Disorders of Fluid Electrolyte, Acid-base balance and blood flow Flashcards
1
Q
Water Balance
Water comprises ?? total body weight.
A
50 - 60%
2
Q
Water Balance
What are the components of bodily fluids?
A
- intracellular fluids
- extracellular fluids
3
Q
Water Balance
Intracellular fluid makes up ?? of total fluids.
A
2/3
4
Q
Water Balance
Extracellular fluids make up ?? of total fluids.
A
1/3
5
Q
Water Balance
What 2 things are in extracellular fluid?
What percentages?
A
- interstitial fluid (80%)
- plasma (20%)
6
Q
Water Balance
Water balance is determined by what 2 things?
A
- fluid intake
- fluid loss
7
Q
Water Balance
Examples of fluid intake.
A
- food and water
- metabolism
8
Q
Water Balance
Examples of fluid loss.
A
- urine
- sweat
- lungs
- feces
9
Q
Structure and Function
Capillaries are ?? lying between arteries and veins.
A
vessels
10
Q
Structure and Function
Capillaries consist of only an ??.
A
intimal layer
11
Q
Structure and Function
Capillary Function
A
regulate fluid, electrolyte and nutrient exchange between blood and extracellular space
12
Q
Structure and Function
Capillaries can ?? to help repair injured areas.
A
proliferate
13
Q
Structure and Function
What 3 factors mediate exchange of nutrients across capillaries?
A
- hydrostatic pressure
- osmotic pressure
- integrity of endothelial cells
14
Q
Structure and Function
What is osmotic pressure determined by?
A
the amount of proteins in fluid
15
Q
Structure and Function
Lymph is composed of…
A
water, proteins and white blood cells
16
Q
Edema
A
accumulation of fluid in tissues
17
Q
Effusion
A
accumulation of fluid in body cavities
18
Q
What are the 2 types of edema?
A
- exudate
- transudate
19
Q
What type of edema has high protein?
A
exudate
20
Q
What type of edema has low protein?
A
transudate
21
Q
What type of edema is associated with an inflammatory response?
A
exudate
22
Q
What type of edema is associated with pitting?
A
transudate
23
Q
Transudate edema is caused by:
- decreased ??
- increased ??
A
- osmotic pressure
- capillary fluid pressure
24
Q
Clinical aspects of edema
Why is edema a problem?
A
- edema can result of underlying disease
- range from mild to severe
- can be fatal
25
Give two examples of fatal edema.
- cerebral edema
- pulmonary edema
26
# Types of Edema
Name for edema of the peritoneum.
ascites
27
# Types of Edema
Name for severe generalized edema.
anasarca
28
# Types of Edema
Name for edema of the lungs.
pleural
29
# Types of Edema
Name for edema around the heart.
pericardial
30
# Pathogenesis of Edema: Increased Hydrostatic Pressure
Hydrostatic edema may be due to ??.
impaired venous return
31
# Pathogenesis of Edema: Increased Hydrostatic Pressure
Hydrostatic edema is often observe in ??.
Why?
- lower extremities
- gravity, vein function, standing/sitting, lymphatic draining
32
# Pathogenesis of Edema: Alts in Osmotic Pressure
Osmotic edema is typically seen with low albumin; which is caused by?
- liver disease
- poor nutrition
- kidney disease
33
# Pathogenesis of Edema: Alts in Osmotic Pressure
Osmotic edema is considered which type of edema?
transudate (low protein)
34
# Pathogenesis of Edema: Lymphatic Obstruction
Lymphedema is the build of up fluid when...
lymphatics are damaged or blocked
35
# Pathogenesis of Edema: Lymphatic Obstruction
Lymphedema typically has ?? protein levels.
high
36
# Pathogenesis of Edema: Lymphatic Obstruction
Lymphedema is most commonly caused by...
the removal of lymph nodes
37
# Pathogenesis of Edema: Lymphatic Obstruction
T/F: Primary lymphedema is clinically more common than secondary lymphedema.
FALSE -- primary is typically caused by congenital and genetic abnormalities. secondary occurs when there is damage due to external forces
38
High protein edema is seen with what 2 events?
- observed with inflammation: leaky capillaries release water and plasma protein into interstitial space
- lymphedema: obstruction of lymphatics
39
# Water Balance
Euhydration
optimal state of water content as regulated by the brain
40
# Water Balance
overhydration
too much water
41
# Water Balance
What are the risks of overhydration?
- hyponatremia
- electrolyte imbalance
- fluid shifts
42
# Water Balance
Dehydration
deficiency of body water
43
# Water Balance
Dehydration is caused by?
- insufficient water intake
- excess water loss
44
Dehydration severity is categorized by .....
relative amount of lost body weight
45
Mild dehydration percentage
2% of body weight lost
46
moderate dehydration percentage
5% of body weight lost
47
severe dehydration percentage
8% of body weight lost
48
Symptoms of Dehydration
- headache
- rapid pulse
- thirst
- low urine output
- loss tissue elasticity (tenting)
49
Who is at greatest risk of dehydration?
- elderly: less water to begin with because loss of mass
- babies: cant communicated
50
Tonicity
osmolarity of solution relative to cell
51
# Classifications based on electrolytes in fluid loss
Normotonic
sweat
52
# Classifications based on electrolytes in fluid loss
Hypotonic
urine
53
# Classifications based on electrolytes in fluid loss
Hypertonic
diarrhea
54
Third Spacing characterisitics
- low urine output
- low BP
- increased weight
- puffiness
55
Third Spacing definition
shift of fluid from intrvascular space into another body space or cavity
56
What can cause third spacing
- ascites
- severe burns
- low oncotic pressure
57
Electrolytes
minerals that dissolve in water and carry an electrical charge
58
# electrolytes
Cations (+)
- sodium
- potassium
- calcium
- magnesium
59
# electrolytes
Anions (-)
- bicarbonate
- chloride
- phosphate
60
Hypokalemia hyperpolarizes the membrane:
- cells fire...
- decreases the...
- causes...
- fire less easily
- excitability of cells
- cardiac arrhythmias
61
Hypokalemia is caused by:
1. ?
2. ?
1. diuretics
2. eating disorders
62
What does hyperkalemia do to membrane potential?
- depolarizes (brings closer to 0)
- increases excitability
63
T/F: Hyperkalemia is common with normal kidney function.
FALSE -- hyperkalemia is uncommon with normal kidney function
64
# Electrolytes
Sodium function
- main extracellular cation
- important for controlling water movement
65
Hyponatremia pathogenesis
- low serum sodium (extracellular fluid hypotonic relative to intracellular fluid)
- water enters brain cells
- cerebral edema
66
# [](http://)
pH
the measure of hydrogen ion concentration within a solution
67
extracellular fluid pH
7.4
68
blood pH
7.35 - 7.45
69
Death can occur when pH is...
- less than 6.8
- greater than 8.0
70
Acidosis pH
below 7.35
71
alkalosis pH
above 7.45
72
# Buffering systems
Intracellular -- phosphate buffer
[H+] + [HPO4 2+] = [H2PO4-]
73
# Buffering systems
Plasma
carbonic acid-bicarbonate pair
74
# Buffering systems
protein buffering (hemoglobin)
proteins have negative charges, so thay can serve as buffers for H+
75
# buffering systems
renal buffering
secretion of H+ in the urine and reabsorption of HCO3-
76
# buffering systems
ion exchange (between ICF and ECF)
exchange of K+ for H+ in acidosis and alkalosis
77
# 4 categories of acid-base imbalances
Respiratory acidosis
elevation of pCO2 as a result of ventilation depression
78
# 4 categories of acid-base imbalances
Respiratory alkalosis
depression of pCO2 as a result of alveolar hyperventilation
79
# 4 categories of acid-base imbalances
metabolic acidosis
depression of HCO3- or an increase in noncarbonic acidds
80
# 4 categories of acid-base imbalances
metabolic alkalosis
elevation of HCO30 usually caused by an excessive loss of metabolic acids
81
What is the principal effect of acidosis?
depression of the CNS through decreases in synaptic transmission
82
What are the major concerns of deranged CNS function due the acidosis?
- disorientation
- coma
- death
83
# Respiratory Acidosis
Carbonic acid excess caused by elevated...
blood levels of CO2 (hypercapnia)
84
# Respiratory acidosis
hypercapnia may be due to:
- depression of respiratory center in brain that controls breathing rate - drugrs or head trauma
- paralysis of respiratory or chest muscle
- emphysema
85
# respiratory acidosis
?? compensates for repiratory acidosis by eliminating ?? and retaining ??.
- the kidneys
- hydrogen ions
- bicarbonate ions
86
# Metabolic Acidosis
Metabolic acidosis is caused by:
1. ??
2. ??
1. losss of bicarbonate through diarrhea or renal dysfunction
2. accumulation of acids (lactic acid or ketones)
87
# Metabolic Acidosis
compensation?
1. ??
2. ??
1. increased ventilation
2. renal excretion of hydrogen ions is possible
88
Alkalosis causes...
over excitability of the central and peripheral nervous systems
89
alkalosis can lead to:
- nervousness
- muscle spasms or tetany
- convulsions
- loss of consciousness
- death
90
respiratory alkalosis is due to...
low pCO2 (hypocapnea)
91
primary cause of respiratory alkalosis?
hyperventilation
92
what are other causes of respiratory alkalosis?
- oxygen deficienfy at high altitudes
- pulmonary disease and congestive heart failure
- acute anxiety
- fever
- early salicylate intoxication
- cirrhosis
- gram-negative sepsis
93
How can respiratory alkalosis be compensated?
- kidneys conserve hydrogen ions
- excrete bicarbonate ion
94
Metabolic alkalosis is caused by...
- excess vomiting = loss of stomach acid
- certain diuretics
- endocrine disorders-hyperaldosteronism
- heavy ingestion of antacids
- severe dehydration
95
T/F: metabolic alkalosis most commonly occurs with renal dysfunction.
TRUE - the body cannot rely of kidneys to combat metabolic alkalosis
96
Why is respiratory compensation difficult for metabolic alkalosis?
hypoventilation risks hypoxia
97
Which pH correction mechanism works the fastest?
buffer function works almost instantaneously
98
Which pH correction mechanism take minutes to hours?
respiratory mechanisms
99
Which pH correction mechanism take hours to days?
renal mechanisms
100
T/F: Kidneys can conserve and produce bicarb ions.
TRUE -- most effective regulator of pH; if kidneys fail, pH balance fails
101
active hyperemia
dilation of arteriols
- blushing, exercise, inflammation
102
passive hyperemia (congestion)
due to impaired venous outflow
- heart failure: pulmonary edema
103
hemorrhage
the escape of blood into the tissue
104
hemostasis stops hemorrhage by using...
vascular factors, platelets, and coagulation factors
105
When is blood coagulation considered pathological?
when it occurs inside of the vessel
106
What are the phases of normal hemostasis?
1. vascular system: vasoconstriction
2. platelet plug
3. coagulation-clot
107
# First Phase: Vasoconstriction
Injury to endothelial cell promote localized clot formation which start with:
- narrowing the lumen to minimize blood loss
- bringing hemostatic components of blood closer to vessel wall
108
# Second Phase: Platelets
Platelets are cell fragments of?
megakaryocytes
109
# Second Phase: Platelets
How long do platelets circulate in the blood?
approximately 10 days
110
# Second Phase: Platelets
Platelet function at rest?
minimal interaction with other blood components or the vessel wall
- intact endothelial cells normally inhibt platelet adherence and blood coagulation
111
What activates platelets?
contact with basement membrane
112
Activated platelet function?
- plug the defect = round and sticky aggregation (hemostatic plug)
- release secretions
- cause more platelets to aggregate
113
What do platelets secrete?
- ADP
- vasoactive amines
- thromboxane A2
114
# Platelet secretion
ADP function
- shape change
- granule release
- thromboxane A2 production
115
# Platelet secretions
vasoactive amines example
epinephrine
116
# platelet secretions
Thromboxane A2 structure and function
- metabolite of arachodonic acid
- amplifies the initial aggregation of platelets into a large platelet mass
117
Von Willebrand factor can be described as...
the framework for platelets
118
# Third Phase: Coagulation
Define coagulation.
clot formation
119
# Third Phase: Coagulation
What are the 2 pathways?
- intrinsic
- extrinsic
120
# Third Phase: Coagulation
What 2 molecules are needed for coagulation?
- calcium
- vitamin K
121
T/F: Platelets and coagulation factors are the same thing.
FALSE -- mutually dependent but complimentary
122
Coagulation inhibitors
tissue plasminogen activator (TPA) activates plasminogen to plasmin
- plasmin dissolves fibrin
123
hemmorrhage size classification (small to large)
- petechiae
- purpura
- ecchymosis
- hematoma
124
Hemrrhage: bleeding from large vessels
- trauma
- coagulation deficiency
125
Hemorrhage: bleeding from capillaries
- low platelet count
- vasculitis
126
# Consequences of hemorrhage
massive hemorrhage
blood loss, hypovolemic shock, death
127
# Consequences of hemorrhage
hematoma
compression of tissues
128
# Consequences of hemorrhage
intracerebral hemorrhage
stroke, death
129
# Consequences of hemorrhage
chronic hemorrhage
slow blood loss, iron deficiency anemia
130
What are the 4 types of abnormal hemostasis?
- abnormalities of small blood vessels
- abnormality of platelet formation
- deficiency of one or more plasma coagulation factors
- liberation of thromboplastic material into circulation
131
# Reduced Platelet Numebrs or Function
thrombocytopenia is caused by...
- genetic
- acquired (radiation)
- disease (leukemia)
- autoimmune
- hypersplenism
132
deficiencies of blood coagulation
usually hereditary and relatively rare
- hemophilia A
- hemophilia B
- von Willebrand's disease
133
Hemophilia:
- x-linked hereditary disease affecting males
- most common and best known
134
hemophilia A
- classic hemophilia = factor VIII (antihemophilic factor)
135
hemophilia B
christmas disease = factor IX
136
charateristics of hemophilia A
- spontaneous or traumatic subcutaneous bleeding
- blood in the urine
- bleeding in the moth, lips, tongue
- bleeding to the joints, CNS, GI
137
Hemophilia A treatment
- transfusion
- treated with missing factor
138
partial thrombloplastion time (PTT)
- measures time it takes for blood plasma to clot after adding artificial surface
- intrinsic and overall eficiency
139
prothrombin time (PT)
- time to clot after addition of tissue factor
- extrinsic pathway
140
thrombin time = fibrinogen assay
measures the level of fibrinogen
141
# Anti-coagulants
warfarin (caumadin)
- reduced amount of vitamin K availability
- decrease risk of clot formation
142
# anti-coagulants
heparin
inactivates thrombin
143
# anti-platelets
aspirin
inhibits thromboxane A2 formation
144
# Anti-platelets
plavix
inhibits ADP
145
thrombosis
- inappropiate acitvation of the hemostatic procss in an uninjured or slightly injured vessel
- never normal, always pathological
146
virchow's triangle in regards thrombosis formation
- endothelial injury
- abnormal local blood flow
- hypercoaguability
147
where do thrombi form?
- usually in large veins or arteries damaged by athersclerosis
- bifurcations
148
steps in formation of a thrombus?
1. platelet aggregation
2. blood coagulation-fibrin
3. further platelet agglutination
4. WBC adhere to platelets
5. clot grows larger
149
Thrombus outcomes
- grows by adding clot
- break loose and become embolus
- dissolve
- re-channel
150
ischemia
- lack of O2 to tissue
- due to obstruction
151
ischemia can be due to things other than vascular occlusion:
- torsion
- drowning
- CO
152
define infarct
ischemic necrosis
153
white infarction
- bloodless
- arterial obstruction in dense, solid tissue (liver, heart)
154
red infarction
- bloody
- occurs in loose spongy tissue
- dual blood supply
155
# Factors that influence the development of an infarct
Single or dual vascular supply
- tissues with dual supply will take longer to develop in infarct
- lungs and liver
156
# Factors that influence the development of an infarct
rate at which obstruction develops
- atherosclerosis takes a lifetime to develop into serious blockage
- an embolus can form instantaneously
157
# Factors that influence the development of an infarct
sensitivity of downstream tissue to ocygen deprivation
- neurons die within minutes of hypoxia
- fibroblast can last hours without oxygen
158
# Factors that influence the development of an infarct
oxygen content of blood
higher oxygen content will take longer for infarct to develop
159
Shock
inability of the cardiovascular system to meet the O2 demands of the body
160
Shock can signify the final stage of:
- severe hemorrhage
- bacterial sepsis
- burns
- MI
- severe soft tissue damage
161
What it the typical end result of shock?
multi-organ failure and death
162
Types of shock
- cardiogenic
- hypovolemic
- anaphylactic
- obstructive
- septic
163
obstructive shock
fluid in the pericardium
164
cardiogenic shock
- pump failure
- cannot maintain perfusion pressure
165
Disseminated intravascular coagulation (DIC)
- widespread clotting inside vessels
- can obstruct small blood vessels
- causes hemorrhaging bc of consumption of clotting factors and platelets
- always secondary to some other pathology
166
septic shock is associated with...
systemic bacterial infection = sepsis
- LPS, endotoxins
167
Stages of shock
- non-progressive
- progressive
- irreversible
168
characcteristics of irreversible shock
- circulatory collapse
- marked hypoperfusion of vital organs
- loss of vital functions
- multiorgan failure
- death
169
complications of shock
- acute respiratory distress syndrome
- acute renal dailure
- GI complications
- disseminated intravascular caogualation
- multiple organ dysfunction syndrome
