Hemodynamics Flashcards
Most common cause of generalized edema
heart failure
effusion
excess fluid in serosal body cavity
hydrothorax
fluid in a pleural cavity
anasarca
generalized edema
pathophysiologic categories of edema
- increased hydrostatic pressure
- decreased oncotic pressure (decreased plasma osmotic pressure)
- lymphatic obstruction (least common)
- sodium retention
- inflammation
Causes of increased hydrostatic pressure leading to edema in:
- leg
- lungs
- lower body
- DVT
- left heart failure
- right heart failure
How does hydrostatic edema cause sodium retention?
- heart failure decreases blood flow to the kidney
- activation of the renin-angiotensin-aldosterone system
- aldosterone causes retention of sodium (and water)
- leads to edema (along with hydrostatic edema)
How does nephrotic syndrome cause edema?
protein loss through kidneys and therefore decreased oncotic pressure leading to edema
Hepatic cirrhosis edema is due to:
- increased hydrostatic pressure in the portal venous system
- decreased oncotic pressure do to loss of protein into ascites and decreased production of protein by liver
Hypoalbuminemia
- decreased oncotic pressure
2. leads to hyperaldoteronism if it is enough to cause generalized edema which then leads to edema due to Na retention
Causes of edema due to sodium retention
- heart failure
2. kidney failure
Types of edema due to inflammation
- localized at site of infection
2. general with SIRS/sepsis
Edema in SIRS
- site of insult: maximal edema- EXUDATE (cytokines cause vascular permeability; chemokine cause leukocyte transmigration)
- generalized- TRANSUDATE (cytokines, but few chemokine)
peau d’orange
lymphedema due to breast cancer
Causes of lymphedema
lymphatic obstruction due to 1. tumor 2. inflammation 3. surgery 4. radiation 5. scar usually localized
cause of elephantiasis
parasitic filariasis
lymphedema due to fibrotic obstruction
Causes of pulmonary edema
- left heart failure (most common)
- ARDS
- hypersensitivity
- pneumonia
- renal failure
major symptom of pulmonary edema
dyspnea
major sign of pulmonary edema
pulmonary crackles
hyperemia
active increase in arterial blood flow
red color
congestion
decrease in venous outflow; cyanosis
What causes passive congestion of the liver? Where does it occur first? What is this called?
- right heart failure
- centrilobar area
- nutmeg liver (hemorrhagic alternates with steatotic areas)
hematoma
hemorrhage in enclosed tissue
petechiae
1-2 mm hemorrhages due to platelet deficiency
purpura
3-10 mm hemorrhages due to vasculitis, vessel fragility, et.
ecchymoses
over 1 cm subcutaneous hemorrhages
red-blue -> blue-green -> gold-brown
hemothroax
hemorrhage in pleural cavity
hemostasis
formation of a blood clot at site of vascular injury
regulation of hemostasis
- endothelium
- platelets
- coagulation cascade
Platelet factors important for hemostasis
- ADP
- fibrinogen
- factors V and VIII
- Ca2+
- Epinephrine
Platelet factors that are important for healing
- TGF-beta
- PDGF
- platelet factor-4
- fibronectin
eptifibatide (Integrilin)
IV to patients who are clotting off coronary arteries
clopidogrel (Plavix)
blocks platelet ADP receptors
Antiphospholipid antibody syndrome
causes arterial thrombosis; most common in young females; autoimmune (Ab against phospholipids)
Presentation of antiphospholipid antibody syndrome
miscarriages, DVT, cerebral infarctions, migraines, cardiac vegetations, ischemic hands or feet, thrombocytopenia, etc.
Disseminated intravascular coagulation (DIC)
thrombus formation in small blood vessels all over body
complication of: sepsis, metstatic cancer, multi organ trauma, etc.
Manifestation of DIC
1st: brain malfunction
2nd: lung malfunction
Also: heart and kidney
Use up all the platelets: now have a bleeding problem
mycotic aneurysm
localized outpouching of an artery, especially the aorta, containing infected thrombus (piece of infected vegetation)
Coagulopathy
an abnormal tendency to bleed
How would you treat:
- hemorrhagic shock
- cardiogenic shock
- septic shock
- blood transfusion
- assist heart
- antibiotics
cardiac tamponade triad
- shock
- distant heart sounds
- jugular venous distension
CARS
compensatory anti-inflammatory response syndrome
sepsis can be fatal due to counter-regulation (overshooting)
MARS
mixed antagonistic response syndrome
swing back and forth between pro and anti inflammatory response
superantigen
promote T cell mitosis in a nonspecific way, bypassing antigen receptor specificity
release massive amounts of cytokines like IL-1 and TNF
MOF
multiple organ failure: can be caused by shock
