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Pathology -- Cardiology > Fluid and Hemodynamic Alterations I > Flashcards

Fluid and Hemodynamic Alterations I Flashcards

1
Q

Total volume of water in the body =

How much intracellular? Extracellular?

A

36L

Intra – 24. Extra – 12.

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2
Q

Blood volume is approximately…

A

5L

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3
Q

of the 5L of blood, apprximately ___ is plasma and ____ is cells.

A

3L Plasma

2L Cells

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4
Q

Hematocrit is approximately ______%

A

40%

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5
Q

What is an osmole?

A

One mole of nonpermeant and non-ionizable

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6
Q

4/5 of the osmolarity of the interstitial fluid is caused by ___________

A

Sodium and Chloride

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7
Q

Half the osmolarity of the intracellular fluid is caused by…

A

Potassium

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8
Q

Examples of isotonic solutions

A

0.9% Sodium Chloride

5% Dextrose

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9
Q

60% of serum protein is _______

A

Albumin

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10
Q

16% of serum protein is ______

A

Immunoglobulin/Gamma Globulin

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11
Q

Other than Albumin and Gamma Globulins, what other proteins are running around?

A

Transport Proteins
Enzymes
Coagulation Proteins (Fibrinogen)

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12
Q

Normal Albumin:Immunoglobulin Ration

A

3-4:1

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13
Q

Loss of serum protein causes….

A

Shift of water from the blood into the interstititium (edema)

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14
Q

Changes in sodium act primarily to….

A

Change the volume of cells, not to move water in or out of interstitial space

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15
Q

What causes edema in renal failure?

A

Increased hydrostatic pressure

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16
Q

How does acidosis alter blood chemistry?

A

It will shift Hydrogens from outside the cell and replace them with potassium which leaves the cell. Resulting in hyperkalemia.

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17
Q

What is the definition of Edema

A

Accumulation of abnormal amounts of fluid in the intercellular tissue spaces or within body cavities

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18
Q

Two types of edema and the types of fluid.

A

Inflammatory Edema – Exudate

Non-inflammatory Edema – Transudate

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19
Q

Inflammatory edema is caused by…

A

Increased vascular permeability

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20
Q

Non-inflammatory edema is caused by…

A

a change in hemodynamic forces across a capillary wall

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21
Q

What is Anasarca?

A

Severe generalized subcutaneous edema

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22
Q

What is ascites?

A

edema within the pleural cavity

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23
Q

What is hydrothorax?

A

Edema within the pleural cavity

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24
Q

What is pitting edema?

A

Subcutaneous edema in which digital pressure leaves indentations

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25
Q

What is an effusion?

A

An outpouring of fluid

26
Q

Causes of increased hydrostatic pressure?

A
  • Obstruction of normal BF on venous side of capillaries
  • Localized causes (Venous thrombus, pulmonary edema)
  • Generalized (Fluid Retention)
27
Q

Causes of fluid retention

A

Renal Failure, Inadequate Renal Perfusion

28
Q

Explain the mechanism of congestive heart failure

A
  1. Heart Failure
  2. Decreased renal perfusion
  3. Renin (JGA)
  4. Angiotensinogen –> Ang I and II
  5. Aldosterone
  6. Retained Na + H2O
  7. Increased Intravascular Volume
  8. Increased Hydrostatic Pressure
  9. Edema
29
Q

Causes of loss of albumin?

A

Nephrotic Syndrome – Leakage across glomerular BM

Protein Losing Gastroenteropathy

30
Q

Causes of decreased albumin synthesis?

A

Hepatic Cirrhosis
Liver Failure
Malnutrition (Kwashiorkor, Marasmus)

31
Q

Pathological features of cirrhosis

A

Diffuse destruction of hepatic parenchyma

Fibrosis, Nodular regeneration

32
Q

What is kwashikor?

A

Protein caloric under nutrition

33
Q

What is marasmus?

A

Loss of calories (starvation)

34
Q

Causes of lymphatic obstruction?

A

Filariasis, Neoplasia, Scarring

35
Q

Pathology of filariasis?

A

Fibrosis of lymphatics in inguinal area

36
Q

Where is the fluid in pulmonary edema?

A

Initially in lower lung lobes

Initially in alveolar septa around capillaries, but eventually collects in the alveoli

37
Q

Three causes of pulmonary edema

A

Increased Hydrostatic Pressure
Decreased Oncotic Pressure
Microvascular Injury

38
Q

Causes of increased hydrostatic pressure in pulmonary edema?

A

left CHF
Mitral Valve/Aortic Valve Stenosis
Obstruction of Pulmonary Vein

39
Q

Cause of decreased oncotic pressure in pulmonary edema?

A

hypoalbuminemia

40
Q

Causes of microvascular injury leading to pulmonary edema?

A

Infection, Inhaled Gasses, liquid aspiration, drugs, shock/sepsis/radiation

41
Q

Clinical pathology of CHF?

A

Vascular congestion, Alveolar Transudate, Few red cells

42
Q

Clinical pathology of microvascular injury?

A

Exudate with high protein (fibrin)

43
Q

In edema of the brain, swelling in an enclosed space?

A

Narrowed Sulci
Flattened gyri
Necrosis
Herniation

44
Q

Symptoms common to right congestive heart failure?

A 
Subcutaneous edema (esp. in lower extremities) caused by higher hydrostatic pressure. Stays low because its dependent edema (influenced by gravity). 
Nutmeg liver.
45
Q

Causes of hyperemia (active hyperemia)?

A

Sympathetic neurogenic mechanisms

Release of vasoactive substances (histamine, serotonin)

46
Q

What is congestion (passive hyperemia)?

A

Accumulation of blood in the capillaries caused by impaired venous drainage. It shows up as blue-red discoloration. T

47
Q

Two primary examples of congestion?

A

Nutmeg Liver

Pulmonary Edema

48
Q

What is nutmeg liver all about?

A

Rt. Heart Failure.
Causes obstruction of vena cava/hepatic vein
Liver gets alternating light/dark pattern that resemble a nutmeg.

49
Q

What are in the light and dark regions of a nutmeg liver?

A

Light – Pale hepatocytes

Dark – Distended sinusoids

50
Q

Microscopic features of nutmeg liver?

A
  • Congestion of central vein increasing blood in sinusoids
  • +/- atrophy or necrosis of centrilobar hepatocytes
  • +/- fatty change in the perilobular hepatocytes (chronic ishemia)
51
Q

What’s the story with pulmonary edema?

A

left heart failure

Wet, heavy boggy lungs

52
Q

Microscopic features pulmonary edema?

A

Congestion of Pulmonary Veins
Transudate and red cells within alveoli
“Heart Failure Cells” (alveolar macrophages full of hemoglobin)

53
Q

What is hemorrhage?

A

Release of blood outside of the cardiovascular system

54
Q

Define hematoma

A

accumulation of blood in a tissue

55
Q

Define hemothorax

A

accumulation of blood within the pleural cavity

56
Q

Define hemopericardium

A

accumulation of blood within the pericardial cavity

57
Q

Define hemoperitoneum

A

Accumulation of blood within the peritoneal cavity

58
Q

Define hemarthrosis

A

Accumulation of blood within a joint space

59
Q

Define petechial hemorrhages

A

Minute (mm) hemorrhages of the skin, mucous membranes, and serosal surfaces

60
Q

Define purpura

A

Hemorrhages slightly larger than petechia

61
Q

Example of a benign hematoma? Lethal hematoma?

A

Benign – Bruise

Lethal – brain

62
Q

What is cardiac tamponade?

A

Decreased venous return due to increased fluid volume in the pericardium

Pathology -- Cardiology (13 decks)

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