fluids

Question 1

water and ions

Answer 1

60 % of body weight is water- 40% of that is intracellualar

transcelluar- body in body cavity- 1%- stomach, brain

Question 2

TRANSCELLULAR

Answer 2

TRANSCELLULAR- THIRD SPACE: Pericardial, Peritoneal, Pleural, Joint etc. spaces

Question 3

hemostasis

Answer 3

what we put in is exixted everyday- if not then it will cause problem

Question 4

NORMAL FLUID EXCHANGE

Answer 4

Hydrostatic pressure toward the arteriolar end of the capillaries pushes water out into tissues (FILTRATION).
Opposed by minor hydrostatic pressure of interstitial fluid
Oncotic pressure toward the venular end of the capillaries pulls water in the vessels (REABSORPTION)
Opposed by minor oncotic pressure in the interstitial fluid.
Small amount of water that remains in the interstitium is removed by lymphatics and returned to circulation.

Question 5

increasec interstitial fluid

Answer 5

edema

Question 6

transudate

Answer 6

protein poor vs exudates- protein rich

Question 7

puffy eyes

Answer 7

kidney failure- in adults- water gets distributed while you sleep around the eyes- durign the day they get it at the ankles

Question 8

hydrostatic pressure increases

Answer 8

when pregnant ex.

Question 9

what are the four reasons for edema!!!!!!!!!!!!!!!!!

Answer 9

3. decreese plasma proteins (decrease oncotic pressure):
   a) decrease protein intake:/synthesis Malnutrition
   b) increase protein loss Nephrotic syndrome
4. Lymphatic blockage: obstruction by:
   a) Microorganisms (e.g. elephantiasis),
   b) Cancer cells (e.g. breast cancer – giving rise to orange peel skin)
5.  fluid volume:
   a) Kidney failure (retention of sodium)
6.  (hydrostatic) pressure with in the veins:
   a) Legs (prolonged standing);
   b) Generalized (heart failure)

Question 10

Edema: Location and Extent

Answer 10

Organs
Skin
Blister
Pulmonary edema
Heavy lungs, coughing up frothy fluid
Cerebral edema
Brain swelling and herniation of its contents into upper cervical spinal canal
Angioedema- throat- very bad
Preexisting cavities
Ascites
In peritoneal cavity
Hydrothorax
In pleural cavities
Hydropericardium
In pericardial cavity
Hydrocephalus
cerbrospinal fluid

Question 11

brian edema

Answer 11

pushes against skull, or down the spinal cavity- respiration and circulation get compressed and die

Question 12

ANASARCA

Answer 12

Protein malnutrition
Hydrops fetalis
Bad generalized edema!!!!- swells the whole body is also called ANASARCA.
-

Question 13

Too much blood!Reddish swollen organs

Answer 13

may not be on exam

Question 14

hemorrhage Types of vessels damaged:

Answer 14

Types of vessels damaged:
Cardiac!!!! ( VERY BAD AND BRAIN, EYE, PITUITARY GLAND)
Gunshot, Stab wound, infarction (often fatal)
Aortic
Trauma (motor vehicle accident), aortic aneurysm
Arterial
Penetrating wounds (knife, bullet), fractures
Venous
Trauma
Capillary
Trauma, venous pressure, weak capillary walls (scurvy)

Question 15

hemorrhage- site

Answer 15

SITE:
Body cavities
Hemopericardium (pericardial space)

Bad sites to have bleeding
Brain
Into pericardial sac
Vitreous fluid of eye
Pituitary gland
Looks bad, but not so bad, per se
Black eye (periorbital hematoma)

Question 16

ORIFICE- hemorrhaGE

Answer 16

Menorrhagia – menstrual

Question 17

SIZE

Answer 17

Bleeding into the skin
Petechiae: Bleeding into skin less than 3 mm
Purpura: Bleeding into skin 3-10 mm
Ecchymoses: Bleeding into skin more than 10mm; also called Bruise

Question 18

HOW MUCH BLOOD IS lost

Answer 18

. How much blood lost?
Very small amounts: 
OK 
10%: 
1 U of blood
20%: 
feel sick
40%: 
hypovolemic shock

Question 19

thrombosis

Answer 19

Transformation of fluid blood into solid aggregate of cells and fibrin within the vascular lumen.
Clot: Blood that has solidified anywhere else during life or within the vascular lumen after death.

only happens during life- liquid to solid in the blood vessels!!!!!!!!!!!!!!

Question 20

embolism

Answer 20

Emboli are free particles / masses floating in blood stream that are not normally present in that state in normal blood.
Thrombi are said to embolize when they break free.
Emboli can come from Heart, Arteries, Veins, Capillaries

Question 21

Thrombi: why do these form? Virchow’s triad

patients will need to know which of these caused the thrombosis to treat it

Answer 21

Blood vessel wall damage
Endothelial injury ( e.g. from vasculitis, atherosclerosis)
Blood flow abnormalities
Turbulence
Slowing of blood flow
Blood component alterations (hypercoagulable blood)
Pregnancy, Cancer, Severe burns
Disseminated intravascular coagulation (DIC)

Question 22

how can the bood flow to an organ be reduces

Answer 22

embolism,

Question 23

What would be the effect(s) of reduced or obstructed blood flow in the affected organ?

Answer 23

death, organ death, decrease in function,

Question 24

Thrombi: what are these composed of ? What do they look like?

Answer 24

Irregular swirling layers of red cells, fibrin, platelets and a few white cells (lines of Zahn).
Red (many red cells)
When flow is turbulent more red cells are included
White (layered, more fibrin)
When flow is laminar fewer red cells are included
Naked eye - have different colours
try and pull the clot away- thrombis will be attached to blood vessell wall vs post mortum clot will come out easily
the thrombis will be crumpis vs post-modern- like a worm

Under the microscope- will see the lines of Zahn

Question 25

know the difference btw post and premodern clots

Answer 25

``` Non-adhesive Soft Chicken fat and currant jellyappearance Attached (hard and crumbly) Friable Lines of Zahn ```

Question 26

Disseminated intravascular coagulation (DIC)

Answer 26

The clotting cascades are activated throughout the body. This is bad, since it tends to shut down organs due to microthrombi, and also causes bleeding due to consumption of clotting factors and activation of plasmin. 1 cause is systemic infection number 2 reason is cancer

Question 27

what do they look like DIC

Answer 27

angled blood cells

Question 28

Clinical effects of thrombi:

Answer 28

Occlude lumen of vessel Death of the end organ or part of it (e.g. myocardial infarction (syn. Heart attack) Narrow lumen = decreased blood flow = hypoxia & decreased function May become source of Emboli

Question 29

What is the fate of thrombi: | - all these things can happen

Answer 29

Lysis : no sequelae Organization (ingrowth of vessels and inflammatory cells) Recanalization Embolization (break free)

Question 30

recanalization

Answer 30

restoring flow

Question 31

embolization

Answer 31

break off and go a blood multiple small blodd vessels

Question 32

EMBOLISM

Answer 32

anything in the blood that should not be there Any solid, liquid, or gaseous thing other than liquid blood that travels along the bloodstream. It will impact and lodge somewhere. Thromboembolus: broken off thrombus Liquid: Amniotic fluid, Fat Solid:Cholesterol, Tumor Gaseous: Air- bends

Question 33

what does embolism do (clinical effect)

Answer 33

Emboli travel from the site of origin till they get trapped at the next narrow point in the circulation From leg veins - trapped in lungs From heart - trapped in small vessels in other organs Once trapped, obstruct the vessels and cause ischemic damage to the organs (death - infarction), hypoxic injury.

Question 34

fat embolism

Answer 34

bone breaks and fat droplets travel in blood vessels

Question 35

what can travel in the blood

Answer 35

liquid (amniotic fluid, solid( tumor) | gases

Question 36

Clinical example of embolism; Pulmonary embolism

Answer 36

From Veins of Lower leg, abdomen Effects: May occlude main branches of Pulmonary Artery (e.g. Saddle embolus) Small emboli cause small pulmonary infarcts Air Embolism “Bends” can also happen for ppl sitting too long and when they get up the thrombi breaks off - travells to lungs and die

Question 37

thrombi and emboli vs

Answer 37

know

Question 38

infartion

Answer 38

necrosis by blockage of blood vessels Death of Tissue from loss of Blood supply (ischemia) Usually caused by thrombi

Question 39

what happens to the person in infarction

Answer 39

``` What happens to infarcts? PERSON: May die (Stroke, heart attack) ORGANS: Heart – replacement of damaged cells by fibrous tissue (Repair) Brain – liquefies and is absorbed Liver – may regenerate The organ may simply die and fall off (with or without secondary infection)- Gangrene ```

Question 40

What do infarcts look like?

Answer 40

Pale (white) infarcts result from arterial occlusion | no blood can get to it

Question 41

how to red infacts happen

Answer 41

Red infarcts result from venous occlusion, or hemorrhage (because of reperfusion or lots of collaterals) into a white infarct. or restauration of a a infarct -adding mmore blood to it

Question 42

SHOCK

Answer 42

(low blood flow) Hypoperfusion of tissues leading to organ dysfunction Shock is likely to deteriorate into a vicious cycle of organ failure and subsequent exacerbation of shock. Reduced organ perfusion leads to: Organ dysfunction Secondary mediators of shock (e.g. TNF and IL-1) are produced by hypoperfused organs Exacerbate effects of shock Metabolic acidosis

Question 43

3 features of shock

Answer 43

``` organ dysfunction secondary mediators of shock (e.g. TNF and IL-1) are produced by hypoperfused organs Exacerbate effects of shock Metabolic acidosis ```

Question 44

3 causes of shock

Answer 44

``` Pump failure (Heart) Myocardial infarction Arrythmia Loss of fluid from circulation Hemorrhage Burns, Vomiting, Diarrhea Loss of peripheral vascular tone Pooling of blood in peripheral vessels Anaphylactic Shock Bacterial Sepsis (Septic Shock) ```

Question 45

3 stages of shocl

Answer 45

``` Compensated shock Blood shunted away from skin, gut, kidneys etc, to brain and heart and peripheral vasoconstriction to help maintain BP. Blood pressure is maintained Cold clammy skin, dry mouth  Urine output 2. Progressive (decompensated) shock Can not maintain heart and brain function Low blood pressure Altered consciousness ``` End-organ damage Lungs (Shock lung: adult respiratory distress syndrome) Kidneys etc. ``` Lactic acidosis and release of cytokines Peripheral vasodilatation (warm skin) Vascular permeability -> loss of fluids form circulation ``` 3. Irreversible Shock Circulatory Collapse Marked Hypoperfusion Loss of Vital Functions

Question 46

compensated shock

Answer 46

``` Compensated shock Blood shunted away from skin, gut, kidneys etc, to brain and heart and peripheral vasoconstriction to help maintain BP. Blood pressure is maintained Cold clammy skin, dry mouth  Urine output ```

Question 47

2. Progressive (decompensated) shock

Answer 47

2. Progressive (decompensated) shock Can not maintain heart and brain function Low blood pressure Altered consciousness End-organ damage Lungs (Shock lung: adult respiratory distress syndrome) Kidneys etc. ``` Lactic acidosis and release of cytokines Peripheral vasodilatation (warm skin) Vascular permeability -> loss of fluids form circulation ```

Question 48

3. irreversible shock

Answer 48

3. Irreversible Shock Circulatory Collapse Marked Hypoperfusion Loss of Vital Functions

Question 49

hemorhage

Answer 49

where are key cites where they are bad

Question 50

how much blood can we loose confortably

Answer 50

kno

Question 51

3 componenets of the triad

Answer 51

know

Question 52

3 causes of shack

Answer 52

and the 3 stages