hemodynamics part 1 Flashcards
define hydrothorax
- fluid in pleural space
- like in between lungs
defien hydropericardium
- fluid in the space between the heart and pericardium
define ascites or hydroperitoneum
- fluid in peritoneal space
What are some causes of edema (5)
- elevated hydrostatic pressure
- decreased plasma oncotic pressure (low protein)
- lymphatic obstruction
- sodium retention
- inflammation
what can cause elevated hydrostatic pressure
- CHF, constrictive pericarditis, ascites from liver cirrhosis, venous obstruction
define Edema
- increased fluid in the interstitial tissue spaces
- occurs when there is a greater movement of fluid out of the vasculature than is returned by venous absorption or lymphatic drainage, then edema results
define transudate
protein poor fluid with a specific gravity of < 1.012
what causes a decreased plasma oncotic pressure
- Low protein due to nephrotic syndrome, end stage liver disease, malnutrition, protein losing gastroenteropathy
- -> low albumin levels
what causes lympahtic obstruction
- inflammation, neoplastic, surgery, postirradiation
what causes sodium retention
- renin, angiotensin, aldosterone (sodium reabsorption, renal insufficiency
- water follows sodium causing increase in vascular volume
what causes inflammation
- acute and chronic, angiogenesis
describe how heart failure causes edema
- heart failure leads to an increase in hydrostatic pressure which directly leads to edema due to back up of blood
- heart failure decreases renal blood flow leading to the activation of renin-angiotensin system which causes retention of Na+ and H2O that results in an increase in blood volume (edema)
what is the cause of reduced plasma oncotic pressure
- ALBUMIN is the protein most responsible for maintaining colloid osmotic pressure
EXAMPLES - Reduced synthesis or production of albumin caused by liver failure or cirrhosis
- Loss of protein via glomerular injury caused by nephrotic syndrome
define anasarca
- severe generalized edema
- due to lack of oncotic pressures
- earliest sign is periorbital edema
describe sodium and water retention
- increased salt in circulation causes:
- -> shift of fluid in intravascular space
- -> increased hydrostatic pressure due to expansion of fluid volume
- -> increased plasma water content results in decreased oncotic pressure resulting from dilution of albumin (not as much reabsorption on venous end**)
- Secondary to renin-angiotensin- aldosterone system activation
- common in renal failure
describe inflammation
- edema caused by inflammation is due to increased passage of fluid into the extracellular space
- it is localized unless it is the result of a systemic inflammatory response
- e.g allergic reaction
- OFTEN EXUDATE
describe lymphatic obstruction
- impaired lymphatic drainage results in lymphedema, therefore it is usually localized
- common result of:
- -> inflammation
- -> neoplasia
- -> surgical removal of axillary lymph nodes during treatment of breast cancer may cause obliteration of lymphatic drainage
describe the microscopic appearance of endema
- depends on the amount of protein exudate
- just see clearing and separation of the ECM elements
- may see pink-staining if protein content is significant
- edema is most commonly seen in subcutaneous tissue, lungs and brain
describe subcutaneous edema
- important, but seldom of clinical significance
- edema may interfere with healing because fluid must be removed before healing can take place
- severe edema may compromise venous return and increase the risk of infection and ulceration (pooling fluid is bad and can cause infections)
what are the two site of clinically relevant edema
- LUNG AND BRAIN
- due to the increased risk of death
describe the clinical manifestations of pulmonary edema
- Dyspnea; sudden, orthopnea, cyanotic (central), “air hunger”, tachypnea
- Cough: copious sputum, frothy, blood tinged
- Pulse: tachycardic, bounding
- breath sounds: crackles (fine to course)
- Engorged neck vein
describe the radiographical findings of the two types of pulmonary edema
- Interstitial pulmonary edema
- -> poorly defined pulmonary vessels
- -> visible lung fissures
- -> septal lines
- -> thick bronchial walls
- -> see haziness on X-ray
- Alveolar pulmonary edema (more severe)
- -> bilateral symmetric perihilar lung consolidation
- -> you see densities on X-ray
- also look for enlarged heart and pleural effusion
describe cerebral edema
- extremely serious condition because when brain swells, skull prevents further expansion so tissue is compressed
- Parenchymal edema may shift brain due to increased pressure and if generalized may push the brainstem down into the foramen magnum (tonsillar herniation)
- if edema is more localized (focal), one part of the brain may herniate into adjacent compartments tearing brain tissue
what causes localized cerebral edema
- abscess
- neoplasm
- trauma