Fluid and Hemodynamics Flashcards
What is the definition of edema?
Too much interstitial fluid in the tissues or outside individual cells
What is Anasarca?
Generalized, severe edema
What is an effusion?
Liquid in the pericardial, pleural, peritoneal, or joint cavities
What is Ascites?
Causes?
Effusion in the peritoneal cavity
Causes- Liver dz (hepatitis, cancer, cirrhosis), CHF, severe pancreatitis
What is Empyema?
Pus or purulent effusion in the pleural cavity
aka pyothorax
What is an Ileus?
Too much fluid in the small bowel
What is a Seroma?
Non-infected fluid in a surgical incision
What is a Loculated effusion?
Effusion in more then one compartment due to scarring, harder to drain
What is the difference between Bulla and Vesicles?
Bulla: Big blisters
Vesicles: Little blisters
What are the mechanisms in which transudate edema can form?
- Excess total body fluid
- Increased pressure in small veins
- Decreased total plasma protein/albumin
- Lymphatic vessel obstruction
What causes edema in liver failure?
Increased portal venous pressure and low serum albumin (ascites, caput medusa)
What usually causes lymphedema?
Cancer
Other causes: Surgery, radiation therapy (i.e. agressive mastectomy)
What is Milroy’s disease?
Malformed lymphatics-> produces lifelong lymphedema, worst in legs
What is the difference between transudates and exudates?
Exudates- protein-rich fluid accumulations
Transudates- low-protein fluid accumulation
What does orange peel skin indicate?
Plugging of dermal lymphatics- probably by breast cancer
What does thrombin do?
Converts fibrinogen into fibrin
Activates factor XIII (cross links fibrin)
Promotes neutrophil adhesion
Induces platelet, monocyte, lymphocyte activation
What does plasmin do?
Breaks down fibrin
Activates fibrinolysis
What is the Virchow triad?
- Endothelial injury
- Stasis (turbulent blood flow)
- Hypercoagulability of blood
What is primary hemostasis?
Formation of platelet plug
Induced by vWF, collagen
What is secondary hemostasis?
Deposition of Fibrin meshwork
Consolidation of clot (essentially, the clotting cascade)
What are genetic factors of hypercoagulable blood?
Factor V-Leiden
Prothrombin G20210A
Protein S, C, and AT-III deficiency
High homocysteine
What should be considered when edema around the eyes is observed?
Total body water overload (pools in periorbit first)
Possibly from low blood albumin/renal edema
A patient presents with abdominal edema. What should you consider first?
Primary liver disease
Low albumin + resistance to portal venous flow
A patient presents with edema in the feet after standing. First differential you should consider?
Heart failure- cardiac edema
A patient presenting with lower eyelid petechiae should be worked up for what?
Bacterial endocarditis (cardiac)
In patients with platelet deficiencies, what are the most feared consequences?
GI and brain bleeds
CN: may be diagnostic petechiae
What does thrombin do when it is bound to thrombomodulin?
Stops activating fibrinogen, activates protein C instead
Prevents/stops clotting
(Thrombomodulin modulates thrombin)
What are lines of Zahn?
Lines that form on a thrombus ante-mortem
Thrombi without lines of Zahn occurred after death
What is recanalization?
Thrombi turn into granulation tissue, and contract
This opens little channels
What can cause an injured vessel endothelium?
Smoking, HTN, MI, indwelling lines, radiation/electrical injury, ruptured atherosclerotic plaques, inflamed heart valves
What can cause altered blood flow (stasis)?
MI, Afib, aneurisms, arterial branch points, viscous blood, immobilization, ruptured atherosclerotic plaques, vascular malformations
What are non-genetic causes of hypercoagulable blood?
Pre/Post-partum, post-trauma, nephrotic syndrome, tumors producing prothrombotic products, APL syndrome, old age
What is white clot syndrome/heparin induced thrombocytopenia?
Illness caused by antibodies to heparin & platelet factor IV.
Masses of platelets become white clots, existing thrombi extend, moderate thrombocytopenia
What is Disseminated Intravascular Coagulation?
Excessive clotting then excessive bleeding, both platelet/clotting factor consumption and plasmin activation
Histo: will see schistocytes, thrombocytopenia
What causes of DIC cause thromboplastin to get into the bloodstream?
OB emergencies, cancer, APL, infarcts, hemolysis, snakebites
What causes of DIC damage the epithelium?
Rickettsial dz, meninococcemia, vasculitis, toxemia of pregnancy
What causes DIC via epithelial damage AND increased thromboplastin into the bloodstream?
Massive trauma, large infarcts, shock, Gm- sepsis, burns, heat stroke, emerging infectious diseases (i.e. ebola, marburg)
What kind of edema will pit?
What can cause this?
Edema due to transudates- excess total body fluid and increased venous hydrostatic pressure
CHF, Liver dx, Kidney kz
What is hyperemia?
Increased blood flow to and organ- arterioles dilated more then venules. Typically red, throbs. i.e. blushing
What is congestion?
Decreased blood flow from an organ due to impaired venous drainage. Purple. i.e. Tourniquet
What is nutmeg liver?
Congestion of blood in the liver due to pooling of blood post-mortem
