blood pressure leads to what type of edema?
Pulmonary edema (left sided heart failure)
Elephantiasis is caused by what?
Lymph blockage from a parasite.
Heart problems will show edema where?
lower extremities, or back if patient supine.
Kidney problems will show edema where?
Diffuse edema.
Liver problems will show edema where?
ascites (fluid in peritoneal cavity) due to low albumin and portal hypertension.
What is hyperemia?
Excess blood flow.
What is active hyperemia?
Dialation of arterioles like when blushing, exercise, inflammation.
What is passive hyperemia?
Venous backpressure
What is passive hyperemia associated with?
hydrosatic edema, cyanosis, and heart failure.
What does chronic passive congestion of lungs lead to?
edema and RBC extravasation into alveoli.
What is chronic passive congestion of the lungs accompanied by?
Anoxia (low oxygen in blood), and pulmonary fibrosis.
With chronic passive congestion of the lungs, macrophages take up RBCs and degrade hemoglobin - what does this lead to?
Hemosiderin accumulation.
Cardiac hemorrhage is often what?
Fatal.
What will arterial hemorrhage look like?
Bright red pulsating/squirting.
Capillary hemorrhage does what to venous pressure?
increases it.
What does venous hemorrhage look like?
Dark/bluish color, oozing
What are skin hemorrhages?
Bruises
What is a purpura?
A skin hemorrhage that is between 1mm and 1 cm.
What is ecchymosis?
A skin hemorrhage - large blotchy bruises
What is petechia?
Skin hemorrhages that are less than 1mm.
What is hemoptysis?
Respiratory tract hemorrhage - coughing up blood
What is epistaxis?
Nose bleeds.
What is hematemesis?
Vomiting blood.
What is hematochezia?
Anorectal bleeding.
What is melena?
Passage of black blood in stool from bleed in upper GI tract.
What is hematuria?
Blood in urine.
What is metrorrhagia?
Bleeding not related to normal monthly menses.
What is menorrhagia?
Profound menstrual bleeding.
How much blood can we lose and be ok?
Less than 500 ml
What happens if we lose 1000- 1500 ml of blood?
Circulatory shock.
How much blood loss is lethal?
1500 ml or more.
What is hematoma?
Compression of tissues.
What happens with intracerebral hemorrhage?
Stroke, death.
Slow chronic hemorrhage leads to what?
Iron deficiency anemia.
What type of hemorrhage has slower onset - subdural or epidural? And why?
Subdural - the lower pressure veins bleed more slowly than arteries.
What is thrombosis?
Clotting.
How does thrombosis take place?
transformation of fluid blood into a solid aggregate encompassing RBCs and fibrin.
What does thrombosis form?
A thrombus.
What are the 3 principle components of an intravascular coagulation?
- Coagulation factors. 2. Platelets. 3. Endothelial cells.
What are the 2 pathways for coagulation factors?
Endogenous (intrinsic) and exogenous (extrinsic).
What 2 things will platelets do?
- neutralize heparin and other anticoagulant factors 2. secrete thromboxane, which stimulates coagulation.
What do endothelial cells normally have?
Antithrombotic properties.
What happens when IL-1 and TNF activate endothelial cells?
They lose their negative charge and antithrombotic properties
Endothelial damage uses which coagulation factor pathway?
Intrinsic.
Tissue damage uses which coagulation factor pathway?
Extrinsic.
What is the first step in forming a thrombi?
Defect is covered with fibrin and platlets.
What is the second step in forming a thrombi?
Fibrin meshwork anchors RBCs into nascent thrombus.
What is the third step in forming a thrombi?
Fully formed thrombi consists of layers of fibrin and RBCs
What does intramural thrombi of the heart cause?
overlying Myocardial infarct.
What does valvular thrombi of the heart mimic?
endocarditis (small fibrinous excretions).
What do arterial thrombi cause?
atherosclerosis when attached to the walls, can be found in aortic aneurysms
Where is a venous thrombi found?
in dilated veins (vericose veins)
Where are microvascular thrombi found at?
Arterioles, capillaries, and venules.
How are thrombi classified?
On the basis of their location
What can deep venous thrombosis lead to?
Pulmonary embolism
Deep venous thrombosis is predisposed by Virchow’s triad, which is what 3 things?
- Stasis. 2. Hypercoagulability (inflammation, increased ESR) 3. endothelial damage.
Who is at risk for deep venous thrombosis?
Elderly people on transcontinental flights.
What are lines of zahn?
Distinct layering of cellular elements and fibrin that occur in atrial and venous thrombi.
What is occlusion of the lumen from a thrombi called?
Infarct.
What is lysis of the thrombus called?
reperfusion.
What does recanalization of the thrombus do?
reestablish blood flow
What is embolization of a thrombi?
Breaking off of a clot.
What is an embolus?
Undissolved materials like thrombus in blood.
Name 4 types of embolisms?
thromboemboli, liquid emboli, gaseous emboli, solid particle emboli.
What is the most common etiology for an embolism?
Thromboemboli
What can cause a liquid embolism?
oil, fat (long bone fracture), amniotic fluid
What can cause a gaseous embolism?
Air injection, caisson disease (decompression sickness, from N2)
What can cause a solid particle embolism?
cholesterol crystals, bone marrow (from fractures), tumor emboli
What can amniotic fluid emboli lead to?
DIC, especially postpartum.
What does pulmonary embolus clinically present with?
Chest pain, tachypnea, dyspnea.
95% of pulmonary emboli arise from what?
Deep leg veins.
Origin of venous thromboemboli?
Anywhere
Origin of arterial thromboemboli?
Left ventricle
What is white infarct typical of?
Arterial occlusion in solid organs with single blood supply (heart, kidney, spleen)
What is red infarct typical of?
Venous obstruction, like intestines and testis twisting.
What does the fate of infarcts depend on?
Their anatomical site, type of cells forming the tissue, circulatory status , extent of necrosis.
White infarcts are ________ areas.
Rimmed
What is volvulus?
Twisting.
What type of infarct is seen with volvulus?
Red infarct.
What are 3 possible causes of shock?
- Pump failure of the heart. 2. Loss of fluid from circulation. 3. Loss of peripheral vascular tone.
Pump failure leads to what type of shock?
Cardiogenic shock.
Loss of fluid from circulation lead to what type of shock?
Hypovolemic shock.
Loss of peripheral vascular tone leads to what type of shock?
Hypotensive shock.
What will loss of blood, myocardial or valvular disease, or vasodilation lead to?
Heart failure
What does heart failure lead to?
Decreased cardiac output.
What will decreased cardiac output lead to?
Decreased blood to tissues (hypoperfusion)
What will hypoperfusion lead to?
Cell anoxia.
What will cell anoxia lead to?
Shock and edema
What does shock lead to?
Coma, renal failure, lung failure, GI bleeding, death
What are the 3 clinical stages of shock?
- early or compensated shock. 2. Decompensated but reversible shock. 3. Irreversible shock.
What happens with the heart during compensated shock?
Tachycardia (beats faster).
What happens to arterioles during compensated shock?
Vasoconstriction - vital organ perfusion
What happens to urine production during compensated shock?
Reduced urine production
What happens with decompensated reversible shock?
hypotension, tachypnea and shortness of breath, oliuria, acidosis.
What happens with irreversible shock?
- Circulatory collapse. 2. marked hypoperfusion of vital organs. 3. Loss of vital functions.
