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Pathology- fluid Hemodynamics > Fluid and hemodynamics disorders I > Flashcards

Fluid and hemodynamics disorders I Flashcards

1
Q

total volume of water in the body

A

36 liters

  • 24 within cells
  • 12 extracellular
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2
Q

intracellular fluid % body weight

A

40%

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3
Q

extracellular fluid % body weight

A

16%

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4
Q

blood serum % body weight

A

4%

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5
Q

approximate blood volume

A

5 liters

  • 3 liters in plasma
  • 2 liters in cells (hematocrit 40%)
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6
Q

what is hematocrit represent?

A

% volume of cells to total volume

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7
Q

what influences water movement between compartments

A

changes in molecular components in the different compartments

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8
Q

what is osmolarity is approximately equal to

A

between the compartments (intracellular a little higher)

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9
Q

what determines water flow from intravascular space to extravascular space?

A

protein concentrations within the vascular space

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10
Q

where is sodium excluded from?

A

intracellular

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11
Q

changes in sodium equilibrates

A

between the vascular and interstitial spaces, but cases net flux of water into or out of cells

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12
Q

osmole gap

A

calculated 172
measured 198
-something in plasma adding to osmolality don’t know: ketones, ethyleneglycol, methyl-alcohol

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13
Q

percent of serum proteins thats albumin

A

60%

-influenced by degree of hydration, synthesis by liver

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14
Q

protein content: IG’s

A

16%

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15
Q

albumin:immunoglobulin ratio

A

A:G is 3:4:1

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16
Q

in serum electrophoresis: albumin peak

A

tallest widest peak

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17
Q

what does decrease in serum protein?

A

influences the shift of water from blood to the interstitium (edema)

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18
Q

main intracellular ion

A

potassium

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19
Q

changes in sodium concentrations act primarily to?

A

change the volume of cells, NOT shift water into or out of the intersitial space (both water and sodium are freely exchanged)
NO EDEMA

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20
Q

in renal failure edema results from?

A

increased hydrostatic pressure NOT changes in sodium concentrations

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21
Q

what does acidosis do to fluid?

A

shift hydrogen ions from outside the cell and replaced potassium which leaves the cell-> resulting in hyperkalemia

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22
Q

edema

A

accumulation of excessive fluid within intercellular tissue spaces or body cavities

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23
Q

two types of edema

A
  1. inflammatory (exudate)

2. non-inflammatory (transudate)

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24
Q

difference between the two types edema

A

increase in vasodilation

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25
Q

anasarca

A

generalized edema

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26
Q

pitting edema

A

occurs where fluid collects-> usually LE

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27
Q

ascites

A

hydroperitoneum

-peritenium

28
Q

effusions

A

collection of fluid within potential space

-can be transudate or exudate

29
Q

pleural effusions

A

congestive heart failure, infections, neoplasms

30
Q

examples of effusions

A

pleural effusions
pericardial effusions
hemorrhagic effusion-> bloody fluid within a cavity (TB)

31
Q

edema and effusion

A

what can cause edema can cause effusion

32
Q

some causes of effusions

A

hemorrhages
tumors
infections

33
Q

how is it determined what caused an effusion

A

aspirated to determine composition

34
Q

edema: two ways to increase in interstitial fluid

A
  1. increased delivery of fluid to interstitial space

2. decreased efflux of fluid from interstitial space

35
Q

edema mechanism

A
  1. increased vascular permeability
  2. increased hydrostatic pressure (decreased venous outflow)
  3. decreased protein in the blood
  4. decreased lymphatic flow
36
Q

four components hydrostatic pressure

A
  1. hydrostatic pressure
  2. Plasmoid colloid: bring fluid into vasculature
  3. Lymphatics
  4. Venous statsis
37
Q

Hydrostatic pressure change

A

can mean hypertension

38
Q

plasma colloid changes

A

scerosis

39
Q

lymphatics changes can mean

A

surgical obstruction

40
Q

venous stasis can mean

A

no flow on venous side-> increase pressure-> edema

-pulmonary edema with heart failure, thrombosis, cirrhosis of liver

41
Q

increased hydrostatic pressure

A
  • obstruction of normal blood flow on venous side of capillaries
  • localized: venous thrombosis in extremities, pulmonary edema
  • generalized: increased vascular volume due to fluid retention, can effect subcutaneous tissues, visceral tissues (pulmonary edema, pleural effusion, etc)
42
Q

congestive heart failure

A

can be left sided or right

43
Q

left sided heart failure

A

results in increased pressures in venous pulmonary system, leading to edema within alveoli
-pulmonary

44
Q

right sided heart failure

A

results from in increased pressures in vena cava, mainly liver, from liver congestion and peripheral edema
-peripheral edema is increased in lower limbs

45
Q

thrombosis of hepatic vein

A

Bud-chiaria syndrome

46
Q

what can cause sodium and water retention

A

acute reduction of renal function

-inadequate perfusion of kidneys resulting in activation of renin/angiotensin

47
Q

mechanism of water/sodium retention

A

retained Na + water—-> increased intravascular volume—-> increased hydrostatic pressure—->edema

48
Q

decreased oncotic pressure can be caused by

A
  1. loss of albumin: nephrotic syndrome, protein-losing enteropathies
  2. decreased synthesis of albumin: hepatic cirrhosis, liver failure
  3. malnutrition: kwashiokor-> protein caloric undernutrition
49
Q

lymphatic obstruction

A

normal net flow of fluid from capillaries to lymphatics
-obstruction results in collection of fluid in extravascular space-> subcutaneous edema or ascites (obst. of liver lymphatics)

50
Q

causes of obstruction to lymphatics

A

filariasis
neoplasma
scarring

51
Q

pathological features of edema

A

enlarged, swollen tissues

  • spaces separating cells within tissues
  • fluid filling spaces
52
Q

clinical syndromes

A 
pulmonary edema
cerebral edema
nephrotic syndrome-> anscarca
right sided heart failure-> 
-peripheral edema "dependent edema"
-liver congestion: nutmeg liver
53
Q

hyperemia characteristics

A

arteriole congestion

  • red in color
  • active or reactive
  • inflammatory
54
Q

congestion characteristics

A

passive
involves veins
blue in color
left heart

55
Q

hyperemia

A

increased blood flow into capillary beds

-DUE TO arterial or arteriolar dilation

56
Q

causes of hyperemia

A
  1. sympathetic neurogenic mechanisms

2. release of vasoactive substances-> histamine, serotonin

57
Q

redness associated with

A

heat dissipation (fever, exercise)
blushing
inflammation

58
Q

congestions

A

accumulation of blood within capillaries

  • DUE TO impaired venous drainage
  • increased deoxygenated hemoglobin in blood (cyanosis)
  • chronic congestion can lead to ischemia, necrosis
59
Q

nutmeg liver

A

right heart failure

-obstruction of vena cava or hepatic vein

60
Q

gross features of nutmeg liver

A

Alternating areas of light (pale hepatocytes) and dark (distended sinusiods) in a pattern resembling a nutmeg

61
Q

microscopic features nutmeg liver

A

congestion of central vein with increased blood in sinusoids
+/- atrophy or necrosis centrilobular hepatocytes
+/- fatty change in perilobular hepatocytes (chronic ischemia)

62
Q

pulmonary edema->CHF

A

left heart failure

63
Q

gross features pulmonary edema

A

wet, heavy, boggy lungs

64
Q

microscopic features of pulmonary edema

A

congestion of pulmonary veins

  • transudate and red cells within alveoli
  • “heart failure cells”-> alveolar macrophages containing hemoglobin
65
Q

hemorrhage

A 
blood outside of cardiovascular system
-vascular disruption
-diapedesis 
petechia, purpura, ecchymosis
hematoma
hemopericardium, hemothorax, hemoperitoneum, hemarthrosis, hematosalpinx
66
Q

consequences of hemorrhage

A

shock-> severe blood loss
-if results in decreased intravascular volume, then tachycardia, pale, cool skin

hematoma: benign-> skin bruise, lethal-> brain

cardiac tamponade: decreased venous return due to increased fluid volume in pericardium

anemia

Pathology- fluid Hemodynamics (4 decks)

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