Hemodynamic disorders (Edema. Congestion, & Hyperemia) Flashcards
Edema is described as
Increased fluid in the interstitial space
Hyperemia is described as
Increase in blood flow
Congestion is described as
Out flow obstruction
Hemostasis is described as
the formation of a blood clot that can prevent or limit bleeding
Thrombosis is described as
The clotting od a blood vessel
Embolism is described as
The detachment of a solid, liquid, or gaseous mass that gets carried away in the blood to another site
can cause an occlusion
Infarction is described as
Death of cells/tissue because lack of blood supply
Shock is described as
Circulatory failure/collapse
Starling’s forces:
Hydrostatic pressure in the capillary
Pushes fluid out of capillary
Increased in Venous obstruction/heart failure
Starling’s forces:
Hydrostatic pressure in interstitium
Pushes fluid in the capillary
increased in lymphatic obstruction
Starling’s forces:
Oncotic pressure in capillary
Pulls fluid into the capillary
Increased in liver failure, nephrotic syndrome, or protein malnutrition
Starling’s forces:
Oncotic pressure in interstitium
Pulls fluid into the interstitium
Increased in lymphatic obstruction
Normal
RA= 5mmHg
RV= 25/5mmHg
LA= 10mmHg
LV= 120/10mmHg
PA= 25/10
AA= 120/8
PCWP= 10mmHg
Abnormal = PCWP 30mmHg (pulmonary capillary wedge pressure)
The 6 mechanisms behind edema
- Increased hydrostatic pressure
- Decreased osmotic pressure (hypoproteinemia)
- increased vascular permeability (inflammation)
- Lymphatic obstruction
- Myxedema
Edema due to increased hydrostatic pressure can be due to 4 conditions associated with impaired venous return & 2 conditions associated with venous obstruction
Imp Venous return:
- CHF
- Constrictive pericarditis
- Cardiac tamponade
- Portal hypertension in cirrhosis (causes ascites)
Venous obstruction:
- Thrombosis
- Lower extremity inactivity + prolonged dependency
CHF & Edema in hypertension occurs due to
the decreased cardiac output decreases renal perfusion and triggers RAAS to reabsorb sodium and water to up the intravascular fluid volume.
The weekended heart can’t handle the extra load, so the ejection fraction reduces meaning end-diastolic volume increases, upping the pressure in the ventricles but not actually helping the heart push fluid out. The build up of pressure increases venous hydrostatic pressure causing fluid to leak (EDEMA)
Think of plugging a hose and the backward increase in pressure
Signs & symptoms of heart failure (name some)
Dyspnea
Resting Tachycardia
Jugular venous pressure elevation
Lung crackles
3rd heart sound
Peripheral edema
Ascites
Pink frothy sputum + cough
What are the horizontal, pleural-based linear densities seen on the patients chest x-ray
Kerley B lines (bat-wing like look)
Happens when pulmonary capillary pressure increases above 18-20mmHg causing pulmonary edema
You see a chest X-ray of a patient with the following markers, what is the likely diagnosis?
Pulmonary edema/congestion
Constrictive pericarditis induced edema:
Constrictive pericarditis is described as
A thickening fibrotic pericardium impedes normal diastolic filling
Coxsackievirus A+B, Echoviruses, & adenovirsues are common causes of what condition?
Viral pericarditis
Staphylococci, Group A & B streptococci, & gram-negative rods (pseudomonas or e.coli) are common causes for what condition?
Bacterial pericarditis
Pericarditis can be caused by
Constriction, bacterial infection, viral infections, or radiation exposure
Jugular venous pressure wave form: Normal
a wave
x descent
c wave
x’ descent
v wave
y descent
a wave (right atrium contracts)
x descent (right atrium relaxes)
c wave (tricuspid valve closes & right ventricle contracts)
x’ descent (end of right ventricular contraction & right atrium fills with blood)
v wave (right atrium fills against a closed tricuspid)
y descent (Tricuspid opens blood moves from RA to ventricle)
Jugular venous pressure wave form: Pathological
Atrial fibrillation
Absent a-waves
Jugular venous pressure wave form: Pathological
Pulmonary hypertension & Pulmonary stenosis
Large a-waves
Jugular venous pressure wave form: Pathological
Complete heart block & ventricular arrhythmias/ectopics
Cannon a-waves
Jugular venous pressure wave form: Pathological
Tricuspid regurgitation
Large v-waves
Jugular venous pressure wave form: Pathological
Constrictive pericarditis
Rise in JVP during inspiration (Kussmaul’s sign)
This x-ray indicates patient has what condition?
Constrictive pericarditis
Front chest x-ray shows ______ sign, which indicated ________
Water bottle sign which indicated pericardial effussion
Liver cirrhosis is described as
A consequence of chronic liver disease where liver tissue is replaced by fibrosis and causes portal venous obstruction
This causes an increase in venous hydrostatic pressure & ascites
Common causes are alcoholism, hep B & C, & fatty liver disease (diabetes/obesity)
Patient presents with __________
Lower extremity & chronic venous insufficiency and edema
Edema due to reduced plasma oncotic pressure (aka hypoproteinemia) is described as a deficiency in what protein?
Albumin
Edema due to reduced plasma oncotic pressure (aka hypoproteinemia) can be due to which conditions (4)
*Protein-losing glomerulopathies (nephrotic syndrome)
*Liver cirrhosis (less albumin)
*Protein-losing gastroenteropathy
*Protein energy malnutrition (Kwashiorkor)
Process of nephrotic syndrome leading to edema
- Hypoalbuminemia
- Reduced intravascular oncotic pressure
- Fluids move to interstitial space (edema)
- less plasma volume triggers aldosterone secretion and decreased renal function = salt & water are retained (edema)
- Kidneys make more albumin and lipoproteins to up serum triglycerides and LDL’s = lipiduria
What are the 2 main outcomes of nephrotic syndrome?
Edema & Lipiduria
Protein-losing gastro enteropathies are described as
Excessive loss of serum proteins into the GI tract causing hypoproteinemia (hypoalbuminemia), edema, and sometimes pleural & pericardial effusions
What is a common cause of protein-losing enteropathy?
Celiac disease (gluten enteropathy)
Processes of heart failure leading to edema include
- Heart failure
- More capillary hydrostatic pressure (edema)
- Less renal blood flow triggers RAAS to up Na & H2O retention upping blood volume (edema)
Processes of Malnutrition, decreased hepatic synthesis, & nephrotic syndrome cause edema are
- A decrease in albumin reduces capillary oncotic pressure (edema)
Patient presents with the following, what is the likely diagnosis?
Kwashiorkor
What’s the edema type
Cerebral edema
- wide gyri, narrow sulci, & flat surface
What’s the edema
Pulmonary edema
Edema due to increased vascular permeability (aka acute/chronic inflammation & angiogenesis) can be due to
Cellulitis
Bee/insect stings
Edema due to lymphatic obstruction (lymphedema) is described as
Disrupted lymphatic vessels from trauma, fibrosis, invasive tumors, or infections that impair the clearance of interstitial fluid causing edema
Modified radical mastectomy or radiation can put patient at risk of which type of edema
Lymphedema
Wuchereria cancrofti puts patients at risk of what condition
Lymphedema in filariasis
Scrotal and vulvar lymphedema are due to which type of edema?
lymphogranuloma venereum
Blockage of subcutaneous lymphatics by malignant cells can cause which condition in breast tissue?
Breast lymphedema (inflammatory carcinoma)
Myxedema is described as
An increase in the production of ECM components (i.e glycosaminoglycans = swelling) because of T cell mediated cytokines which stimulate fibroblasts to make hyaluronic acid
Tissue swelling in Myxedema, Hypothyroidism, & Graves occurs because of increased production of which ECM components?
Glycosaminoglycans
Types of edema:
Pitting
Types of edema:
Non-pitting (hyperthyroid or lymphedema induced)
Anasarca is described as
extreme generalized peripheral edema
Lymphedema & Myxedema are both ________ edema
non-pititng
Hyperanemia vs Congestion:
Both are caused from ________ in tissues
an increase in blood volume within tissues
Congestion commonly occurs in which 3 tissues?
Liver (acute/chronic), lung (acute/chronic), and brain
Describe the following histo slide condition:
Acute passive congestion in the lung (precedes acute pulmonary edema aka fluid in the alveoli)
What condition does the following histo slide describe?
Chronic passive congestion in the lung
Lung tissue with hemosiderin laden macrophages stained with Prussian blue are a good indication of what type of congestion?
Chronic passive congestion of the lung
Congestion of the liver:
Liver congestion is described as
The liver is swollen and rubbery on the section surface with alternating red and yellow strips (tiger liver),
Histo details will show centrilobular hemorrhage with hemosiderin-laden macrophages, and degenerated hepatocytes (fatty degradation)
What condition is most likely to present with congestion of the liver?
Right-sided heart failure
Describe the following histo:
Chronic passive congestion due longstanding obstruction to the venous flow
Patient presents with a “nutmeg” looking liver, what’s the likely condition?
Congestion of the liver
Kwashiorkor is described as
Protein-energy malnutrition
Describe the pathology of Nephrotic syndrome
Patient has low albumin (hypoalbuminemia) which reduces intravascular oncotic pressure pushing fluid out of capillaries causing lipiduria (Albumin production & LDL production) and edema (via increased RAS + renal dysfunction)
Hypoalbuminemia is also known as
Protein-losing gastro enteropathy (aka loss of proteins into the GI tract causing hypoproteinemia = edema + pleural/pericardial effusions
Wuchereria bancrofti can lead to which condition?
Wuchereria bancrofti
Radical mastectomy and radiation therapy can result in ________?
Lymphedema
Hyperemia is due to what?
Increased inflow of blood (exercise/inflammation)
Congestion is due to what?
Decreased outflow (obstruction or CHF etc)
Describe the major features of Right sided heart
- Becks triad (hypotension, distended jugular veins, & heart murmurs)
- Nutmeg liver
Describe the major features of Left sided heart
Pulmonary edema or effusion
hemolytic uremic syndrome
Due to E.coli 0157:H7
Most commonly in kids
Common signs are petechiae, jaundice, oliguria, schistocytes, low platelet count, & normal PT (INR) Time
Thrombotic thrombocytopenic purpura
Deficient ADAMTS13 (vWF)
Common in adults
Common signs are neurological symptoms, fever, petechiae, fatigue/parlor, schistocytes, low platelet count, & normal PT (INR)
**Positive Ristocetin test (agglutinated when plasma is added)
Immune thrombocytopenic purpura
Anti-platelet antibodies (GPIIb/IIa)
Common signs are petechiae, purpura, epistaxis, menorrhagia, bleeding gums, normal platelet morphology, low platelet counts, & normal PT (INR)
Bernard Soulier
An adhesion party deficient GPIbIX an AUTO REC
Common signs are petechiae, purpura, epistasis, menorrhagia, bleeding gums, giant platelets, & low platelet count
** Negative Ristocetin test (no agglutination with plasma)
What are the 2 major components of the intracellular adherence junctions?
Keratin (cytoskeletal filaments) & Cadherin (adhesion protein)
Dense bodies contain which factors?
Contain
- ADP
- Aggregating agents
- Calcium
Binding agents for vitamin K-dependent factors
a-granules contain what factors?
They contain
- vWF
- Fibrinogen
- PDGF (Platelet Derived Growth Factor)
- PF4 (Platelet Factor 4)
These are heparin-neutralizing factors
Describe hyperemia
Increased blood flow (normal during exercise etc)
Describe congestion?
Outflow of blood is obstructed
High PCWP indicates what?
Left ventricular failure (an approximation of left ventricular EDV, normal being 10mmHg)
High hydrostatic pressure indicates which conditions (3)
Heart failure, Hypertension, & Embolism
Low osmotic pressure indicates which of the following conditions? (2)
Liver failure/cirrhosis & kidney failure
High vascular permeability (inflammation) is indicative of what conditions? (5)
SLE, TB infection, Rheumatoid arthritis, & Hep B/C
Myxedema (non pitting) is due to an increase in what contents? And which conditions can it be present in?
ECM contents i.e glycosaminoglycans & hyaluronic acid)
Present in Hypothyroidism, graves disease, & Hashimoto’s
