Edema And Shock

Question 1

Which are the starling forces and what determined them?

Answer 1

The Starling forces determine fluid movement through capillary membranes, there are 4 forces: Pc, Pi, TTc, TTi.

Question 2

Which Starling’s force pushed fluid out of the capillary?

Answer 2

Pc = Capillary pressure.

Question 3

Which Starling’s pressure pushed fluid into of the capillary?

Answer 3

Pi = Interstitial fluid pressure.

Question 4

Which Starling’s pressure pull fluid into of the capillary?

Answer 4

TTc = Plasma Colloid Osmotic Pressure.

Question 5

Which Starling’s pressure pull fluid out of the capillary?

Answer 5

TTi = Interstitial fluid colloid osmotic pressure.

Question 6

What is the Kf?

Answer 6

Filtration constant, measure of capillary permeability.

Question 7

What’s going to cause an increase in a hydrostatic pressure inside the capillaries?

Answer 7

1) CHF (Elevated of the central venous pressure).
2) Venous thrombosis.
3) Compression veins.
4) Sodium and water retention.

Question 8

What’s going to cause an increase capillary permeability ?

Answer 8

Infections and septic shock.
Toxins.
Burns.

Question 9

What’s going to cause an decrease plasma colloid osmotic pressure?

Answer 9

Nephrotic syndrome.
Liver disease.
Protein malnutrition.
Protein-losing enteropathy.

Question 10

What’s going to cause an increase interstitial colloid osmotic pressure?

Answer 10

Lymphatic obstruction.

Question 11

Which are the major causes of edema?

Answer 11

1) Increase capillary pressure.
2) Increase capillary permeability.
3) Increase interstitial fluid colloid osmotic pressure.
4) Decrease plasma proteins.

Question 12

What is the definition of edema?

Answer 12

Excess of fluid outflow into interstitium.

Question 13

What is a pitting edema?

Answer 13

Excess amount of fluid in absence of additional colloid.

Question 14

What causes Non-pitting edema?

Answer 14

Colloid in interstitial fluid.

Question 15

What is the Transudate ?

Answer 15

Protein-poor edema fluid caused by increased capillary pressure or decreased plasma protein.

Question 16

What is the Exudate?

Answer 16

Protein-rich edema fluid caused by increased capillary permeability.

Question 17

How going to find the Systemic vascular resistance and cardiac output in Hypovolemic? And what will be the treatment?

Answer 17

SVR: Increased.
CO: Decreased.
Rx: I.V. Fluids / blood.

Question 18

How going to find the Systemic vascular resistance and cardiac output in Cardiogenic shock? And what will be the treatment?

Answer 18

SVR: Increased.
CO: Decreased.
Rx: Dobutamine.

Question 19

How going to find the Systemic vascular resistance and cardiac output in Sepsis/anaphylaxis shock? And what will be the treatment?

Answer 19

SVC:Decreased.
CO:Increased.
Rx: Antibiotics, I.V. Fluids and Norepinephrine.

Question 20

How going to find the Systemic vascular resistance and cardiac output in Neurogenic shock? And what will be the treatment?

Answer 20

SRV: Decreased.
CO: Decreased.
Rx: I.V. Fluids, Spinal cord injury = Steroids.

Question 21

What types of shock are known as a low output heart failure?

Answer 21

Hypovolemic shock and Cardiogenic shock

Question 22

What is the shock with high output heart failure?

Answer 22

Sepsis/anaphylaxis shock.

Question 23

What are the causes of hypovolemic shock?

Answer 23

Loss of blood and Severe burns (insensible fluid loss).

Question 24

What can cause Cardiogenic shock?

Answer 24

Myocardial infarction, Pulmonary embolism, CHF, Arrhythmias, Cardiac tamponade, Tension pneumothorax and Cardiac contusion.

Question 25

Which are the best locations for the collocation of a central lines?

Answer 25

Femoral, subclavian, internal Jugular.

Question 26

Why the femoral central line cannot stay in place more tha 5-7 days?

Answer 26

Risk of infection.

Question 27

How do the heart failure impact the starling forces of fluid movement through capillaries?

Answer 27

Increase capillary hydrostatic pressure (Pc).

Question 28

How do the liver failure impact the starling forces of fluid movement through capillaries?

Answer 28

Decrease plasma colloid osmotic pressure.

Question 29

How do the Oliguric renal failure impact the starling forces of fluid movement through capillaries?

Answer 29

Increase capillary hydrostatic pressure.

Question 30

How do the infections and toxins impact the starling forces of fluid movement through capillaries?

Answer 30

Increase capillary permeability.

Question 31

How do the nephrotic syndrome impact the starling forces of fluid movement through capillaries?

Answer 31

Decrease plasma colloid osmotic pressure.

Question 32

How do the lymphatic blockage impact the starling forces of fluid movement through capillaries?

Answer 32

Increase interstitial colloid pressure.

Question 33

How do the burns impact the starling forces of fluid movement through capillaries?

Answer 33

Increase capillary permeability.

Question 34

How do the diuretic administration impact the starling forces of fluid movement through capillaries?

Answer 34

Decrease capillary hydrostatic pressure.

Question 35

How do the I.V. Infusion of albumin or clotting factors impact the starling forces of fluid movement through capillaries?

Answer 35

Increase plasma colloid osmotic pressure.

Question 36

How do the venous insufficiency impact the starling forces of fluid movement through capillaries?

Answer 36

Increase capillary hydrostatic pressure.

Question 37

What are some causes of Cardiogenic shock?

Answer 37

MI, cardiac tamponade, tension pneumothorax, cardiac contusion, pulmonary embolism, CHF, Arrhythmias.

Question 38

How is the skin of a patient different in Cardiogenic shock compared to septic shock?

Answer 38

Cardiogenic shock: Cold, Clammy, Cyanotic and Poorly perfused.
Septic shock: initially warm and flushed.

Question 39

What does the filtration constant (Kf) give you a measure of?

Answer 39

Capillary permeability.

Question 40

What types of problems will increase capillary permeability and increase Kf?

Answer 40

Sepsis, some bacterial toxins and burns.