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Pathophysiology I > Fluids & Shock > Flashcards

Fluids & Shock Flashcards

1
Q

what is edema?

A

excess interstitial (tissue) fluid-may be localized or systemic

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2
Q

what can edema include?

A

excess fluid in body cavities (“third spaces”)

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3
Q

what is edema in the peritoneal cavity?

A

ascites

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4
Q

what is edema in the pericardial cavity?

A

pericardial effusion

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5
Q

what is excess cerebrospinal fluid?

A

hydrocephalus

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6
Q

what is edema in the testicular cavity?

A

hydrocele

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7
Q

what is edema in the uterine tube?

A

hydrosalpinx

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8
Q

what is edema in the small intestine?

A

ileus

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9
Q

what is edema between the epidermis and dermis?

A

blister

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10
Q

what is edema in a surgically-created space (wound)?

A

seroma

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11
Q

what is edema in the pleural cavity (hemothorax, empyema)?

A

hydrothorax

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12
Q

what are transudates composed of?

A

salt water, little to no protein content

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13
Q

what do transudates result from?

A

alterations in starling forces or lymphatic failure

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14
Q

what can cause transudates?

A 
heart failure
cirrhosis
renal failure
salt-indulgence
mechanisms can be complex
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15
Q

starling forces

A

things that contribute to fluid exchange across capillary walls

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16
Q

what causes fluid to go out of capillaries?

A 
hydrostatic pressure (BP) is higher than the pressure in the tissues (osmotic/oncotic pressure)
capillary hydrostatic pressure (BP), as fluid is lost BP goes down at venous end, capillary hydrostatic pressure drops on venous end
positive at end
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17
Q

what causes fluid to go into capillaries?

A

osmotic pressure is greater than capillary hydrostatic pressure

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18
Q

causes of transudative edema

A 
excess total body water
salt/fluid overloading
excess aldosterone (tumor, hepatic failure)
kidney failure from any cause
systemic veins (all)-R heart failure
pulmonary veins-L heart failure
leg veins-prolonged standing, pregnancy, valve failure
portal vein-cirrhosis
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19
Q

causes of transudative edema 2

A

cerebral capillaries-brain trauma
systemic capillaries-decreased plasma proteins (liver failure, malnutrition, nephrotic syndrome)
lymphatic obstruction-inflammation/scarring-filariasis “elephant man”, cancer, radiation

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20
Q

is treatment needed for transduative edema?

A

varies depending on cause

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21
Q

what are exudates composed of?

A

protein-rich salt water

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22
Q

what causes exudates?

A

overly leaky capillaries

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23
Q

what are exudates seen with?

A

inflammation
sepsis
burns
abnormal capillaries in tumors

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24
Q

what happens when exudates are created?

A

leaked proteins draw water into interstitial space or “third” space

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25
Q

how would you tell transudate or exudate?

A

lab can distinguish from sample of fluid, protein content main determining factor

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26
Q

hemorrhage

A

loss of whole blood from blood vessels

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27
Q

where can hemorrhages be?

A

external, into tissues, or into “third” spaces

28
Q

what are small hemorrhages?

A

petechiae <3mm

29
Q

what are medium hemorrhages?

A

purpura 3-10mm

30
Q

what are large hemorrhages?

A

ecchymosis >10mm “bruise”

31
Q

hematoma

A

blood in tissues produces a mass

32
Q

hematoma in thorax, pericardium, peritoneum

A

hemathorax
hemopericardium
hemoperitoneum

33
Q

hemoptysis

A

coughing blood

34
Q

hematemesis

A

vomiting lood

35
Q

hematochezia

A

bright red blood per rectum

36
Q

melena

A

black, tarry, digested blood per rectum

37
Q

causes of hemorrhage

A 
trauma
diseases of blood vessels
diseases around blood vessels
lack of clotting factors
lack of platelets
38
Q

what determines significance of hemorrhage?

A 
where and how much
brain bleeds-devastating
hemopericardium-rapidly fatal
black eye-harmless
500mL in street no big deal, 500mL pericardial space means death
39
Q

can hemorrhages be quantified?

A

yes if it is into tissues or external

40
Q

class I hemorrhage blood loss

A

up to 750mL (1-15%)

41
Q

class I hemorrhage clinical signs

A

minimal to none

42
Q

class II hemorrhage blood loss

A

750-1500mL (15-30%)

43
Q

class II hemorrhage clinical signs

A

tachycardia, tachypnea, anxiety

44
Q

class III hemorrhage blood loss

A

1500-2000mL (30-40%)

45
Q

class III hemorrhage clinical signs

A

tachycardia, tachypnea, hypotension, altered mental status

46
Q

class IV hemorrhage blood loss

A

2000mL (>40%)

47
Q

class IV hemorrhage clinical signs

A

tachycardia, hypotension, cold, clammy, severely altered mental status

48
Q

what can class III and IV hemorrhages progress to?

A

irreversible shock

49
Q

where can significant internal losses occur?

A

thoracic/abdominal cavities

thigh

50
Q

shock

A

widespread hypoperfusion of body tissues

51
Q

what does hypoperfusion lead to?

A

organ malfunction/failure

52
Q

what can compensatory mechanisms do in hypoperfusion?

A

maintain blood pressure

53
Q

what does anaerobic metabolism predominate in shock?

A

lactic acidosis
release of inflammatory mediators
further vasodilation
decreased perfusion

54
Q

hypovolemic shock

A

decrease in blood volume

55
Q

what can cause hypovolemic shock?

A 
hemorrhage-internal or external
vomiting
diarrhea
burns
third-space losses
56
Q

cardiogenic shock

A

pump failurs

57
Q

what can cause cardiogenic shock?

A

massive infarction (heart attack)
rupture of ventricle or valve
some rhythm disturbance

58
Q

distributive shock (“warm” shock)

A

profound vasodilation, lack of venous return

59
Q

what can cause distributive or warm shock?

A 
sepsis
anaphylaxis
high spinal cord injury
profpund anesthesia
vasovagal (pain, emotion)
newer war gases
60
Q

obstructive shock

A

external compression of heart or its outflow

61
Q

what can cause obstructive shock?

A

tension pneumothorax
large pericardial effusion “cardiac tamponade”
massive pulmonary embolism

62
Q

what happens during compensated stage of shock?

A

blood shunted from kidneys, salivary glands, gut, skin
maintains perfusion to heart and brain
oliguria, dry mouth and skin
BP is maintained

63
Q

what happens during progressive stage of shock?

A 
sympathetic compensatory mechanisms fail
BP and cardiac output drop
lung and kidney damage occurs
survival becomes unlikely
-tissue injury may not be reversible
64
Q

what is the goal of treatment for shock?

A 
restore tissue perfusion
not simply raise BP
control of bleeding
fluids, fluids, fluids
address underlying cause
65
Q

how much fluid is adequate to treat shock?

A

1L in 5 minutes, repeat 2L over 10 mintes

Pathophysiology I (10 decks)

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