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Path SJSM > Hemodynamic disorders (Edema. Congestion, & Hyperemia) > Flashcards

Hemodynamic disorders (Edema. Congestion, & Hyperemia) Flashcards

1
Q

Edema is described as

A

Increased fluid in the interstitial space

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2
Q

Hyperemia is described as

A

Increase in blood flow

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3
Q

Congestion is described as

A

Out flow obstruction

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4
Q

Hemostasis is described as

A

the formation of a blood clot that can prevent or limit bleeding

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5
Q

Thrombosis is described as

A

The clotting od a blood vessel

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6
Q

Embolism is described as

A

The detachment of a solid, liquid, or gaseous mass that gets carried away in the blood to another site
can cause an occlusion

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7
Q

Infarction is described as

A

Death of cells/tissue because lack of blood supply

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8
Q

Shock is described as

A

Circulatory failure/collapse

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9
Q

Starling’s forces:

Hydrostatic pressure in the capillary

A

Pushes fluid out of capillary

Increased in Venous obstruction/heart failure

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10
Q

Starling’s forces:

Hydrostatic pressure in interstitium

A

Pushes fluid in the capillary

increased in lymphatic obstruction

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11
Q

Starling’s forces:

Oncotic pressure in capillary

A

Pulls fluid into the capillary

Increased in liver failure, nephrotic syndrome, or protein malnutrition

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12
Q

Starling’s forces:

Oncotic pressure in interstitium

A

Pulls fluid into the interstitium

Increased in lymphatic obstruction

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13
Q
A

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)

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14
Q

The 6 mechanisms behind edema

A
  1. Increased hydrostatic pressure
  2. Decreased osmotic pressure (hypoproteinemia)
  3. increased vascular permeability (inflammation)
  4. Lymphatic obstruction
  5. Myxedema
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15
Q

Edema due to increased hydrostatic pressure can be due to 4 conditions associated with impaired venous return & 2 conditions associated with venous obstruction

A

Imp Venous return:
- CHF
- Constrictive pericarditis
- Cardiac tamponade
- Portal hypertension in cirrhosis (causes ascites)

Venous obstruction:
- Thrombosis
- Lower extremity inactivity + prolonged dependency

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16
Q

CHF & Edema in hypertension occurs due to

A

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

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17
Q
A
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18
Q

Signs & symptoms of heart failure (name some)

A

Dyspnea
Resting Tachycardia
Jugular venous pressure elevation
Lung crackles
3rd heart sound
Peripheral edema
Ascites
Pink frothy sputum + cough

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19
Q

What are the horizontal, pleural-based linear densities seen on the patients chest x-ray

A

Kerley B lines (bat-wing like look)

Happens when pulmonary capillary pressure increases above 18-20mmHg causing pulmonary edema

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20
Q

You see a chest X-ray of a patient with the following markers, what is the likely diagnosis?

A

Pulmonary edema/congestion

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21
Q

Constrictive pericarditis induced edema:

Constrictive pericarditis is described as

A

A thickening fibrotic pericardium impedes normal diastolic filling

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22
Q

Coxsackievirus A+B, Echoviruses, & adenovirsues are common causes of what condition?

A

Viral pericarditis

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23
Q

Staphylococci, Group A & B streptococci, & gram-negative rods (pseudomonas or e.coli) are common causes for what condition?

A

Bacterial pericarditis

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24
Q

Pericarditis can be caused by

A

Constriction, bacterial infection, viral infections, or radiation exposure

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25
Q

Jugular venous pressure wave form: Normal

a wave
x descent
c wave
x’ descent
v wave
y descent

A

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)

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26
Q

Jugular venous pressure wave form: Pathological

Atrial fibrillation

A

Absent a-waves

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27
Q

Jugular venous pressure wave form: Pathological

Pulmonary hypertension & Pulmonary stenosis

A

Large a-waves

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28
Q

Jugular venous pressure wave form: Pathological

Complete heart block & ventricular arrhythmias/ectopics

A

Cannon a-waves

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29
Q

Jugular venous pressure wave form: Pathological

Tricuspid regurgitation

A

Large v-waves

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30
Q

Jugular venous pressure wave form: Pathological

Constrictive pericarditis

A

Rise in JVP during inspiration (Kussmaul’s sign)

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31
Q

This x-ray indicates patient has what condition?

A

Constrictive pericarditis

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32
Q

Front chest x-ray shows ______ sign, which indicated ________

A

Water bottle sign which indicated pericardial effussion

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33
Q

Liver cirrhosis is described as

A

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)

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34
Q

Patient presents with __________

A

Lower extremity & chronic venous insufficiency and edema

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35
Q

Edema due to reduced plasma oncotic pressure (aka hypoproteinemia) is described as a deficiency in what protein?

A

Albumin

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36
Q

Edema due to reduced plasma oncotic pressure (aka hypoproteinemia) can be due to which conditions (4)

A

*Protein-losing glomerulopathies (nephrotic syndrome)
*Liver cirrhosis (less albumin)
*Protein-losing gastroenteropathy
*Protein energy malnutrition (Kwashiorkor)

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37
Q

Process of nephrotic syndrome leading to edema

A
  1. Hypoalbuminemia
  2. Reduced intravascular oncotic pressure
  3. Fluids move to interstitial space (edema)
  4. less plasma volume triggers aldosterone secretion and decreased renal function = salt & water are retained (edema)
  5. Kidneys make more albumin and lipoproteins to up serum triglycerides and LDL’s = lipiduria
38
Q

What are the 2 main outcomes of nephrotic syndrome?

A

Edema & Lipiduria

39
Q

Protein-losing gastro enteropathies are described as

A

Excessive loss of serum proteins into the GI tract causing hypoproteinemia (hypoalbuminemia), edema, and sometimes pleural & pericardial effusions

40
Q

What is a common cause of protein-losing enteropathy?

A

Celiac disease (gluten enteropathy)

41
Q

Processes of heart failure leading to edema include

A
  1. Heart failure
  2. More capillary hydrostatic pressure (edema)
  3. Less renal blood flow triggers RAAS to up Na & H2O retention upping blood volume (edema)
42
Q

Processes of Malnutrition, decreased hepatic synthesis, & nephrotic syndrome cause edema are

A
  1. A decrease in albumin reduces capillary oncotic pressure (edema)
43
Q

Patient presents with the following, what is the likely diagnosis?

A

Kwashiorkor

44
Q

What’s the edema type

A

Cerebral edema
- wide gyri, narrow sulci, & flat surface

45
Q

What’s the edema

A

Pulmonary edema

46
Q

Edema due to increased vascular permeability (aka acute/chronic inflammation & angiogenesis) can be due to

A

Cellulitis
Bee/insect stings

47
Q

Edema due to lymphatic obstruction (lymphedema) is described as

A

Disrupted lymphatic vessels from trauma, fibrosis, invasive tumors, or infections that impair the clearance of interstitial fluid causing edema

48
Q

Modified radical mastectomy or radiation can put patient at risk of which type of edema

A

Lymphedema

49
Q

Wuchereria cancrofti puts patients at risk of what condition

A

Lymphedema in filariasis

50
Q

Scrotal and vulvar lymphedema are due to which type of edema?

A

lymphogranuloma venereum

51
Q

Blockage of subcutaneous lymphatics by malignant cells can cause which condition in breast tissue?

A

Breast lymphedema (inflammatory carcinoma)

52
Q

Myxedema is described as

A

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

53
Q

Tissue swelling in Myxedema, Hypothyroidism, & Graves occurs because of increased production of which ECM components?

A

Glycosaminoglycans

54
Q

Types of edema:

A

Pitting

55
Q

Types of edema:

A

Non-pitting (hyperthyroid or lymphedema induced)

56
Q

Anasarca is described as

A

extreme generalized peripheral edema

57
Q

Lymphedema & Myxedema are both ________ edema

A

non-pititng

58
Q

Hyperanemia vs Congestion:

Both are caused from ________ in tissues

A

an increase in blood volume within tissues

59
Q

Congestion commonly occurs in which 3 tissues?

A

Liver (acute/chronic), lung (acute/chronic), and brain

60
Q

Describe the following histo slide condition:

A

Acute passive congestion in the lung (precedes acute pulmonary edema aka fluid in the alveoli)

61
Q

What condition does the following histo slide describe?

A

Chronic passive congestion in the lung

62
Q

Lung tissue with hemosiderin laden macrophages stained with Prussian blue are a good indication of what type of congestion?

A

Chronic passive congestion of the lung

63
Q

Congestion of the liver:

Liver congestion is described as

A

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)

64
Q

What condition is most likely to present with congestion of the liver?

A

Right-sided heart failure

65
Q

Describe the following histo:

A

Chronic passive congestion due longstanding obstruction to the venous flow

66
Q

Patient presents with a “nutmeg” looking liver, what’s the likely condition?

A

Congestion of the liver

67
Q

Kwashiorkor is described as

A

Protein-energy malnutrition

68
Q

Describe the pathology of Nephrotic syndrome

A

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)

69
Q

Hypoalbuminemia is also known as

A

Protein-losing gastro enteropathy (aka loss of proteins into the GI tract causing hypoproteinemia = edema + pleural/pericardial effusions

70
Q

Wuchereria bancrofti can lead to which condition?

A

Wuchereria bancrofti

71
Q

Radical mastectomy and radiation therapy can result in ________?

A

Lymphedema

72
Q

Hyperemia is due to what?

A

Increased inflow of blood (exercise/inflammation)

73
Q

Congestion is due to what?

A

Decreased outflow (obstruction or CHF etc)

74
Q

Describe the major features of Right sided heart

A
  • Becks triad (hypotension, distended jugular veins, & heart murmurs)
  • Nutmeg liver
75
Q

Describe the major features of Left sided heart

A

Pulmonary edema or effusion

76
Q

hemolytic uremic syndrome

A

Due to E.coli 0157:H7
Most commonly in kids
Common signs are petechiae, jaundice, oliguria, schistocytes, low platelet count, & normal PT (INR) Time

77
Q

Thrombotic thrombocytopenic purpura

A

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)

78
Q

Immune thrombocytopenic purpura

A

Anti-platelet antibodies (GPIIb/IIa)
Common signs are petechiae, purpura, epistaxis, menorrhagia, bleeding gums, normal platelet morphology, low platelet counts, & normal PT (INR)

79
Q

Bernard Soulier

A

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)

80
Q

What are the 2 major components of the intracellular adherence junctions?

A

Keratin (cytoskeletal filaments) & Cadherin (adhesion protein)

81
Q

Dense bodies contain which factors?

A

Contain
- ADP
- Aggregating agents
- Calcium

Binding agents for vitamin K-dependent factors

82
Q

a-granules contain what factors?

A

They contain
- vWF
- Fibrinogen
- PDGF (Platelet Derived Growth Factor)
- PF4 (Platelet Factor 4)

These are heparin-neutralizing factors

83
Q

Describe hyperemia

A

Increased blood flow (normal during exercise etc)

84
Q

Describe congestion?

A

Outflow of blood is obstructed

85
Q

High PCWP indicates what?

A

Left ventricular failure (an approximation of left ventricular EDV, normal being 10mmHg)

86
Q

High hydrostatic pressure indicates which conditions (3)

A

Heart failure, Hypertension, & Embolism

87
Q

Low osmotic pressure indicates which of the following conditions? (2)

A

Liver failure/cirrhosis & kidney failure

88
Q

High vascular permeability (inflammation) is indicative of what conditions? (5)

A

SLE, TB infection, Rheumatoid arthritis, & Hep B/C

89
Q

Myxedema (non pitting) is due to an increase in what contents? And which conditions can it be present in?

A

ECM contents i.e glycosaminoglycans & hyaluronic acid)

Present in Hypothyroidism, graves disease, & Hashimoto’s

90
Q
A

Path SJSM (26 decks)

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