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Pathophysio > Edema > Flashcards

Edema Flashcards

1
Q

What is edema?

A

Excessive accumulation of fluid in the interstitial spaces of body.
Caused by disturbances in the mechanism of fluid interchange between capillaries, tissue spaces and lymphatic vessels

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2
Q

What is the classification of edema?

A
  • General (Affecting four legs)
  • Focal (Affecting local area of the body) - Asymetric
  • Regional (Affecting a certain region) - Symetric
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3
Q

What is Anasarca and what can cause it?

A

General swelling (edema) and causing weight edema and serous fluid seeps into the tissues and accumulates.

The edema can be pitting or non-pitting edema.

Can be caused due to:

  • Heart problems
  • Kidney failure
  • Liver failure
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4
Q

What are more exact reasons for edema?

A
  • Inflammation in body - Exudation

- Due to circulatory imbalances

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5
Q

What are the mechanisms of edema formation?

A

4 mechanisms

  • Increased capillary hydrostatic pressure
  • Increased capillary permeability
  • Decreased plasma oncotic pressure
  • Lymphatic obstruction
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6
Q

Local causes for increased capillary hydrostatic pressure are abscesses, tumors and thrombi which can cause venous occlusion or vascular compression. What is a common development that all of them cause or lead to?

A

Venostasis

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7
Q

What is prior to venostasis during edema formation?

A

Increased hydrostatic pressure in the capillaries

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8
Q

What are local causes of edema due to increased capillary hydrostatic pressure?

A

Abscess, tumors and thrombi which can cause venous occlusion or vascular compression.
All of them cause Venostasis.

Prior to Venostasis is increased hydrostatic pressure.
Blood flow is impaired and under Hypoxic conditions, capillary wall become more permeable –> Allowing leakage of fluids.

In later stages of capillary wall being more permeable even components of blood like proteins can leave the intravasculare space.

This fluid + proteins can accumulate and form Edema.

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9
Q

What are general causes of edema due to increased hydrostatic pressure?

A

Chronic or congestive heart failure is a pathological condition where the heart stops to work as a pump.
= Pumping capacity is impaired

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10
Q

What is typical for chronic insufficiency of right ventricle?

A

Decreased systolic pressure and accumulation in front of right ventricle and atrium leading to increased venous pressure and hydrostatic pressure in the capillaries

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11
Q

Due to high hydrostatic pressure in capillaries during cardial edema there is?

A

A continual transudation of fluid into interstitial space.

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12
Q

Which is the principal organ when it comes to inactivation, degradation and metabolism of many hormones?

A

The Liver

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13
Q

What is dependent edema?

A

Edema in a part of body due to gravitational forces, mainly in legs

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14
Q

Chronic insufficiency of cardial edema is often characterized by?

A

Decreased systolic pressure in (right) ventricle and decreased cardiac filling pressure

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15
Q

What can be reason for capillaries becoming more permeable during edema formation?

A

INFLAMMATION

  • Can be from inflammatory mediators as for example Histamine
  • Accumulation of osmotic compounds in the area of inflammation
  • Microthrombosis

HYPERSENSITIVITY
- Mediators of anafylaxis

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16
Q

Albumin is……

A
  • A protein: Low molecular weight molecular protein so easily “lost” during permeable changes.
  • Synthesized in the liver and it’s level within the blood depends on several factors.
  • Principal contributor to plasma oncotic pressure
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17
Q

Reasons for increased losses of Albumins can be

A

Increased losses

  • By GIT
  • By kidneys
  • By massive effusive diseases
  • By skin
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18
Q

Reasons for decreased synthesis of albumin in liver due to

A
  • Damaged hepatocytes
  • Lack of substrates for proteosynthesis due to
    • Starvation, malnutrition
    • Action of inhibitors of proteosynthesis e.g
      antibiotics drugs
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19
Q

Regardless reason for loss of Albumin _________ always occurs.

A

Hypoalbuminemia

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20
Q

What is the reason for Hypoalbuminemia?

A
  • Decreased oncotic pressure in the capillaries which can lead to
    1. Shift of intravascular fluid into ISF
    2. Decreased reabsorption of fluid from IS space into capillaries

These two in turn lead to decreased in blood volume –> Increased releasing of Aldosterone + ADH –> Retention of water and Na+ leading to Nutritional Edema

Nutritional Edema is usually due to Malnutrition

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21
Q

Lymphatic obstruction can occur due to…

A

Drainage can be impaired when lymph vessels are narrowed or not fully developed, inflammed or occluded;

  • Hypoplasia and Aplasia lymph nodes
  • Compression due to tumors
  • Occlusion due to tumors
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22
Q

Lymphoedema can occur due to….

A

Obstruction of lymph vessels.

  • Increased retention of proteins
  • Oncotic pressure in interstitial space exceeds oncotic pressure in vessels which promotes capillary filtration and lymphoedema can then occur
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23
Q

What is Ascites?

A

Accumulation of transudate in peritoneal cavity

24
Q

What is main reason for Ascites development?

A

Principal cause is liver damage due to

  • parasite infestation
  • accumulation of fat in liver: Fatty liver
25
Q

What are the main development of Ascites due to liver damage?

A
  1. Decreased albumin synthesis - Liver loses several functions
  2. Decreased inactivation of ADH and Aldosterone in the liver - Inactivation of hormones due to portal hypertension
26
Q

Damage of liver during Ascites formation liver loses several functions like…

A
  1. Decreased synthesis of albumin: Decreased protein synthesis
    - Decreased blood oncotic pressure
    Leading to fluid shifting from intravascular space into peritoneal cavity
  2. Inactivation of hormones due to portal hypertension
    - ADH + aldosterone function will be prolonged which eventually leads to increased BV but due to low Albumin level it causes a shift of fluid from vessels into tissues where the fluid accumulates and mainly in peritoneal cavity
27
Q

What is the only way to interrupt Circulus vitiosus “Vitious circle”

A

To increase oncotic pressure in the blood

  • Can be done by increased protein level, mainly Albumin in the blood
  • Prevents the fluid from “escaping” from the vessels and accumulate in peritoneal cavity
28
Q

What is the principal hormone for IC K+ regulation?

A

Aldosterone

29
Q

Neophropathy is characterized by?

A

Decreased reabsorption of K+ by kidneys

30
Q

What characterizes Cushing’s disease?

A

Too much Aldosterone released

  • Promotes K+ excretion
  • Under pathological conditions mainly in Alkalosis
31
Q

What is the function of K+ in organism?

A
  • Maintaining IC osmotic pressure

- Imp for synthesis / breakdown of energy-rich complexes: ATP/ADP/AMP

32
Q

What can cause disorders / imbalances of K+

A
  • Caused by decreased intake when diet is low in K+ or when intake of food is low in eg. anorectic animals
  • Kidneys are better in excretion than in retention and require 2 - 3 days for conversion.
    This lacking period is long enough to cause Hypokalemia
33
Q

What is typical for Metabolic alkalosis?

A
  • Causes H+ ions of ECF to decrease and in order to keep electric charges there’s a shift of H+ from ICF to ECF and exchanging with ECF K+.

This leads to K+ levels of ECF to decrease.

34
Q

A change of K+ ions from ECF into ICF is stimulated by?

A

Insulin and Glucose causing Metabolic alkalosis

35
Q

When does paradoxic aciduria occur?

A

When there’s a shortage / decrease of K+ intake

36
Q

During paradoxic aciduria when K+ is being exchanged with H+ in ICF it causes ICF and ECF to become what?

A

Alkalosis of ECF

Acidosis of ICF

37
Q
  • Aldosterone release
  • More Na+ being retained,
  • Cations being secreted but K+ ions are depleted and leading to H+ ions to be secreted and H+ ions in blood decreases

This is typical for?

A

Hypovolemia / Metabolic alkalosis

38
Q

Polyuria may be a result due to

A

Low levels of K+. (Hypokalemia)
Which in its turn promote prostaglandin synthesis.
- Prostaglandins reduce the tubules sensitivty to ADH and causes Polyuria

39
Q

Hyperkalemia can be due to

A

Decreased excretion of K+ by kidneys due to

  • Anuria
  • Oligura
  • Postrenal blockage of excretory of urinary tract
  • Hypoaldosteronism (Addison’s disease)
40
Q

Hemolysis of cells can cause a change of K+ ions in what way?

A

Leakage of K+ ions from IC to blood

- Causing an increase of K+ in blood = Hyperkalemia

41
Q

What is the cardiovascular effects of hyperkalemia?

A

Causes a change in the ECG

  • spiked T waves
  • flattened P waves
  • prolonged P-R interal and QRS interal
  • decrease R wave amplitude

Bradycardia
Complete heart block
Cardiac arrest

42
Q

What is the neuromuscular effects of hyperkalemia

A

Causes a

  • decrease in resting membrane potential below threshold
  • impaired repolarization, cell excitation
  • sustained depolarization
43
Q

What is the main regulators of Na+

A

Aldosterone and Atrial natriuretic factor, ANP.

44
Q

What is Na+ role in homeostasis?

A

Principal osmotic compound and involved in the very imp osmolality and distribution of H2O btw EC and IC fluid compartment

45
Q

What is the mechanism of Hyponatremia disorder?

A
  • Increased losses - E.g. juices rich in Na+ are intestinal fluid. Losses due to diarrhea
  • Decreased intake - E.g in diet or Ru
  • Sweating
46
Q

What stimulates release of Renin-Angiotensin System? And what happens?

A

Low Na+ levels in plasma

Stimulation of RAS case a release of Aldosterone from adrenal cortex : Leading to increased reabsorption of Na+ by the kidneys
(Retention of Na+ and H2O by kidneys)

47
Q

What stimulates release of ANP?

A

Increased Na+ levels and hypervolemia (Leading to distension/widening of stretch receptors of hearts atriums)

48
Q

Why is low levels of Na+ so dangerous, having severe effects?

A

When trying to restore osmolality it causes excretion of water.
This leads to a drop of blood pressure, circulatory failure and shock can develop.

49
Q

What is the mechanism of Hypernatremia disorder?

A
  • Increased retention of Na+, intake of Na+ and by infusion of saline and sodium bicorbonate, NaHCO3
  • Increased H2O loss from body
50
Q

Hypernatremia very often lead to__________

A

NaCl poisoning

51
Q

What is the major anion in ECF?

A

Chloride

52
Q

Which anion provides electroneutrality in relation to Na?

A

Chloride

53
Q

Chloride is indirectly regulated by________ and why?

A

Indirectly regulated by Aldosterone since it passively follows Na+

Both of them are absorbed from GIT and in the nephron

54
Q

Hypochloraemia is often associated with?

A

Often associated with Na+ deficiency.
1. Metabolic acidosis and prolonged vomiting

  1. Loss of GI fluid, perspiration, renal failure
  2. Also due to K+ retention which can cause loss of Na+.
    When loss of Cl follows Na+ loss, Hypochloraemia may result
55
Q

Dehydration and Polydipsia can be signs of?

A

Hypochloraemia and Hyponatremia

56
Q

Hyperchloraemia is often associated with?

A

Associated with Na+ excess

  1. Dietary excess or excessive I.V infusion of NaCl in Na+ depletion therpay
  2. Acid-base imbalances: Not dependent on Na+

Pathophysio (5 decks)

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