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Pathology > Exam 1: Edema, Hyperemia, Congestion > Flashcards

Exam 1: Edema, Hyperemia, Congestion Flashcards

1
Q

What does the health of cells and organs depend on?

A

Uninterrupted circulation to deliver oxygen and nutrients and to remove waste

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2
Q

What does tissue well-being also require?

A

Normal “fluid balance”

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3
Q

What can abnormalities in vascular permeability or homeostasis result in?

A

Injury, even with an intact blood supply

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4
Q

What does normal fluid homeostasis encompass?

A

Maintenance of vessel wall integrity as well as intravascular pressure and osmolarity within certain physiologic ranges

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5
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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6
Q

What percentage of lean body weight is water?

A

Approximately 60%

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7
Q

Describe the distribution of water in the body

A

66% is intracellular

25% is extracellular

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8
Q

What percent of total body water is in blood plasma?

A

8%

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9
Q

What is edema?

A

Increased fluid extravasation into interstitial/extracellular spaces (including body cavities)

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10
Q

How is edema most easily recognized?

A

Grossly

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11
Q

Where does edema generally manifest microscopically?

A

Only as subtle cell swelling, with clearing and separation of the intracellular matrix elements

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12
Q

Where may edema occur and where is it most commonly seen?

A

In any tissues

SQ, brain, and lungs

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13
Q

What can edema occur as?

A

Localized process or may be systemic

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14
Q

How can you indicate edema?

A

Add “hydro” to the anatomic site (hydrothorax, hydropericardium, etc)

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15
Q

What kind of lesion is edema considered to be?

A

A space displacing lesion (exerts pressure in a closed area; brain and lung)

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16
Q

What are general causes of 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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17
Q

What are general causes of 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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18
Q

Describe non-inflammatory edema

A

Transudate
Low protein levels
Fluid accumulation due to hydrostatic imbalances between intravascular and extravascular compartments despite normal vascular permeability
Clear, colorless, or slightly yellow

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19
Q

Describe inflammatory edema

A

Exudate
Related to increased endothelial permeability
High protein levels
Caused by leakage of plasma proteins and leukocytes
Usually opaque

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20
Q

What is the specific gravity of transudate and exudate?

A

T: Less than or equal to 1.015
E: Greater than 1.017

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21
Q

What is the protein content of transudate and exudate?

A

T: Less than 2.5 gm/dL
E: More than 3 gm/dL

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22
Q

How many cells are present in transudate and exudate?

A

T: Less than 1000
E: More than 1000

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23
Q

Are there fibrin clots in transudate and exudate?

A

T: No
E: Yes, fibrin is escaping

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24
Q

What is the clarity of transudate and exudate?

A

T: Clear
E: Turbid

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25
Q

What is the gross appearance of edema?

A

Swollen, distended, tends to gravitate ventrally
Tissue pits on pressure and indentations remain after pressure is removed
Tissue is cool to touch
Tissue is not red or painful

26
Q

Describe SQ edema

A

Different distributions, depending on the cause

Can be diffuse or may be more conspicuous at sites of highest hydrostatic pressure

27
Q

What is anasarca?

A

Severe and generalized edema with profound SQ tissue swelling

28
Q

What is the microappearance of edema?

A

Separation of tissues by spaces that are clear or pink in H and E stained slides
Dilation of lymphatic vessels

29
Q

What are the causes/pathogenesis of edema? What kind of edema is produced?

A

Increased intravascular pressure (transudate)
Decreased plasma colloid osmotic pressure (transudate)
Increased vascular permeability (exudate)
Lymphatic obstruction (transudate)
Heart failure/sodium retention (transudate)

30
Q

What happens to fluid when there is increased hydrostatic pressure or diminished plasma osmotc presure?

A

There is a net accumulation of extravascular fluid (edema)

31
Q

What happens as interstitial fluid pressure increases?

A

Tissue lymphatic remove much of the excess volume, eventually returning it to the circulation via the thoracic duct

32
Q

What does venous obstruction or impaired venous outflow result in?

A

Increased hydrostatic pressure as blood backs up in the venous system
Leakage of sodium and fluid into the interstitial tissue

33
Q

What are some diseases that can cause increased hydrostatic pressure?

A

Congestive heart failure
Cirrhosis of the liver
Obstruction or narrowing of the veins

34
Q

What do the diseases that can cause increased hydrostatic pressure result in?

A

Impaired venous return and congestion

35
Q

Why does capillary blood contain decreased colloids?

A

Decreased hepatic synthesis of proteins

Increased protein loss through the kidney or GI tract

36
Q

What happens as a result of hypoproteinemia with decreased plasma colloidal pressure?

A

Fluid and sodium are not reabsorbed at the venous end of the capillary
Fluid is accumulated in the interstitium as edema

37
Q

What are some diseases that cause decreased oncotic pressure of plasma?

A 
Kidney disease
Cirrhosis of the liver/liver failure
Malnutritious/starvation
Protein-losing gastroenteropathies
Gastrointestinal parasitism
38
Q

What does endothelial cell damage result in?

A

Increased capillary permeability to fluids, salts, and colloids

39
Q

What does an increase in colloids within the interstitium do?

A

Reduces reabsorption of fluid at the venous end of the capillary

40
Q

What happens with lymphatic obstruction?

A

Small quantities of fluids, salts, and colloids accumulate

41
Q

What are some diseases that cause lymphatic obstruction?

A

Inflammation
Neoplasia
Post-surgical
Post-irradiation

42
Q

What is the mechanism of heart failure/sodium retention?

A

Increased tubular reabsorption of sodium

  • –Common pathway in congestive heat failure and edema due to hypoproteinemia
  • –Reduced renal perfusion due to CHF
  • –Increase renin-angiotensin-aldosterone secretion
43
Q

Describe what occurs with heart failure

A

Hypoperfusion of the kidneys
Renin is released from juxtaglomerular apparatus
Angiotensin causes secretion of aldosterone
Aldosterone causes increased absorption of Na in the kidneys
With Na comes H2O

44
Q

Describe what occurs with kidney disease to cause Na retention

A

Na is not excreted which results in Na retention

45
Q

What is active hyperemia?

A

An active process resulting in increased tissue blood flow due to arteriolar dilation
Excess blood of arterial origin

46
Q

Why is the affected area red during active hyperemia?

A

Engorgement with oxygenated blood

47
Q

What are causes of active hyperemia?

A

Normal physiologic process

Hallmark of inflammatory response

48
Q

What is congestion?

A

A passive process resulting from impaired outflow from a tissue
Interference with venous drainage

49
Q

Why is the tissue have a red-blue color with congestion?

A

Due to the accumulation of deoxygenated blood

50
Q

What are causes of congestion?

A 
Heart failure (generalized slowing of blood everywhere)
Venous occlusion (thrombus, pressure, twisting)
Hypostasis (hypostatic congestion)
51
Q

What is most affected with left heart?

A

Lung (chronic pulmonary congestion)

52
Q

What is affected with right heart failure?

A

Liver (chronic passive congestion)

53
Q

What is hypostatic congestion?

A

Blood pooling in organs and tissues on the lower side of a recumbent animal

54
Q

What is chronic passive congestion caused by?

A

Any disease that results in right heart failure

55
Q

What is chronic pulmonary congestion caused by?

A

Any disease that results in left heart failure

56
Q

Describe what happens in active hyperemia

A

Increased inflow leads to engorgement with oxygenated blood, resulting in erythema

57
Q

Describe what happens in congestion

A

Diminished outflow leads to a capillary bed swollen with deoxygenated venous blood and resulting in cyanosis

58
Q

What is the tissue like in active hyperemia?

A

Bright red, warm to touch, and often pulsating

59
Q

What is the tissue like in congestion?

A

Bluish, slightly swollen, and cool

60
Q

What is the microscopic appearance of hyperemia?

A

Arterioles and capilaries are dilated and filled with blood
If the cause is inflammatory, other morphologic features of inflammation may also be present (inflammatory cells, necrotic cells)

61
Q

What can chronic congestion cause?

A

Anoxic injury (stasis of blood with no new blood coming in; atrophy and fibrosis)
Thrombosis
Edema
Hemosiderin deposition

Pathology (16 decks)

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