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Systems: Cardiovascualar AB > Congestion and Oedema: Pathophysiology > Flashcards

Congestion and Oedema: Pathophysiology Flashcards

1
Q

What is the fundamental truth about the flow of water?

A

It flows downhill, down the pressure gradient

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2
Q

What is Darcy’s law?

A

Q=(delta)P/R

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3
Q

What is congestion?

A

Relative excess of blood in vessels od tissue or organ

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4
Q

What kind of process is congestion?

A
  • Passive process

- Secondary phenomenon

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5
Q

Is congestion acute or chronic?

A

Can be either

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6
Q

What types of congestion are there?

A
  • Local acute congestion
  • Local chronic congestion
  • Generalised acute congestion
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7
Q

Give an example of local acute congestion.

A

Deep vein thrombosis

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8
Q

Give an example of local chronic congestion.

A

Hepatic cirrhosis

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9
Q

Give an example of generalised acute congestion.

A

Congestive cardiac failure

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10
Q

How does DVT relate to congestion?

A

Vein is blocked causing localised acute congestion

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11
Q

How can DVT cause ischaemia and infarction?

A
  • Blood backs up in the veins, venules and capillaries
  • Decreased outflow of blood
  • Local, acute congestion
  • Decreased pressure gradient
  • Decreased flow across system
  • No O2 delivery
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12
Q

What is hepatic cirrhosis?

A

Regenerative nodules of hepatocytes with intervening fibrosis

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13
Q

What causes hepatic cirrhosis?

A

Liver damage e.g. HBV, alcohol

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14
Q

What does hepatic cirrhosis result in?

A

Loss of normal architecture leading to altered hepatic flow

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15
Q

What does blocked portal blood flow lead to?

A
  • Congestion in portal vein and branches
  • Increased portal venous pressure
  • Collateral circulation- several sites anastomose with systemic circulation
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16
Q

What type of risk does local chronic congestion pose?

A

Haemorrhage risk

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17
Q

What clinical appearances can portal-systemic shunts result in?

A
  • Oesophageal varices

- Caput medusae

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18
Q

What is congestive cardiac failure?

A
  • Heart unable to clear blood, right and left ventricles

- Ineffective pump

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19
Q

What is the pathophysiology of congestive cardiac failure?

A
  • Decreased CO
  • Decreased renal GFR
  • Increased amount of fluid in body
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20
Q

What does an increased amount of fluid in the body lead to?

A

Increased fluid overload in the veins

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21
Q

What is the treatment for fluid overload in the veins?

A

Diuretics

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22
Q

What are the effects of congestive heart failure?

A
  • Heart cannot clear blood from ventricles
  • Back pressure, blood dammed back in veins
  • Liver experiences central venous congestion
  • Acute and chronic changes in lungs leading to pulmonary oedema
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23
Q

What is central venous congestion associated with?

A
  • Right heart failure
  • Increased JVP
  • Hepatomegaly
  • Peripheral oedema
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24
Q

What is pulmonary oedema associated with?

A

-Left heart failure
-Crepitations in the lungs
Tachycardia

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25
Q

What appearance does the liver take with hepatic central venous congestion?

A
  • Nutmeg liver

- Red/brown + pale spotty appearance macroscopically

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26
Q

What is the red part of the nutmeg liver in hepatic central venous congestion?

A
  • Pericentral hepatocytes

- Stasis of poorly oxygenated blood

27
Q

What is the pale part of the nutmeg liver in hepatic central venous congestion?

A
  • Periportal hepatocytes

- Relatively better oxygenated due to proximity of hepatic arterioles

28
Q

What is normal microcirculation?

A

Constant movement of fluid through capillary beds: process of dynamic equilibrium

29
Q

What is normal microcirculation driven by?

A

Hydrostatic pressure from the heart

30
Q

What is normal microcirculation balanced by?

A

Osmotic pressures and endothelial permeability

31
Q

Where does filtratiuon occur in the normal microcirculation?

A

From capillary beds to interstitium

32
Q

Why does filtration occur at the arterial side?

A

Capillary hydrostatic pressure > capillary oncotic pressure

33
Q

Why does reabsorption occur at the venous side?

A

Capillary oncotic pressure > capillary hydrostatic pressure

34
Q

What 3 components affect net flux and filtration?

A
  • Hydrostatic pressure
  • Oncotic pressure
  • Permeability characteristics and area of endothelium
35
Q

What do disturbances of normal components lead to?

A

Oedema

36
Q

What is oedema?

A

Accumulation of abnormal amounts of fluid in the extravascular space

37
Q

Give examples of extravascular space.

A
  • Intracellular tissue space (extracellular space)

- Body cavities

38
Q

What is peripheral oedema?

A

Increased interstitial fluid in tissues

39
Q

What is an effusion?

A

Fluid collections in body cavities

40
Q

Give 3 examples of effusions.

A
  • Pleural effusion
  • Pericardial effusion
  • Joint effusions
41
Q

What is an effusion in the abdominal cavity known as?

A

Ascites

42
Q

What are the characteristics of a transudate oedema?

A
  • Alterations in the haemodynamic forces which act across the capillary wall
  • Cardiac failure, fluid overload
  • Not much protein/albumin
  • Lots of H2O and electrolytes
  • Low specific gravity
43
Q

What are the characteristics of an exudate oedema?

A
  • Part of the inflammatory process due to increased vascular permeability
  • Tumour, inflammation, allergy
  • Higher protein/albumin content
  • H2O and electrolytes
  • High specific gravity
44
Q

What is the pathophysiology of pulmonary oedema with left ventricular failure?

A
  • Increased left atrial pressure causing passive retrograde flow to pulmonary veins, capillaries and arteries
  • Increased pulmonary vascular pressure
  • Increased pulmonary blood flow
  • Increased capillary hydrostatic pressure causing increased filtration and pulmonary oedema
45
Q

What is the pathophysiology of pulmonary oedema in the lungs?

A
  • Perivascular and interstitial transudate
  • Progressive oedematous widening of alveolar space
  • Accumulation of oedema fluids in alveolar spaces
46
Q

What is the pathophysiology of peripheral oedema?

A
  • Right heart failure
  • Blood retained in systemic veins
  • Congestive cardiac failure
47
Q

Why does right heart failure lead to peripheral oedema?

A

Cannot empty right ventricle in systole

48
Q

Why does blood retained in systemic veins lead to peripheral oedema?

A

Increased pressure in capillaries leads to increased filtration and peripheral oedema

49
Q

Why does congestive cardiac failure lead to peripheral oedema?

A
  • Right and left ventricles fail
  • Pulmonary oedema and peripheral oedema at the same time
  • All about hydrostatic pressure
50
Q

What does lymphatic obstruction cause?

A

Hydrostatic pressure upset

51
Q

What happens if the lymphatic system is blocked?

A

Lymphoedema

52
Q

Why might someone with breast cancer develop lymphoedema?

A
  • May require radiotherapy to axilla
  • Causes fibrosis
  • Decreased outflow
  • Oedema of upper limb
53
Q

What is the pathophysiology of oedema in abnormal renal function?

A
  • Abnormal renal function results in salt and H2O retention
  • Secondary in heart failure due to reduced renal blood flow
  • Primary in acute tubular damage
54
Q

What is decreased renal function a result of?

A
  • Increased salt and H2O
  • Increased fluid volume
  • Secondary increased hydrostatic capillary pressure
  • Oedema
55
Q

What does capillary oncotic pressure require?

A

Normal protein levels

56
Q

What can lead to hypoalbuminaemia?

A
  • Nephrotic syndrome
  • Hepatic cirrhosis
  • Malnutritions
57
Q

Why does nephrotic syndrome lead to hypoalbuminaemia?

A
  • Leaky renal glomerular basement membrane
  • Lose proteins
  • Generalised oedema
58
Q

Why does hepatic cirrhosis lead to hypoalbuminaemia?

A
  • Diffuse nodules and fibrosis in liver

- Liver unable to synthesis enough protein

59
Q

Why does malnutrition lead to hypoalbuminaemia?

A

Insufficient intake of protein

60
Q

What is the pathophysiology of low protein oedema?

A
  • Oncotic pressure

- Transudate

61
Q

What is the pathophysiology of permeability oedema?

A
  • Endothelial permeability

- Exudate

62
Q

Why does damage to the endothelial lining lead to oedema?

A
  • Increased pored in membrane
  • Leads to osmotic reflection coefficient of endothelium decreases towards 0
  • Proteins and larger molecules can leak out
63
Q

Give examples of when oedema due to permeability of endothelium may occur?

A
  • Acute inflammation such as pneumonia

- Burns

Systems: Cardiovascualar AB (42 decks)

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