Edema, Hemorrhage, Congestion and Shock Flashcards
(105 cards)
1
Q
edema
A
increased fluid in the extracellular matrix
2
Q
hyperemia
A
increased flow
3
Q
congestion
A
increased backup
4
Q
hemorrhage
A
extravasation
5
Q
hemostasis
A
keeping blood as a fluid
6
Q
thrombosis
A
clotting blood
7
Q
embolism
A
downstream travel of a clot
8
Q
infarction
A
death of tissues w/o blood
9
Q
shock
A
circulatory failure/collapse
10
Q
fluid collection in lung
A
hydrothorax
11
Q
fluid collection in heart
A
hydropericardium
12
Q
fluid collection in abdominal cavity
A
ascitis
13
Q
fluid collection in entire body
A
anascara
14
Q
mechanism of edema
A
- increased vascular hydrostatic pressure
- decreased plasma oncotic pressure
- lymphatic obstruction
- sodium and water retention
- inflammation
15
Q
increased hydrostatic pressure due to
A
impaired venous return
16
Q
impaired venous return due to
A
- congestive heart failure/constrictive pericarditis
- cirrhosis of liver
- venous obstruction or compression by thrombosis, external pressure or LE inactivity
17
Q
mechanism of congestive heart failure
A
heart not pumping blood effectively causing backing of blood in veins
18
Q
mechanism of cirrhosis of liver
A
scarring of liver impairs return of blood through portal vein, increased back pressure in smaller veins causes ascites
19
Q
mechanism of venous obstruction
A
back up of blood causes edema of surround tissues
20
Q
arteriolar dilation caused by
A
- heat
- neurohumoral dysregulation
21
Q
reduced plasma oncotic pressure leads to
A
protein losing glomerulopathies - leaky capillaries cause loss of albumin
22
Q
causes of reduced plasma oncotic pressure
A
- liver cirrhosis - reduced albumin synthesis
- malnutrition
- protein losing gastroenteropathy
23
Q
lymphatic obstruction leads to
A
impaired lymphatic drainage - lymphedema
24
Q
causes of lymphatic obstruction
A
- inflammatory
- neoplastic
- postsurgical
- postirradiation
25
examples of lymphedema
- filiariasis causing elephantiasis
| - irradiation of breast and axilla for treatment of breast cancer causing upper limb edema
26
sodium and water retention
excessive water intake with renal insufficiency
27
increased tubular reabsorption of sodium (salt) occurs in
-renal hypoperfusion
| increased oncotic pressure
28
increased salt retention causes water retention and leads to
- increased hydrostatic pressure (due to intravascular fluid volume expansion)
- decreased vascular colloid osmotic pressure (due to dilution)
29
subcutaneous edema caused by
cardiac or renal disease
30
pulmonary edema
impedes oxygen diffusion
31
brain edam caused by
herniation of brain stem or impedes vascular supply to brain stem
32
transudate
Protein and cell poor fluid
Specific gravity: less than 1.012
Protein content: less than 3 gms/dl
Lactic dehydrogenase low
33
example of transudate
cardiac failure and decreased protein levels
34
exudate
Protein and cell rich fluid
Specific gravity: more than 1.012
Lactic dehydrogenase high
35
example of exudate
inflammation
36
where does dependent edema occur
in extremities and gravity prone areas of body
| ex. heart failure
37
pitting edema
When skin and underlying soft tissues with edema are compressed with fingers, the impressions remain
38
pitting edema is associated with
heart failure and is transudate
39
hypermeia and congestion caused by
locally increased blood volumes
40
hyperemia
- active process of arteriolar dilation
| - increased blood flow leading to erythema
41
example of hyperemia
inflammation, muscle during exercise
42
types of congestion
1. passive process
| 2. cyanosis
43
passive process of congestion
reduced outflow of blood from a tissue
44
cyanosis of congestion due to
red cell stasis and accumulation of deoxygenated Hb
45
chronic passive congestion caused by --- heart failure
left
46
left heart failure causes back up of blood in
lungs --> lack of blood flow --> chronic hypoxia --> schema tissue injury and scarring
47
what are heart failure cells
hemosiderin-laden macrophages found in alveoli
48
acute hepatic congestion
- distended central vein and sinusoids
- ischemic centrilobular hepatocytes
- fatty change in periportal hepatocytes
49
chronic passive congestion caused by -- sided heart failure
right
50
right sided heart failure causes blood to backup in
liver bc R ventricle is unable to pump blood out efficiently
51
gross appearance of chronic passive congestion of liver
centrilobular regions red-brown and slightly depressed; accentuated against zones of uncongested tan liver (nutmeg liver)
52
microscopic appearance of chronic passive congestion of liver
sinusoidal dilation, centrilobular hemorrhagic necrosis
53
hemorrhage
extravasation of blood into the extravascular space
54
hematoma
hemorrhage contained within a tissue
55
petechiae
minute 1-2 mm hemorrhages into skin, mucous membranes or serosal surfaces
56
petechiae are associated with
locally increased intravascular pressure, low platelet counts of defective platelet function
57
purpura
hemorrhages > 3 mm
58
pupura can be associated with
same disorder that cause petechia
| -can be secondary to trauma, vasculitis or increased vascular fragility (eg. amyloidosis)
59
ecchymoses
larger (>1 -2cm) subcutaneous hematomas due to trauma
60
ecchymoses color change caused by
macrophages phagocytize RBCs; hemoglobin (red-blue color) -->converted into bilirubin (blue-green color) --> hemosiderin (gold-brown color)
61
clinical significane of hemorrhage depends on
1. volume and rate of bleeding
| 2. site of hemorrhage
62
large volume and rate of bleeding can cause
hemorrhagic (hypovolemic) shock
63
intracranial hemorrhage causes increase in
pressure compromising blood supply or cause herniation of brainstem
64
chronic or recurrent external blood loss can cause
anemia
| eg. peptic ulcer, menstrual bleeding
65
hemothorax
hemorrhage in pleural cavity
66
hemopericardium
within pericardial sac
67
hemoperitoneum
within peritoneal cavity
68
shock is characterized by
systemic hypotension due to reduced cardiac output or reduced effective circulating blood volume
69
consequence of shock
impaired tissue perfusion and cellular hypoxia
70
cardiogenic shock due to
failed pumping of blood by heart
71
hypovolemic shock
loss of blood or plasma volume (massive hemorrhage, fluid loss from severe burns) leads to low volume of blood for circulation
72
septic shock results from
vasodilation and peripheral pooling of blood in bacterial or fungal infections
73
septic shock is associated with
severe hemodynamic and hemostatic derangements
74
at risk patients for septic shock
diabets
| immunocompromised
75
septic shock most frequently triggered by gram -- bacteria
positive
76
mechanism of septic shock
- free lipopolysaccharide released by degraded bacteria binds to LPS binding protein and CD14 on monocytes and macrophages
- causes increased levels of IL-1, IL-6, TNF, IL-8
77
septic shock can lead to
- systemic vasodilation
- decreased myocardial contractility
- endothelial injury
- activation of coagulation system
78
metabolic abnormality of septic shock
- insulin resistance and hyperglycemia
- pro-inflammatory cytokines suppress insulin release while simultaneously promoting insulin resistance
- hyperglycemia decreases neutrophil function- suppressing bactericidal activity
79
in septic shock initially there is an acute surge in
glucocorticoid production, then there is adrenal insufficiency and a function deficit of glucocorticoids from depression of adrenal glands or frank adrenal necrosis due to DIC
80
organ dysfunction of septic shock caused by
- Systemic hypotension, interstitial edema, and small vessel thrombosis
- High levels of cytokines and secondary mediators can decrease myocardial contractility and cardiac output
81
increased vascular permeability and endothelial injury can lead to
adult respiratory distress syndrome
82
severity and outcome of septic shock depends on
extent and virulence of infection, immune status of host, presence of other co-morbid conditions and pattern and level of mediator production
83
treatment of septic shock
- antibiotics
- intensive insulin therapy for hyperglycemia
- fluid resuscitation to maintain systemic pressures
- corticosteroids to correct relative adrenal insufficiency
84
clinical presentations of septic shock
Increased respiratory rate, increased heart rate, low blood pressure, fever, chills oliguria, warm skin, confusion
85
toxic shock syndrome caused by
toxin A
| -superantigen causes septic shock by widespread nonspecific activation of T cells
86
clinical presentations of septic shock
Increased respiratory rate, increased heart rate, low blood pressure, fever, chills oliguria, warm skin, confusion
87
neurohumoral mechanisms maintain cardiac output and BP by
- baroreceptor reflexes
- catecholamine release
- renin-angiotensin axis
- antidiuretic hormone release
- sympathetic stimulation – body trying to maintain proper tone of vessel
88
if shock continues and underlying causes are not corrected, shock progressive into
progressive phase
89
neurohumoral mechanisms maintain cardiac output and BP by
- baroreceptor reflexes
- catecholamine release
- renin-angiotensin axis
- antidiuretic hormone release
- sympathetic stimulation – body trying to maintain proper tone of vessel
90
if shock continues and underlying causes are not corrected, shock progressive into
progressive phase
91
irreversible stages of shock causes
- lysosomal enzyme leakage
- worsening myocardial contractile function
- ishcemic bowel which may allow intestinal flora to enter circulation = may lead to bacteremic shock
- acute tubular necrosis of kidney
92
effects of lactic acidosis
lowers tissue pH and blunts vasomotor response
| -arterioles dilate and blood beings to pool in the microcirculation
93
irreversible stages of shock causes
- lysosomal enzyme leakage
- worsening myocardial contractile function
- ishcemic bowel which may allow intestinal flora to enter circulation = may lead to bacteremic shock
- acute tubular necrosis of kidney
94
shock affects GI by causing
- acute gastric petechial haemorrhages
- ulcers
- intestinal ischemia in border zones
95
shock affects DIC
- fibrin-rich microthrombi in various organs
| - consumption of platelets and coagulative factors
96
shock affects GI by causing
- acute gastric petechial haemorrhages
- ulcers
- intestinal ischemia in border zones
97
shock affects brain causing
global hypoxia ischemic encephalopahy (red neurons - dead neurons with red cytoplasm nd pyknotic nuclei)
98
shock affects heart causing
contraction band necrosis
99
shock affects kideny by
acute tubular necrosis
100
shock affects liver by
centrilobular necrosis
101
shock affects kideny by
acute tubular necrosis
102
neurogenic shock caused by
anesthetic accident of spinal cord injury
103
neurogenic shock causes
causes loss of vascular tone and peripheral pooling of blood
104
anaphylactic shock caused by
IgE-mediated hypersensitivity reaction
105
anaphylactic shock causes
widespread vasodilation, tissue hypoperfusion and hypoxia
