Hemorrhage, Edema, and Shock Flashcards
What is a hemorrhage?
Loss of blood from the vascular compartment into extravascular spaces or out of the body, thereby diminishing circulating volume
Hemorrhage into skin: What are they called if less than 2 mm in diameter? What range are they purpura, and ecchymoses?
petechiae: <2 mm purpura: 2 mm to 1 cm ecchymoses >1 cm
What is a hematoma?
local accumulation of blood in soft tissues
If abnormal platelet aggregation testing, but normal plasma clotting times, what does this imply?
problems with platelet adhesion and aggregation. this is characterized by mucosal bleeding and easy bruisability
Iron deficiency anemia in an adult is due to ____ until proven otherwise
GI malignancy
As extravascular RBCs are broken down during internal hemorrhage, what element is toxic and how do we resolve?
iron hemosiderin: intracellular, aggregated ferritin with bound iron. we see it in macrophages after phagocytosis of RBCs after hemorrhage
Every blunt trauma patient should have what procedure to check for bleeding?
Abdominal ultrasound because potential space of the abdomen means u can have hemoperitoneum, lose massive amounts of blood, but might not even show enlargement
What is the difference between hyperemia and congestion, both cause edema?
What causes oncotic pressure, and in which direction does it go? What is in the other direction?
Plasma proteins: don’t diffuse as freely across vasculature, so tend to draw water back into the vascular compartment from extravascular compartment. (LIKE ALBUMIN)
opposed by vascular hydrostatic pressure, which wants to push water and salts out of the capillaries
Oncotic pressure is the portion of osmotic pressure of intravascular fluid that is due to non-filterable components
Edema is the accumulation of excess extracellular interstitial fluid. What is the accumlation of excess extracellular fluid in body cavities?
effusion
Edema may be caused by a ____ in hydrostatic pressure, a ___ in oncotic pressure, ____ capillary permebaility, or if ______ flow of lymph.
Edema may be caused by a increase in hydrostatic pressure, a decrease in oncotic pressure, an increased capillary permebaility, or if obstructed flow of lymph.
What is shock?
Widespread hypoperfusion of tissues due to any combination of reduction in blood volume, reduction in cardiac output, or redistribution of blood (circulatory collapse).
happens after loss of 20% of blood volume if you have a healthy compensatory reserve (lower if sick)
Hemophilia A is characterized by
factor VIII (FVIII) deficiency (X-linked, recessive)
People with hemophilia A often, bleed longer than other people. Bleeds can occur internally, into joints and muscles, or externally, from minor cuts, dental procedures or trauma. How frequently a person bleeds and the severity of those bleeds depends on how much FVIII is in the plasma, the straw-colored fluid portion of blood.
different from how platelet aggregation problems present, which don’t show hemarthroses
Where is this commonly seen?
Hemosiderin iron, not available for reuse but gets rid of iron so that you don’t have toxic free radicals
Commonly in brain, lungs after hemorrhage; or in liver/bone marrow/spleen if overload of iron (hemosiderosis)
What are the three hemorrhage locations that are potential spaces (you can lose a lot but not see it)
hemoperitoneum, hemothorax, retroperitoneal bleed
Pulmonary edema
Heart failure cells: if left heart failure or pulmonary edema, then fluid built up in the lungs,RBCs break out, and then alveolar macrophages engulf them, become engorged with hemosiderin
