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Path 2 > hemodynamics part 1 > Flashcards

hemodynamics part 1 Flashcards

1
Q

define hydrothorax

A
  • fluid in pleural space

- like in between lungs

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2
Q

defien hydropericardium

A
  • fluid in the space between the heart and pericardium
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3
Q

define ascites or hydroperitoneum

A
  • fluid in peritoneal space
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4
Q

What are some causes of edema (5)

A
  • elevated hydrostatic pressure
  • decreased plasma oncotic pressure (low protein)
  • lymphatic obstruction
  • sodium retention
  • inflammation
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5
Q

what can cause elevated hydrostatic pressure

A
  • CHF, constrictive pericarditis, ascites from liver cirrhosis, venous obstruction
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6
Q

define Edema

A
  • 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
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7
Q

define transudate

A

protein poor fluid with a specific gravity of < 1.012

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8
Q

what causes a decreased plasma oncotic pressure

A
  • Low protein due to nephrotic syndrome, end stage liver disease, malnutrition, protein losing gastroenteropathy
  • -> low albumin levels
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9
Q

what causes lympahtic obstruction

A
  • inflammation, neoplastic, surgery, postirradiation
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10
Q

what causes sodium retention

A
  • renin, angiotensin, aldosterone (sodium reabsorption, renal insufficiency
  • water follows sodium causing increase in vascular volume
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11
Q

what causes inflammation

A
  • acute and chronic, angiogenesis
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12
Q

describe how heart failure causes edema

A
  • 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)
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13
Q

what is the cause of reduced plasma oncotic pressure

A
  • 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
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14
Q

define anasarca

A
  • severe generalized edema
  • due to lack of oncotic pressures
  • earliest sign is periorbital edema
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15
Q

describe sodium and water retention

A
  • 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
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16
Q

describe inflammation

A
  • 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
17
Q

describe lymphatic obstruction

A
  • 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
18
Q

describe the microscopic appearance of endema

A
  • 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
19
Q

describe subcutaneous edema

A
  • 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)
20
Q

what are the two site of clinically relevant edema

A
  • LUNG AND BRAIN

- due to the increased risk of death

21
Q

describe the clinical manifestations of pulmonary edema

A
  • 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
22
Q

describe the radiographical findings of the two types of pulmonary edema

A
  • 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
23
Q

describe cerebral edema

A
  • 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
24
Q

what causes localized cerebral edema

A
  • abscess
  • neoplasm
  • trauma
25
Q

what causes generalized cerebral edema

A
  • encephalitis
  • hypertensive crisis
  • obstruction of venous outflow
  • trauma
26
Q

describe the gross appearance of cerebral edema

A
  • swollen brain has distended, flattened gyri and narrowed sulci due to compression of brain against skull
27
Q

Define Hyperemia

A
  • active process in which arteriolar dilatation results in INCREASED FLOW of blood to a tissue
  • -> skeletal muscle during exercise
  • -> inflammation
  • -> Blushing
  • Tissue is erythematous (red) due to engorgement with oxygenated blood
28
Q

define congestion

A
  • passive process due to IMPAIRED OUTFLOW of blood from a tissue
  • caused by:
  • -> systemic = CHF
  • -> local venous obstruction
  • blue-red coloration due to accumulation of deoxygenated hemoglobin (cyanosis)
  • congestion and edema commonly occur together
29
Q

describe chronic passive congestion

A
  • long term congestion producing stasis of poorly oxygenated blood can result in cellular degeneration and death
  • capillary rupture at these sites may result in small foci of hemorrhage
  • if there is capillary rupture, breakdown and phagocytosis of the red cell debris results in accumulation of hemosiderin-laden macrophages at the site
30
Q

describe the microscopic findings in acute pulmonary congestion

A
  • alveolar capillaries engorged with blood
  • alveolar septal edema
  • focal intraalveolar hemorrhage
31
Q

describe the microscopic findings in chronic pulmonary congestion

A
  • thickened and fibrotic septa
  • heart failure cells hemosiderin-laden macrophages in alveolar spaces
  • MORE SEVERE
32
Q

describe chronic hepatic congestion

A
  • Nutmeg liver = central regions of hepatic lobules are grossly red/brown and depressed (due to cellular loss) surrounded by unaffected areas
  • Microscopically
  • -> centrilobular necrosis = hepatocelular death and accompanying hemorrhage with hemosiderin laden macrophages
  • -> long standing hepatic congestion may result in hepatic fibrosis
33
Q

Describe Hemorrhage

A
  • Extravasation of blood due to ruptured vessel

- hemorrhage classified as external or internal

34
Q

what does hemorrhage result from

A
  • Trauma
  • atherosclerosis
  • aneurysm
  • neoplasia or inflammation
  • capillary bleeding can occur in chronic congestion
  • hemorrhagic diathesis potentiates bleeding (fragility of vessels, platelet dysfunctions, coagulation defects etc)
35
Q

define hematoma

A
  • collection of blood under the skin
36
Q

describe the various types of hematoma’s

A
  • Petechiae = 1-2mm hemorrhage in skin, mucous membrane or serosal surfaces (pin point)
  • Purpura = >3mm
  • Ecchymoses = > 1-2cm (LARGE)
37
Q

describe the common causes of ecchymoses

A
  • usually occur due to trauma

- can also occur as a first sign of acute myelogenous leukemia due to a low platelet count (thrombocytopenia)

38
Q

what is the clinical significance of hemorrhage

A
  • RAPID loss of 0% of blood volume has an insignificant impact on healthy individual but can be lethal in the compromised patient
  • sites where bleeding occurs has significant prognostic value (e.g. bleeding into the brain can be rapidly fatal)
  • chronic or recurrent bleeding can result in iron deficiency
  • internal blood loss may allow reuse of iron

Path 2 (11 decks)

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