Hemodynamics Flashcards
Approximately 60% of lean body weight is_____________
water
Two thirds of the body’s water is __________and the remainder is in extracellular compartments, mostly the interstitium (or third space) thatlies between cells
intracellular,
How many percent of Total body water is blood plasma?
only about 5% of total body water is in blood plasma
The movement of waterand low molecular weight solutes such as salts between the intravascular and interstitial spacesis controlled primarily by the opposing effect of vascular ____________
hydrostatic pressure and plasmacolloid osmotic pressure.
Normally the outflow of fluid from the arteriolar end of themicrocirculation into the interstitium is nearly balanced by inflow at the venular end; a smallresidual amount of fluid may be left in the interstitium and is drained by the lymphatic vessels,ultimately returning to the bloodstream via the thoracic duct. Either increased capillarypressure or diminished colloid osmotic pressure can result in increased interstitial fluid
Normally the outflow of fluid from the arteriolar end of themicrocirculation into the interstitium is nearly balanced by inflow at the venular end; a smallresidual amount of fluid may be left in the interstitium and is drained by the lymphatic vessels,ultimately returning to the bloodstream via the thoracic duct. Either increased capillarypressure or diminished colloid osmotic pressure can result in increased interstitial fluid
What is edema?
If the movement of water into tissues (or body cavities) exceeds lymphatic drainage, fluidaccumulates. An abnormal increase in interstitial fluid within tissues is called edema, while fluidcollections in the different body cavities are variously designated hydrothorax,hydropericardium, and hydroperitoneum (the last is more commonly called ascites).
What is Anasarca?
Anasarca isa severe and generalized edema with widespread subcutaneous tissue swelling.
What is a transudate?
There are several pathophysiologic categories of edema ( Table 4-1 ). Edema caused byincreased hydrostatic pressure or reduced plasma protein is typically a protein-poor fluid calleda transudate.Edema fluid of this type is seen in patients suffering from heart failure, renalfailure, hepatic failure, and certain forms of malnutrition,
What is an exudate?
In contrast, inflammatory edema is a protein-rich exudate that is a result ofincreased vascular permeability. Edema in inflamed tissues is discussed in
Pathophysiologic Categories of Edema
- INCREASED HYDROSTATIC PRESSUREREDUCED PLASMA
- OSMOTIC PRESSURE (HYPOPROTEINEMIA
- LYMPHATIC OBSTRUCTION
- SODIUM RETENTION
- INFLAMMATION
Under theTABLE 4-1 – Pathophysiologic Categories of EdemaINCREASED HYDROSTATIC PRESSURE is brought about by diseases such as:
Impaired venous return
- Congestive heart failure
- Constrictive pericarditis Ascites (liver cirrhosis)
- Venous obstruction or compression
- Thrombosis
- External pressure (e.g., mass) Lower extremity inactivity with prolonged dependency Arteriolar dilation
- Heat
- Neurohumoral
- dysregulation
REDUCED PLASMA OSMOTIC PRESSURE (HYPOPROTEINEMIA
Protein-losing glomerulopathies (nephrotic syndrome)
- Liver cirrhosis (ascites)
- Malnutrition
- Protein-losing gastroenteropathy
LYMPHATIC OBSTRUCTION
Inflammatory Neoplastic Postsurgical Postirradiation
SODIUM RETENTION
Excessive salt intake with renal insufficiency Increased tubular reabsorption of sodium Renal hypoperfusion Increased renin-angiotensin-aldosteronesecretion
INFLAMMATION
Acute inflammationChronicinflammationAngiogenesis
What happens inIncreased Hydrostatic Pressure.
Regional increases in hydrostatic pressure can result from a focal impairment in venous return.Thus, deep venous thrombosis in a lower extremity may cause localized edema in the affectedleg. On the other hand, generalized increases in venous pressure, with resulting systemicedema, occur most commonly in congestive heart failure ( Chapter 12 ), where compromisedright ventricular function leads to pooling of blood on the venous side of the circulation.
When does reduced plasma osmotic pressure occurs?
Reduced plasma osmotic pressure occurs when albumin, the major plasma protein, is notsynthesized in adequate amounts or is lost from the circulation.
An important cause of albuminloss is the__________ ( Chapter 20 ), in which glomerular capillaries become leaky;patients typically present with generalized edema.Reduced albumin synthesis occurs in thesetting of severe liver diseases (e.g., cirrhosis, Chapter 18 ) or protein malnutrition ( Chapter 9). In each case, reduced plasma osmotic pressure leads to a net movement of fluid into theinterstitial tissues with subsequent plasma volume contraction. The reduced intravascularvolume leads to decreased renal perfusion. This triggers increased production of renin,angiotensin, and aldosterone, but the resulting salt and water retention cannot correct theplasma volume deficit because the primary defect of low serum protein persists.
nephrotic syndrome
When does reduce osmotic pressure occurs?
- Reduced plasma osmotic pressure occurs when albumin,the major plasma protein, is notsynthesized in adequate amounts or is lost from the circulation.
- An important cause of albuminloss is the nephrotic syndrome ( Chapter 20 ), in which glomerular capillaries become leaky;
- patients typically present with generalized edema. Reduced albumin synthesis occurs in the
- setting of severe liver diseases (e.g., cirrhosis, Chapter 18 ) or protein malnutrition ( Chapter 9
- ). In each case, reduced plasma osmotic pressure leads to a net movement of fluid into the
- interstitial tissues with subsequent plasma volumecontraction.
- The reduced intravascularvolume leads to decreased renal perfusion. This triggers increased production of renin,angiotensin, and aldosterone, but the resulting salt and water retention cannot correct theplasma volume deficit because the primary defect of low serum protein persists.
How can salt retention cause edema?
Salt and water retention can also be a primary cause of edema.Increased salt retention—withobligate associated water—causes both increased hydrostatic pressure (due to intravascularfluid volume expansion) and diminished vascular colloid osmotic pressure (due to dilution). Saltretention occurs whenever renal function is compromised, such as in primary disorders of thekidney and disorders that decrease renal perfusion.One of the most important causes of renalhypoperfusion is congestive heart failure, which (like hypoproteinemia) results in the activationof the renin-angiotensin-aldosterone axis.In early heart failure, this response tends to bebeneficial, as the retention of sodium and water and other adaptations, including increasedvascular tone and elevated levels of antidiuretic hormone (ADH), improve cardiac output and restore normal renal perfusion. [1,] [2]However, as heart failure worsens and cardiac outputdiminishes, the retained fluid merely increases the venous pressure, which (as alreadymentioned) is a major cause of edema in this disorder.Unless cardiac output is restored orrenal sodium and water retention is reduced (e.g., by salt restriction, diuretics, or aldosteroneantagonists), a downward spiral of fluid retention and worsening edema ensues.Salt restriction,diuretics, and aldosterone antagonists are also of value in managing generalized edema arisingfrom other causes.Primary retention of water (and modest vasoconstriction) is produced by therelease of ADH from the posterior pituitary, which normally occurs in the setting of reducedplasma volumes or increased plasma osmolarity. [2]Inappropriate increases in ADH are seen inassociation with certain malignancies and lung and pituitary disorders and can lead tohyponatremia and cerebral edema (but interestingly not to peripheral edema).
Impaired lymphatic drainage results in lymphedema that is typically localized; causes includechronic inflammation with fibrosis, invasive malignant tumors, physical disruption, radiationdamage, and certain infectious agents.One dramatic example is seen in parasitic filariasis, inwhich lymphatic obstruction due to extensive inguinal lymphatic and lymph node fibrosis canresult in edema of the external genitalia and lower limbs that is so massive as to earn theappellation elephantiasis. Severe edema of the upper extremity may also complicate surgicalremoval and/or irradiation of the breast and associated axillary lymph nodes in patients withbreast cancer.
Edema is easily recognized grossly; microscopically, it is appreciated as:
wellinclearing and separation of the extracellular matrix and subtle cell sg.Any organ ortissue can be involved, but edema is most commonly seen in subcutaneous tissues, thelungs, and the brain.
What is subcutaneous edma?
Subcutaneous edema can be diffuse or more conspicuous in regionswith high hydrostatic pressures.