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Edema, Hyperemia, Congestion Flashcards

1
Q

Hemodynamics

A

Health of cells and organs depends on uninterrupted circulation to deliver oxygen, nutrients, and to remove waste
- requires normal fluid balance

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2
Q

What results in injury, while possibly maintaining an intact blood supply

A

Abnormalities in vascular permeability, or hemostasis

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3
Q

What components are a part of normal fluid homeostasis?

A
  • maintenance of vessel wall integrity
  • intravascular pressure
  • osmolarity within certain physiologic ranges
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4
Q

What affects the net movement of water across the vascular wall?

A

Changes in vascular volume, pressure, or protein content, or alterations in endothelial function

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5
Q

Body water composition

A

60% of lean body weight is water

  • 66% intracellular
  • 25% extracellular
  • 8% intravascular (blood plasma)
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6
Q

Edema

A

Increased fluid extravasation into interstitial/extracellular spaces
- includes body cavities

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7
Q

Recognizing edema

A

Easily recognized grossly, appears microscopically as subtle cell swelling, with clearing and separation of intracellular matrix elements

  • occurs in any tissue type
  • commonly seen in SQ, brain, lung
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8
Q

What prefix is used to indicate edema?

A

“Hydro” or “hydrops”

  • hydrothorax: pleural cavity
  • hydropericardium: pericardial sac
  • hydrosalpinx: uterine tube
  • hydrocephalus: brain
  • hydrocoele: fluid filled cyst anywhere in the body
  • hydroperitoneum: peritoneal cavity (ascities)
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9
Q

Anasarca

A

Severe and generalized edema, with profound SQ tissue swelling

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10
Q

Edema is considered to be a __________

A

Space displacing lesion

  • exerts pressure in a closed area such as brain or lung
  • easily resorbed in underlying cause is removed
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11
Q

Intracellular edema

A

Depression of metabolic systems of the tissues or lack of adequate nutrition to cells

  • depressed ionic pumps = Na and water leak in
  • inflammation = increased permeability of cell membranes = Na and water leak in
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12
Q

Extracellular edema

A

Abnormal leakage of fluid from blood capillaries

  • failure of lymphatic system to return fluid from interstitium
  • renal retention of salt and water
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13
Q

Transudate

A

Fluid accumulation due to hydrostatic imbalances between intravascular and extravascular compartments, despite normal vascular permeability

  • low protein levels
  • non inflammatory edema
  • clear, colorless, slightly yellow
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14
Q

Exudate

A

Increased endothelial permeability caused by leakage of plasma proteins (albumin) and leukocytes

  • high protein levels
  • inflammatory edema
  • opaque
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15
Q

Modified transudate

A

Between transudate and exudate

- FIP

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16
Q

Horse generalized edema

A

Usually in ventral abdomen and ventral thorax

- severe: distal extremities (stocking)

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17
Q

Bovine generalized edema

A

Usually in intermandibular space

- brisket area (thoracic inlet)

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18
Q

Cat generalized edema

A

Hydrothorax

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19
Q

Dog generalized edema

A

Ascites

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20
Q

Gross appearance of edema

A

Swollen, distended, gravitates ventrally

  • tissue pits on pressure and indentations remain after pressure is removed
  • tissue is cool to touch, unless inflammation is also present
  • tissue is not red/painful
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21
Q

SQ edema

A

Different distributions, depends on cause

- may be diffuse or more conspicuous at sites of highest hydrostatic pressure –> distribution is gravity dependent

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22
Q

Ascites

A

Recognized by presence of clear, yellow tinged fluid that distends loose connective tissues or accumulates in body cavities
- peritoneal, pleural, pericardial

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23
Q

Pig edema

A

Possible cause: septicemia with E. coli

- exhibit conjunctival edema, cannot open eyes

24
Q

Septicemia

A

Systemic bacterial infection

- bacterial toxins cause vascular leakage of protein = total body edema (anasarca)

25
Micro appearance of edema
Separation of tissues by spaces that are clear (protein poor edema) or pink (protein rich edema) in hematoxylin and eosin stained slides - dilation of lymphatic vessels (natural channel for removal of excess fluid)
26
Pathogenesis of edema
- increased intravascular pressure - decreased plasma colloid osmotic pressure - increased vascular permeability - lymphatic obstruction - heart failure/sodium retention
27
______ and ____ leads to net accumulation of extravascular fluid
Increased hydrostatic pressure; diminished plasma osmotic pressure
28
How do tissue lymphatics remove excess volume?
Returns it to circulation via thoracic duct
29
Persistent tissue edema results when ______
The ability of the lymphatics to drain tissue is exceeded
30
Hydrostatic pressure (blood pressure) vs osmotic pressure (protein)
High hydrostatic, low osmotic --> lose fluid out of vessels --> leads to high osmotic, low hydrostatic --> fluid out; proteins more concentrated
31
Forces driving fluid out of a blood vessel
Hydrostatic pressure (bp) is the main factor in driving fluid OUT - interstitial fluid colloidal osmotic pressure --> IN - interstitium normally decreases protein, little impact on formation of edema
32
Forces driving fluid into vessels
Intravascular colloidal osmotic pressure --> IN - due to plasma protein in vessel lumen - 25 mmHg Tissue tension (tissue hydrostatic pressure) --> OUT - 1-4 mmHg - important in distribution of edema - lax areas of body are more prone to edema
33
Difference between areteriole capillary pressure and venous capillary pressure
- arteriole hydrostatic pressure: 37 mmHg | - venular hydrostatic pressure: 17 mmHg
34
Increased hydrostatic pressure is due to ______
Venous obstruction or impaired venous outflow = increased hydrostatic pressure due to backflow of blood into venous system = leakage of sodium and fluid into interstitial space - no significant leakage of colloids
35
Diseases that cause increased hydrostatic pressure
- congestive heart failure - cirrhosis of liver - obstruction or narrowing of veins
36
Decreased plasma colloidal pressure
Capillary blood contains decreased quantity of colloids due to - decreased hepatic synthesis of protein - increased protein loss thru kidney, or GIT
37
Hypoproteinemia
Fluid and sodium are not reabsorbed at venous end of capillary = decreased colloidal pressure - fluid accumulated in interstitium
38
Diseases that cause decreased plasma oncotic pressure
- kidney disease - cirrhosis of the liver/liver failure (hypoalbuminemia) - malnutrition/starvation - protein-losing gastroenteropathies - GI parasitism
39
Increased vascular permeability
Endothelial cell damage results in increased capillary permeability to fluids, salts, and colloids - increase in colloids within interstitium reduces reabsorption of fluid at the venous end of capillary ---> colloids may eventually be drained away by lymphatics
40
Lymphatic function
Normal: small quantities of fluids, salts, and colloids escape from capillaries and are drained from the interstitium by lymphatics Lymphatic obstruction: materials accumulate
41
Diseases that cause lymphatic obstruction
- inflammation - neoplasia - post-surgical - post-irradiation - common occurance after lymph node disease, until collateral circulation can be established
42
Heart failure/sodium retention
Increased tubular reabsorption of sodium - common in congestive heart failure and edema due to hypoproteinemia - reduced renal perfusion due to CHF - increased renin-angiotensin-aldosterone secretion
43
Can you consume enough salt to cause Na retention edema?
No | - caused by heart failure or kidney disease, leading to increased plasma volume
44
Heart failure
Hypoperfusion of the kidneys - renin: released from juxtaglomerular apparatus - angiotensin: causes secretion of aldosterone - aldosterone: causes increased absorption of Na in kidneys - water follows sodium!!
45
Kidney disease
- Na no excreted | - results in Na retention
46
Active hyperemia
Active process resulting in increased tissue blood flow due to arteriolar dilation - excess blood of arterial origin (skeletal muscles during exercise, at sites of inflammation) - affected area is red due to engorgement with oxygenated blood
47
Causes of active hyperemia
- normal physiologic process (GIT gets blood for digestion) | - hallmark of inflammatory response
48
Congestion
Passive process resulting from impaired outflow from a tissue - interference with venous drainage - may be systemic (heart failure), or local (isolated venous obstruction) - tissue has red-blue color (cyanosis) due to accumulation of deoxygenated blood
49
Causes of congestion
- heart failure: generalized slowing of blood everywhere - -> left heart: lung affected (chronic pulmonary congestion) - -> right heart: liver (chronic passive congestion) - venous occlusion (localized): thrombus, pressure, twisting - hypostasis: hypostatic congestion
50
Hypostatic congestion
Blood pooling in organs and tissues on the lower side of a recumbent animal - contrast to livor mortis: blood pooling on downside of animal after death
51
Chronic passive congestion
Caused by any disease that results in right heart failure
52
Chronic pulmonary congestion
Caused by any disease that results in left heart failure
53
What is common between active and passive hyperemia?
Increased volume and pressure of blood in a given tissue with associated capillary dilation and a potential for fluid extravasation
54
In _________, increased inflow leads to engorgement with oxygenated blood, leading to erythema
Active hyperemia | - tissue is bright red, warm to touch, and pulsating
55
In ________, diminished outflow leads to a capillary bed swollen with deoxygenated venous blood, leading to cyanosis
Congestion | - tissue is blueish, blood is stagnant, slightly swollen, and cool
56
How to microscopically distinguish active hyperemia from congestion
Histologically, they are difficult to distinguish - vessels full of blood - may see inflammatory cells during active hyperemia due to inflammation
57
Chronic congestion
- anoxic injury: stasis of blood with no new blood coming in due to atrophy (cell death and shrinking), fibrosis - thrombosis: expected because of decreased blood flow - edema - hemosiderin deposition

Pathology (19 decks)

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