Hemodynamic Disorders Flashcards
What are the three ways normal fluid homeostasis is maintained?
- vascular wall integrity
- intravascular hydrostatic pressure
- osmolarity
What are the causes of edema?
- Increased hydrostatic pressure
- Reduced Osmotic pressure
- Lymphatic obstruction
What are examples of why there could be increased capillary pressure?
- venous obstruction: DVT, Mass, or Cirrohosis
- systemic: CHF, hypoperfusion to kidneys
Why could osmotic pressure be low causing edema?
Loss of albumin and decreased vascular volume, fluid remains in the interstitium.
Causes of low albumin:
- Damaged Nephrons (leaking through kidney)
- Protein loss through GI pathology
- Malnutrition
- Liver Disease, not making albumin
Causes of lymphatic source of local edema?
- Inflammation
- Neoplastic
- Post surgical / Post radiation
How could excessive sodium intake contribute to edema?
Increases vascular volume, decreasing the colloid osmotic pressure preventing fluid from the interstitium from returning to circulation.
Where would edema be localized when the patient has left ventricular failure?
Pulmonary Edema
If a patient comes into the office with bilateral pedal edema and shortness of breath with a longstanding non-compliance with HTN management. What might be cause of his symptoms?
CHF, increased hydrostatic pressure
A patient has pretibial and ankle edema upon lab testing Creatinine is elevated.
Acute renal insufficiency, damaged nephrons leak protein int he urine and the liver cannot remake fast enough to keep up with leakage.
Edema from lowered osmotic pressure from the low Albumin levels
What is the difference between hyperemia and congestion, even though both are increased blood in tissues?
Hyperemia, active process of increased blood flow into a tissue due to inflammation
Congestion, passive process, decreased venous flow out of tissue.
What are long term consequences of congestion?
The blood can stay built up in the tissue and eventually not enough fresh blood can enter the tissue causing ischemia and necrosis in the congested areas.
Ex. CHF can cause congestion in the liver and can lead to necrosis of the hepatocytes.
What is primary hemostasis?
Primary hemostasis occurs when there is injury or trauma
- Platelet adhesion to vWF on the exposed endothelium
- Platelet changes shape and releases factors
- Factors recruit others and aggregation occurs
What are the steps in secondary hemostasis?
Clot formation
- Tissue factor is released from endothelial cells
- Phospholipid complex expression
- Thrombin Activation***
- Fibrin Polymerization
What lab screening can be performed to evaluate the primary hemostasis mechanism?
Primarily:
- Platelet Count
- Platelet Function
- vWF function
What are common lab testing for secondary hemostasis?
Prothrombin Time - PT (extrinsic and common pathway)
Activated partial thromboplastin time - PTT (intrinsic and common pathway)
Fibrinogen Activity
How do long term anticoagulants reduce the body’s ability to clot?
Depletes Vitamin K reduction
Limiting function of Factors: 2, 7, 9, 10
What is a pathologic reason for depleted clotting factors?
Liver failure, limits production of clotting factors from the liver increasing chances to bleed significantly.
What is an example of pathologic vascular integrity compromise?
Scurvy, no Vitamin C, so defect in collagen and vessel walls
What is the difference between Hemorrhage and Hematoma?
Hemorrhage is when blood comes out of the vessel due to trauma or injury to the tissue.
Hematoma is where there is an injury and the blood is pooled into the tissue.