Lecture | Part 1 Hemodynamic Disorder Flashcards
governed by several forces in the blood vessel wall intravascular volume.
Fluid dynamics
Fluid exits through
arterial vascular compartment/end
Fluid returns through
venous vascular compartment/end
pushing force
hydrostatic pressure
pulling forces
oncotic or osmotic pressure
what happens in hydrostatic pressure
Fluid exits through arterial vascular compartment
what happens in oncotic (osmotic) pressure
Fluid returns to venous vascular compartment
level where pushing forces are about equal to the pulling forces.
At the capillary level
pulling forces so water from the interstitial space are pulled into the intravascular volume
oncotic or osmotic pressure
pushing pressure that promote water out of the blood vessel and into the interstitial space
hydrostatic pressure
behavior of water across compartments and to a certain extent blood. eg, Congestion hyperemia
Hemodynamic Disorders
in blood vessel there is hemostasis and if there is disturbances it may lead to clotting of the blood
Thromboembolic Disease
circulatory collapse
shock
increased fluid in the ECF
Edema
increase in blood blood flow in the arteriolar end
Hyperemia
increase in the backflow at the venus end
Congestion
extravasation of blood
Hemorrhage
blood is within the intravascular compartment if it goes out of the intravascular compartment it is now called
Hemorrhage
keeping keep the blood flowing in the intravascular space
Hemostasis
conditions that can cause clotting of blood
Thrombosis/thrombus formation.
From the adhered blood vessel, clotted blood is detached from the thrombus and travel across the blood vessels it will essentially be called
embolus
death of tissues due to lack of blood
Infarction
death of tissues due to decreased delivery of oxygen and this will cause cellular hypoxia
Infarction
circulatory failure/collapse
Shock
lack of perfusion to the different organs of the body
shock
4 possibilities of EDEMA
- Increased Hydrostatic Pressure
- Reduced Oncotic Pressure
- Lymphatic Obstruction
- Sodium/Water Retention
composes 60% of body
water
2/3 of body water is
intracellular
1/3 of body water is
interstitial
Only 5% water is
Intravascular
shift of water to the interstitial space
edema
water filling in the thoracic cavity
Hydrothorax.
water inside the pericardial space or pericardial cavity
hydropericardium
general term of fluid accumulating in the body cavities
Effusion
accumulation of water that involves the peritoneum
ascites
presence of water in the peritoneal cavity
ascites
generalized edema
anasarca
accumulation of fluid in the soft tissues in the body cavities
anasarca
total body water volume
40 liters, 60% body weight
25 liters, 40% body weight
Intracellular fluid volume
15 liters, 20% body weight
extracellular fluid volume
12 L, 80% of ECF
interstitial fluid volume
3 L, 20% of ECF
plasma volume
15% of water is in the
interstitium
least amount of water is found in
blood
- Impaired venous return
- Congestive heart failure
- Constrictive pericarditis
- Venous obstruction or compression
- Thrombosis
- External pressure (e.g., mass)
- Lower extremity inactivity with prolonged dependency
- Arteriolar dilation
- Heat
- Neurohumoral dysregulation
INCREASED HYDROSTATIC PRESSURE
- Protein-losing glomerulopathies (nephrotic syndrome)
- Liver cirrhosis (ascites)
- Malnutrition
- Protein-losing gastroenteropathy
REDUCED PLASMA ONCOTIC PRESSURE (HYPOPROTEINEMIA)
REDUCED PLASMA ONCOTIC PRESSURE is also referred as
HYPOPROTEINEMIA
one that exert this oncotic pressure and will attract water to go inside the blood vessel
plasma proteins
Most important and abundant plasma protein
albumin
Protein-losing in kidney
Protein-losing glomerulopathies
Protein-losing in intestines
Protein-losing gastroenteropathy
where the arteriolar end the pushing forces will tend to predominate so it will try to push water out of the blood vessel
REDUCED PLASMA ONCOTIC PRESSURE
- Inflammatory
- Neoplastic
- Post-surgical
- Post-irradiation
LYMPHATIC OBSTRUCTION (LYMPHEDEMA)
mechanism of edema that can block the flow of lymph tissue or lymphatic tissue fluid, flow of tissue fluid inside the lymphatic vessels
lymphatic obstruction
conditions that will promote this lymphatic obstruction will tend to cause edema such as
- Inflammation
- presence of tumors
- the lymphatic vessels are destroyed during surgical operation
- or during radiation therapy
any mass tumor, that can block the vessel you know will cause an decrease or increase in the pushing force?
increase in the pushing
elephantiasis is an example of one of the mechanism of edema
lymphatic obstruction or lymphadema
- Excessive salt intake with renal insufficiency
- Increased tubular reabsorption of sodium
- Renal hypoperfusion-Increased renin-angiotensin-aldosterone secretion
Sodium [Na+] retention
where sodium goes
water follows
in the body the sodium is being managed by
kidney
downstream travel of a clot
Embolism
INFLAMMATION
- Acute inflammation
- Chronic inflammation
- Angiogenesis
inflammation can bring in edema and this is due to the
opening of the gaps in the endothelial lining of the blood vessel wall
type of fluid in inflammation
exudate
DECREASED RENAL PERFUSION, triggering of RENIN- ANGIOTENSION-ALDOSTERONE complex, resulting ultimately in SODIUM RETENTION
CHF EDEMA
INCREASED VENOUS PRESSURE DUE TO FAILURE
CHF EDEMA
in congestive heart failure, the heart is not pumping very well and there will be a buildup of
venous pressure
in left-sided heart failure, the build-up will occur in the lungs having a
pulmonary edema in congestive heart failure
kidneys receive how many percentage of cardiac output
20 percent
if kidney receives <20% of the cardiac output it will trigger your
Renin-Angiotensin- Aldosterone Axis (RAAS) (conserve sodium)
HEPATIC ASCITES
- PORTAL HYPERTENSION
- HYPOALBUMINEMIA
another cause of accumulation of water this time in the peritoneal cavity
portal hypertension
in Schistosomiasis, there is an increase in –?– that will cause water to get out of the blood vessel and into the peritoneal cavity
portal hypertension
- SODIUM RETENTION
- PROTEIN LOSING GLOMERULOPATHIES (NEPHROTIC SYNDROME)
RENAL EDEMA
in renal edema, a lot of sodium in the blood will attract water inside the blood vessel so water will pull inside the blood vessel so there’s a build up of water in the intravascular space. this typically happens in
hypertension
edema manifested in the subcutaneous tissues (dependent area) tend to accumulate in the
lower extremities in the feet
most harmful or deadly consequence of edema happens in the
brain
enclosed in a bony cranium
brain
edema in the brain cannot overcome the hard skull making the soft brain to cause
hernation
indentation on the subcutaneous tissue when putting pressure
pitting edema
it will cause torsion of the portion of the brain or herniation
edema near the cingulate gyrus in the frontal lobe
vulnerable area that will impinge on the midbrain
hippocampus
where it will impinge on the lower brain stem.
cerebellum
houses the the area for your respiration
lower brainstem
3 location vulnerable for hernia
- Subfalcine herniation
- transtentorial herniation
- tonsillar herniation
- results from disturbance of Starling forces
- specific gravity < 1.012
- protein content < 3 g/dl
- LDH low
transudate
- results from damage to the capillary wall
- specific gravity > 1.012
- protein content > 3 g/dl
- LDH high
exudate
shift of fluid from one compartment to another
transudate
Active Process
HYPEREMIA
hyperemia is theincrease in the blood flow at the arteriolar end and manifested as
erythema
congestion is the decrease in the outflow at the venous end and manifested as
cyanosis black blue
congestion is manifested as cyanosis black blue because
blood is deoxygenized blood
- Passive Process
- Acute or Chronic
CONGESTION
hyperemia is considered an active process due to the
dilatation of arteries
congestion is considered a passice process because
only the blood will pull at the venus end there’s no dilatation
congestion can occur in different organs such as
lung, the liver, and brain
in acute passive congestion in the lungs it can be manifested in an x-ray when there is increase in the lines not peripheral lines or what we call
kelsey’s lines
indicates a characteristic of your pulmonary edema
kelsey’s lines
In chronic passive congestion in the lungs there is an increased pressure in the pulmonary vessels the small or the thin walls of the blood vessels, making the veins?
rupture and blood can again squeeze through the alveolar spaces
blood is taken up by macrophages when a person died with congestive heart failure. At the lungs there are so many hemosiderin macrophages which is known as
heart failure cells
in right-sided heart failure, the congestion will occur in the
lungs
congestion in the liver occurs in what vein
central veins
congestion in the brain will cause –?– of the gyrus, which is prone to herniation
flattening