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Disease and Defense > Hemodynamic Basis of Disease > Flashcards

Hemodynamic Basis of Disease Flashcards

1
Q

Extravasation of fluid into tissue –>

A

edema

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2
Q

Extravasation of fluid into spaces?

A

effusion

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3
Q

What results from increased hydrostatic pressure and reduced oncotic pressure?

A

transudate

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4
Q

what results from increased vascular permeability (inflammation –> endothelial cell contraction creates small gaps / direct damage to endothelial cells)

A

exudate

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5
Q

etiology of transudate

A

ultrafiltrate of plasma: incrased hydrostatic pressure and/or reduced oncotic pressure

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6
Q

etiology of exudate

A

increased vessel permeability due to inflammation

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7
Q

if our fluid has low specific gravity

A

transudate

low density

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8
Q

if our fluid has low LDH:serum

A

transudate

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9
Q

if our fluid has high specific gravity >1.020

A

exudate

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10
Q

if our fluid has high LDH:serum

A

exudate

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11
Q

if our fluid has many white blood cells

A

exudate

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12
Q

if our fluid has high glucose fluid:serum >0.5?

A

transudate

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13
Q

if our fluid has low protein?

A

transudate

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14
Q

if our fluid has high protein fluid:serum?

A

exudate

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15
Q

if our fluid has low glucose fluid:serum?

A

exudate

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16
Q

if our fluid has few white blood cells

A

transudate

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17
Q

this type of fluid usually results from inflammation / toxins / burns

A

exudate

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18
Q

this type of fluid usually results from heart failure / liver disease / venous obstruction / fluid overload

A

transudate

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19
Q 
transudate 
sg?
tp?
p f:s?
LDH f:s?
glucose f:s?
wbc?
examples?
A

sg 0.5
WBC non or few
e.g. hf / ld / venous obs / fluid overload

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20
Q 
exudate 
sg?
tp?
p f:s?
LDH f:s?
glucose f:s?
wbc?
examples?
A 
sg >1.02
tp > 3
p f:s >0.5
LDH f:s >0.6
Glucose f:s
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21
Q

Types of increased blood volume (2)

A

hyperemia (physiologic)

congestion (pathologic)

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22
Q

hyperemia?

A

physiologic (active) increase in blood volume
due to arterial dilation
oxygenated blood: red

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23
Q

congestion?

A

pathologic (passive) increase in blood volume
impaired venous outflow
deoxygenated blood: pale or red/blue

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24
Q

liver congestion

side of hf?

A

right

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25
Q

gi tract varices

side of hf?

A

right

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26
Q

ascites

side of hf?

A

right

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27
Q

what is ascites

A

accumulation of fluid in the peritoneal cavity causing abdonminal swelling

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28
Q

splenic congestion

side of hf?

A

right

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29
Q

peripheral edema?

side of hf?

A

left?

30
Q

pulmonary edema results from

side of hf?

A

left

31
Q

pleural effusion

side of hf?

A

left

32
Q

renal consequence of left hf?

A

decreased renal blood flow –> retention of na+ and water –> increased blood volume –> peripheral edema

33
Q

hemorrhage

A

blood outside of the vasculature, due to vessel damage

34
Q

causes of hemorrhage (3)

A

impaired integrity of vessel walls
low level / function of platelets
low level / function of coagulation factors

35
Q

petechiae

A

1-2 mm blood dots from hemorrhage

36
Q

purpura

A

> 3mm blood dots from hemorrhage

37
Q

ecchymoses

A

1-2cm blood dots from hemorrhage

38
Q

hematoma

A

blood accumulation from hemorrhage within tissue

39
Q

thrombosis: virchow triad

A

endothelial injury
abnormal blood flow
hypercoagulability

40
Q

virchow triad

cause of endothelial injury?

A

hypercholesterolemia

inflammation

41
Q

virchow triad

cause of abnormal blood flow? (2)

A

stasis (e.g. a-fib, bed rest)

turbulence (e.g. atherosclerotic vessel narrowing)

42
Q

virchow triad

cause of hypercogulability (2)

A

inherited
(e.g. factor V leiden)
acquired
(e.g. disseminated cancer)

43
Q

most common type of embolus?

A

thromboembolus (DVT)

44
Q

Risk factors for DVT (7)

A 
Immobility / recent surgery
estrogen
pregnancy / post-partum 
previous or current cancer
coagulation anomalies
limb and/or orthopedic trauma
obesity
45
Q

thromboemboli - venous
source/cause
organ affected
clinical

A

source - deep leg veins / arm veins
organs - lungs
clinical - respiratory insufficiency / chest pain

46
Q

fat/bone marrow emboli
source
organ
clinical

A

source - long bone fracture - vein damage
organ - lung
clinical - resp insufficiency

47
Q

amniotic fluid emboli
source
organ
clinical

A

source - torn placental membranes / uterine vein rupture
organ - lungs/brain/vasculature
clinical - resp insufficiency / shock / seizures / DIC 10% maternal deaths

48
Q

tumor emboli
source
organ
clinical

A

source - mucin secreting adenocarcinomas / liver / kidney
organ - lungs
clinical - resp insuff / chest pain

49
Q

thromboemboli - arterial
source
organ
clincal

A

source - heart / aorta / carotid
organs - legs (75%) brain (10%)
clinical - stroke / tissue necrosis in leg

50
Q

atheroemboli
source
organ
clinical

A

source - atherosclerotic plaque of aorta / iliac / carotid
organ - legs / brain / GI / kidney
clinical - stroke / tissue necrosis / GI pain or bleeding / acute kidney injury

51
Q

gas bubble emboli
source
organ
clinical

A

source - diving or IV
organ - muscle / joints / lungs / heart
clinical - bends (skeletal / joint pain) - chokes (lung edema and hemmorhage) - respiratory insufficiency / myocardial infarction

52
Q

disseminated intravascular coagulation

A

thrombosis and hemorrhage can occur simultaneously

53
Q

DIC underlying condition?

A

tissue factor release, endothelial damage

54
Q

DIC we see systemic activation of ?

A

coagulation

55
Q

systemic activation of coagulation in DIC leads to (2)

A

widespread fibrin deposition –> thrombosis

consumption of platelets and clotting factors (bleeding)

56
Q

DIC

symptoms?

A 
from multiple organ systems
- resp insufficiency
- mental status changes / convulsions
- acute renal failure
- petechiae / purpura
- GI / oral hemorrhage
Shock
57
Q

DIC blood work?

A 
hemolytic anemia
thrombocytopenia 
low fibrinogen 
elevated D-dimer
other fibrin degradation products
58
Q

infarction

A

tissue death (necrosis) caused by vessel occlusion

59
Q

type of necrosis in infarction?

A

typically coagulative but liquefactive in brain

60
Q 
infarction: white
insufficiency?
blood supply?
reperfusion?
tissue type?
organs?
A 
insufficiency: arterial
blood supply: single
reperfusion: no
tissue type: dense
organs: heart / kidney / spleen
61
Q 
infarction: red 
insufficiency?
blood supply?
reperfusion?
tissue type?
organs?
A 
insufficiency: venous
blood supply: dual
reperfusion: yes
tissue type: loose
organs: lung / liver / intestine
62
Q

what is shock?

A

circulating blood volume or blood pressure is not adquate to perfuse body tissues –> multi-organ dysfunction / damage

63
Q

cardiogenic shock -

A

myocardial pump failure

- myocardial damage, extrinsic compression, outflow obstruction

64
Q

hypovolemic shock

A

low blood volume

- severe dehydration (vomiting / diarrhea), hemorrhage, burns

65
Q

clinical manifestations of cardiogenic and hypovolemic shock?

A

low c.o and low b.p –>

vasoconstriction
increased heart rate
renal conservation of fluid –>

coolness and pallor of skin / tachycardia / low urine output

66
Q

Systemic inflammatory response syndrome is seen in?

A

septic shock (microbial infection - bacteria/fungi)

67
Q

what happens in SIRS

A

Immensely elevated inflammatory mediators –> fever / DIC / ARDS

Arterial vasodilation –> hypotension / warm / flush

vascular leakage –> hypotension / edema

venous blood pooling –> reduced c.o. / increased H.R.

68
Q

If someone is in shock and is cool and has pallor, think?

A

hypovolemic or cardiogenic

69
Q

if someone is in shock and warm and flush think?

A

septic

70
Q

does septic shock respond to IV fluids?

A

often not

Disease and Defense (12 decks)

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