Fluid and Hemodynamic Disorders

Question 1

describe normal capillary filtration

Answer 1

Question 2

describe the flow of lymphatics

Answer 2

Question 3

describe edema

Answer 3

• edema is an abnormal excess accumulation of fluid in the intercellular space
  
  • body cavities = effusion
• occurs most commonly in: subcutaneous tissues, lungs and the brain

Question 4

edema in the pleural space = _____ (_____)

Answer 4

edema in the pleural space = pleural effusion (hydrothorax)

Question 5

edema in the pericardium = ______ (____)

Answer 5

edema in the pericardium = pericardial effusion (hydropericardium)

Question 6

edema in the peritoneum = ____ (____)

Answer 6

edema in the peritoneum = ascites (hydroperitoneum)

Question 7

____ = severe generalized edema

Answer 7

anasarca = severe generalized edema

Question 8

describe fluid collection in a patient with heart failure (CHF)

Answer 8

Question 9

describe fluid accumulation seen in hypoproteinemia

Answer 9

Question 10

describe fluid accumulation as seen in lymphatic obstruction

Answer 10

Question 11

describe fluid accumulation seen in infections

Answer 11

Question 12

describe congestive heart failure (causes of RHF and LHF) and management

Answer 12

• right heart failure
  
  • increased hydrostatic pressure - edema
  • dependent edema (legs, sacrum)
  • signs = HEAD (hepatomegaly, peripheral edema, ascites, distended jugular vein)
• left heart failure
  
  • reduced GFR, renin-angiotensin-aldosterone axis = sodium retention
  • pulmonary edema
• management
  
  • salt restriction, diuretics
  • aldosterone antagonists

Question 13

describe renal disease (what it affects)

Answer 13

• damages basement membrane
  
  • excess albumin loss → hypoalbuminemia (Nephrotic Syndrome)
  • decreased plasma oncotic pressure - edema
• glomerulonephritis
  
  • inflammatory damage with clogging of glomerular capillaries → reduced GFR
  • secondary hyperaldosteronism → sodium and water retention
  • generalized edema: initially periorbital edema

Question 14

describe how liver disease can lead to edema

Answer 14

• cirrhosis of liver
  
  • portal hypertension → increased hydrostatic pressure in splanchnic circulation → ascites
  • decreased albumin synthesis → reduced plasma oncotic pressure

Question 15

describe how malnutrition can lead to edema

Answer 15

Question 16

contrast transudate and exudate

Answer 16

Question 17

Answer 17

Question 18

describe the morphology of skin edema and 3 associated problems

Answer 18

• skin
  
  • cell swelling, clearing and separation of the extracellular matrix
    
    • pitting or non-pitting edema (myxedema)
• 3 problems:
  
  • impaired wound healing
  • thickening
  • susceptible to infxn

Question 19

describe the morphology of pulmonary edema

Answer 19

• interstitial: early phase
• alveolar: frothy fluid in alveolar lumen
• severely congested alveolar capillaries and alveoli filled with homogenous pink-staining fluid
• clinical features:
  
  • cough, dyspnea
  • severe cases: frothy sputum, cyanosis

Question 20

describe what is seen in the image

Answer 20

Question 21

describe cerebral edema

Answer 21

• 2 categories
  
  • vasogenic edema
    
    • disruption of BBB: interstitial edema
    • infxns, trauma, neoplasms
  • cytotoxic edema (gray matter)
    
    • intracellular edema: due to cell injury
    • hypoxic-ischemic insult
• headache, papilledema
• motor/sensory abnormalities
• treat by intravenous mannitol and steroids

Question 22

Answer 22

Question 23

describe a transtentorial (uncal) herniation

Answer 23

• displacement of the temporal lobe
  
  • presses on cranial nerve III and PS fibers → impaired ocular movements, pupillary dilation
  • duret hemorrhages in midbrain and pons

Question 24

describe a tonsillar herniation

Answer 24

• tonsillar herniation through the foramen magnum
  
  • brain stem compression → respiratory centers in medulla oblongata
  • death due to cardio-resp. arrest

Question 25

describe a subfalcine herniation

Answer 25

displacement of cingulate gyrus under the falx cerebri

• compression of branches of ant. cerebral artery
• ischemic injury of primary motor and/or sensory cortex
• weakness and/or sensory abnormalities in leg