Fluid and Hemodynamic Alterations I Flashcards
Total volume of water in the body =
How much intracellular? Extracellular?
36L
Intra – 24. Extra – 12.
Blood volume is approximately…
5L
of the 5L of blood, apprximately ___ is plasma and ____ is cells.
3L Plasma
2L Cells
Hematocrit is approximately ______%
40%
What is an osmole?
One mole of nonpermeant and non-ionizable
4/5 of the osmolarity of the interstitial fluid is caused by ___________
Sodium and Chloride
Half the osmolarity of the intracellular fluid is caused by…
Potassium
Examples of isotonic solutions
0.9% Sodium Chloride
5% Dextrose
60% of serum protein is _______
Albumin
16% of serum protein is ______
Immunoglobulin/Gamma Globulin
Other than Albumin and Gamma Globulins, what other proteins are running around?
Transport Proteins
Enzymes
Coagulation Proteins (Fibrinogen)
Normal Albumin:Immunoglobulin Ration
3-4:1
Loss of serum protein causes….
Shift of water from the blood into the interstititium (edema)
Changes in sodium act primarily to….
Change the volume of cells, not to move water in or out of interstitial space
What causes edema in renal failure?
Increased hydrostatic pressure
How does acidosis alter blood chemistry?
It will shift Hydrogens from outside the cell and replace them with potassium which leaves the cell. Resulting in hyperkalemia.
What is the definition of Edema
Accumulation of abnormal amounts of fluid in the intercellular tissue spaces or within body cavities
Two types of edema and the types of fluid.
Inflammatory Edema – Exudate
Non-inflammatory Edema – Transudate
Inflammatory edema is caused by…
Increased vascular permeability
Non-inflammatory edema is caused by…
a change in hemodynamic forces across a capillary wall
What is Anasarca?
Severe generalized subcutaneous edema
What is ascites?
edema within the pleural cavity
What is hydrothorax?
Edema within the pleural cavity
What is pitting edema?
Subcutaneous edema in which digital pressure leaves indentations
What is an effusion?
An outpouring of fluid
Causes of increased hydrostatic pressure?
- Obstruction of normal BF on venous side of capillaries
- Localized causes (Venous thrombus, pulmonary edema)
- Generalized (Fluid Retention)
Causes of fluid retention
Renal Failure, Inadequate Renal Perfusion
Explain the mechanism of congestive heart failure
- Heart Failure
- Decreased renal perfusion
- Renin (JGA)
- Angiotensinogen –> Ang I and II
- Aldosterone
- Retained Na + H2O
- Increased Intravascular Volume
- Increased Hydrostatic Pressure
- Edema
Causes of loss of albumin?
Nephrotic Syndrome – Leakage across glomerular BM
Protein Losing Gastroenteropathy
Causes of decreased albumin synthesis?
Hepatic Cirrhosis
Liver Failure
Malnutrition (Kwashiorkor, Marasmus)
Pathological features of cirrhosis
Diffuse destruction of hepatic parenchyma
Fibrosis, Nodular regeneration
What is kwashikor?
Protein caloric under nutrition
What is marasmus?
Loss of calories (starvation)
Causes of lymphatic obstruction?
Filariasis, Neoplasia, Scarring
Pathology of filariasis?
Fibrosis of lymphatics in inguinal area
Where is the fluid in pulmonary edema?
Initially in lower lung lobes
Initially in alveolar septa around capillaries, but eventually collects in the alveoli
Three causes of pulmonary edema
Increased Hydrostatic Pressure
Decreased Oncotic Pressure
Microvascular Injury
Causes of increased hydrostatic pressure in pulmonary edema?
left CHF
Mitral Valve/Aortic Valve Stenosis
Obstruction of Pulmonary Vein
Cause of decreased oncotic pressure in pulmonary edema?
hypoalbuminemia
Causes of microvascular injury leading to pulmonary edema?
Infection, Inhaled Gasses, liquid aspiration, drugs, shock/sepsis/radiation
Clinical pathology of CHF?
Vascular congestion, Alveolar Transudate, Few red cells
Clinical pathology of microvascular injury?
Exudate with high protein (fibrin)
In edema of the brain, swelling in an enclosed space?
Narrowed Sulci
Flattened gyri
Necrosis
Herniation
Symptoms common to right congestive heart failure?
Subcutaneous edema (esp. in lower extremities) caused by higher hydrostatic pressure. Stays low because its dependent edema (influenced by gravity). Nutmeg liver.
Causes of hyperemia (active hyperemia)?
Sympathetic neurogenic mechanisms
Release of vasoactive substances (histamine, serotonin)
What is congestion (passive hyperemia)?
Accumulation of blood in the capillaries caused by impaired venous drainage. It shows up as blue-red discoloration. T
Two primary examples of congestion?
Nutmeg Liver
Pulmonary Edema
What is nutmeg liver all about?
Rt. Heart Failure.
Causes obstruction of vena cava/hepatic vein
Liver gets alternating light/dark pattern that resemble a nutmeg.
What are in the light and dark regions of a nutmeg liver?
Light – Pale hepatocytes
Dark – Distended sinusoids
Microscopic features of nutmeg liver?
- Congestion of central vein increasing blood in sinusoids
- +/- atrophy or necrosis of centrilobar hepatocytes
- +/- fatty change in the perilobular hepatocytes (chronic ishemia)
What’s the story with pulmonary edema?
left heart failure
Wet, heavy boggy lungs
Microscopic features pulmonary edema?
Congestion of Pulmonary Veins
Transudate and red cells within alveoli
“Heart Failure Cells” (alveolar macrophages full of hemoglobin)
What is hemorrhage?
Release of blood outside of the cardiovascular system
Define hematoma
accumulation of blood in a tissue
Define hemothorax
accumulation of blood within the pleural cavity
Define hemopericardium
accumulation of blood within the pericardial cavity
Define hemoperitoneum
Accumulation of blood within the peritoneal cavity
Define hemarthrosis
Accumulation of blood within a joint space
Define petechial hemorrhages
Minute (mm) hemorrhages of the skin, mucous membranes, and serosal surfaces
Define purpura
Hemorrhages slightly larger than petechia
Example of a benign hematoma? Lethal hematoma?
Benign – Bruise
Lethal – brain
What is cardiac tamponade?
Decreased venous return due to increased fluid volume in the pericardium
