GP 27 - Hemodynamic Disorders 1 Flashcards
What is the difference between pitting edema and non-pitting edema? What are the primary causes of each? What other symptoms could be present to indicate a specific cause.
- Non-pitting Edema is edema that does not leave an indentations when it is depressed with a finger. It’s usualy cause is a hypothyroid condition (weakness, weight gain, hair loss)
- Pitting Edema is edema that does leave an indentation (“pit”) when it depressed with a finger. It is usually caused by an insufficiency in one of the following systems:
- Heart (chest pain, dyspnea)
- Liver (jaundice, bleeding)
- Kidney (urine and/or BP abnormalities)
- GIT (malnutrition, diarrhea)
Differentiate edema from effusion. In which tissues does edema mostly occur?
Edema is an abnormal excess accumulation of fluid in the intercellular spaces. This most often occurs in the subcutaneous tissues, lungs, and brain.
Effusion is the abnormal excess accumulation of fluid in the body cavities.
List and describe the main types of edemas and effusions.
- Pulmonary Edema - edema in the alveoli
- Pleural Effusion (aka - hydrothorax) - fluid in the pleural space
- Pericardial Effusion (aka - hydropericardium) - fluid in the pericardium
- Ascites (aka - hydroperitoneum) - fluid in the peritoneum
- Anasarca - severe generalized edema
What is dependent edema? What usually causes it and where is it usually seen?
- Dependent edema is edema whose location is dependent on gravity..
- It is usually caused by increased hydrostatic pressure as a result of right heart failure, a vein thrombosis, or seomething pressing on a vein (like a tumor)
- When the patient is mobile, the edema is typically seen in the legs/feet. If the patient is bed ridden, the edema is usually seen in the sacral region.
How can issues with liver, kidney, and GIT cause edema?
By decreasing oncotic pressure:
- Liver Disease - decreased plasma protein synthesis
- Kidney Disease - increased plasma protein loss
- GIT issues - malabsorption also leads to decreased plasma protein synthesis
Malnutrition can also cause decreased plasma protein synthesis
What is and what causes elephantiasis? What is it also known as. What disease normally leads to this and how?
Elephantiasis, or lymphatic edema, is a condition of localized fluid retention caused by a compromised lymphatic system.
Lymphatic Filariasis is a parasitic worm infection that causes fibrosis of the lymphatics.
What are the most common causes of lymphatic obstruction?
- Inflammations
- Neoplasms
- Surgical Operations that remove lymph nodes
- Radiation
List the types of edemas left sided heart failure causes and how these types of edemas are managed?
- Pulmonary edema
- Generalized edema
- reduced GFR leads to activation of the RAA axis (secondary hyperaldosteronism) and sodium retention
Management is usually salt restriction, diuretics, and aldosterone antagonists
List the types of edemas caused by renal disease. Describe the general mechanism.
- Renal Diseases with damage to the glomerulus basement membrane cause hypoalbuminemia (Nephrotic Syndrome) which decreases plasma oncotic pressure.
- In glomerulonephritis, there is inflammatory damage with clogging of the glomerular capillaries. This reduces GFR, causing activation of the RAA axis (secondary hyperaldosteronism) and retention of salt and water.
Both of these cause generalized edema which initially presents as periorbital edema or facial puffiness
What is the usual cause of ascites?
Portal Hypertension
The portal vein is formed by the merger of the superior/inferior mesenteric veins and the splenic veins. Portal vein hypertension causes an increase in hydrostatic pressure in the veins draining the gut and fluid begins to collect in the peritoneum (ascites)
Describe how malnutrition causes edema.
- Reduces Serum Albumin
- Descreases Plasma Oncotic Pressure
- Decreases Effective Plasma Volume
- Secondary Hyperaldosteronism
- Sodium and Water Retention
- Edema
List the key differences between transudate and exudate. Why is it useful to know this?
Refer to image for key differences
When a patient comes in with some kind of edema/effusion, a sample of the fluid can be taken and tested. If it is an exudate fluid, the edema/effusion is most likely caused by some kind of infection. If it is a transudate fluid, the edma/effusion is most likely the result of a change in starling forces.
List the phases of pulmonary edema. How will it appear on a micrograph? How will it present clinically?
- Interstitial Phase - fluid not yet in alveolar space. Alveolar walls may appear more swollen on a micrograph. Patient may present with a cough and dyspnea
- Alveolar Phase - fluid has advanced into the alveolra spaces. Alveolar spaces will be filled with a homogenous pink staining fluid on a micrograph.. Patient will present with a cough and dyspnea. In severe cases there will be a frothy sputum and cyanosis.
What is papilledema? What is its morphology and what does it indicate?
Papilledema is swelling of the optic nerve in the retina. Normally the optic disk has well defined edges when viewed via opthalmoscopy. The edges will appear blunted in papilledema.
Papilledema is an indicator of increased intracranial pressure
