patho week 3

Question 1

The two major categories of fluid imbalances

Answer 1

extracellular fluid volume (ECV) imbalances and body fluid concentration imbalances. The concentration imbalances are often called osmolality imbalances.

Question 2

Signs and Symptoms of ECV Imbalances

Answer 2

sudden changes in body weight and signs of altered vascular and interstitial volume

Question 3

hyponatremia definition and causes

Answer 3

the body fluids are too dilute.
•Gain of relatively more water than salt
•Loss of relatively more salt than water

Question 4

ADH

Answer 4

(anti-diuretic hormone) released by pituitary ; travels in the blood to kidneys and affects the tubules so more water is reabsorbed into the blood. As a result a smaller volume of more concentrated urine is made. The level of water in the blood increases until it is back to normal.

Question 5

what part of the brain detects that there is not enough water in the blood

Answer 5

hypothalimus

Question 6

definition and causes of hypernatrimia

Answer 6

the body fluids are too concentrated
•Gain of relatively more salt than water
•Loss of relatively more water than salt

Question 7

osmotic diuresis

Answer 7

increased urination caused by the presence of certain substances in the small tubes of the kidneys.[1] The excretion occurs when substances such as glucose enter the kidney tubules and cannot be reabsorbed (due to a pathological state or the normal nature of the substance). The substances cause an increase in the osmotic pressure within the tubule, causing retention of water within the lumen, and thus reduces the reabsorption of water, increasing urine output (i.e. diuresis)

Question 8

Diabetes insipidis

Answer 8

a condition characterized by excessive thirst and excretion of large amounts of severely diluted urine, with reduction of fluid intake having no effect on the concentration of the urine.

Question 9

oliguria

Answer 9

low output of urine

Question 10

clinical dehydration

Answer 10

the combination of ECV deficit and hypernatremia. the volume of the extracellular fluid is too low and the body fluids are too concentrated.

Question 11

Signs and symptoms of clinical dehydration, stemming from extra cellular volume deficit:

Answer 11

• Sudden weight loss
• Postural blood pressure drop
• Dizziness upon standing
• Flat neck veins when supine
• Oliguria
• Decreased skin turgor
• Dry mucous membranes
• Absent tears and sweat

Question 12

Signs and symptoms of clinical dehydration, arising from hypernatremia:

Answer 12

• Thirst
• Confusion
• Lethargy
• Seizures
• Coma

Question 13

Edema

Answer 13

an abnormal expansion of the interstitial space. It may arise from ECV excess or from other causes, such as inflammation

Question 14

Endothelium

Answer 14

he thin layer of cells that lines the interior surface of blood vessels and lymphatic vessels,[1] forming an interface between circulating blood or lymph in the lumen and the rest of the vessel wall. The cells that form the endothelium are called endothelial cells. Endothelial cells in direct contact with blood are called vascular endothelial cells, whereas those in direct contact with lymph are known as lymphatic endothelial cells.

Question 15

An excess of electrolytes in the plasma may be caused by:

Answer 15

• Increased electrolyte intake or absorption
• Shift of electrolytes from an electrolyte pool into the ECF
• Decreased electrolyte excretion

Question 16

A deficit of electrolytes in the plasma may be caused by:

Answer 16

• Decreased electrolyte intake or absorption
• Shift of electrolytes from the ECF into an electrolyte pool
• Increased electrolyte excretion
• Loss of electrolytes through an abnormal route

Question 17

Potassium-rich foods

Answer 17

• Many fresh fruits, such as bananas, oranges, and strawberries
• Dried fruits, such as raisins, dates, and dried apricots
• Many vegetables, such as asparagus, broccoli, potatoes, and squash
• Other foods, such as molasses, instant coffee, and almonds

Question 18

Normal plasma potassium concentration

Answer 18

3.5 to 5.0 mEq/Liter. The concentration of potassium inside cells is much higher. The plasma potassium concentration does not reflect the intracellular potassium concentration because potassium can shift rapidly between the extracellular fluid and the cells.

Question 19

The clinical manifestations of hypokalemia are caused primarily by …

Answer 19

dysfunction of skeletal, smooth, and cardiac muscle, as explained in your textbook on page 530.

Question 20

Hypokalemia

Answer 20

a decreased potassium ion concentration in the extracellular fluid; does not necessarily denote a decrease in total body potassium

Question 21

what does aldosterone do to potassium?

Answer 21

It increases potassium excreation in urine; hypokalemia is associated with pathophysiologic condistions such as compensated heart failure and cirrhosis that are accompanied by increased aldosterone levels; black licorie contains a substance that increases renal potassium excretion

Question 22

causes of hypokalemia

Answer 22

Decreased potassium intake, shift of potassium from extracellular fluid to cells, increased potassium excretion through normal routes - fecal rout, skin rout, renal route; and loss of potassium through abnormal routes such as emesis, gastric suction and fistula drainage

Question 23

What is the resting membrane potential of muscle cells determined by?

Answer 23

The ratio of intracellular to extracellular potassium ion concentration.

Question 24

What happens to muscles in hypokalemia?

Answer 24

Both smooth and skeletal muscle cells are hyperpolarized and are less reactive to stimuli;

Question 25

the clinical manifestaions of hypokalemia

Answer 25

include abdominal distention, diminished bowel sounds, paralytic ileus, postural hypotension,m skeletal muscle weakness, flaccid paralysis and respiratory paralysis.; also many types of cardiac dysrhythmias; also causes polyuria by interfering ith action of ADH at renal tubules.

Question 26

hyperkalemia

Answer 26

a serum potassium concentration above 5.0 mEq/L; denotes an elevation of potassium ion concentration in the extracellular fluid.

Question 27

Causes of hyperkalemia

Answer 27

Increased potassium intake, shif of potassium from cells to extracelluolar fluid, decreased potassium excretion

Question 28

Plasma calcium is present in these three forms:

Answer 28

1) calcium ions bound to plasma proteins such as albumin, 2) calcium ions bound to small organic ions (such as citrate), 3) unbound calcium ions

Question 29

Causes of hypocalcemia

Answer 29

decreased calcium intake or absorption, decreased physilogic availability of acacium, increased calcium excretion through normal routes

Question 30

Causes of hypercalcemia

Answer 30

Increased calcium intake or absorption, shift of cacium from bone to extracellular fluid, decreased calcium excretion

Question 31

Caukses of hypomagnesemia

Answer 31

Decreased magnesium intake or absorption, decreased physilogic availability of magnesium, increased magnesium excretion through normal routes - renal, fecal; and loss through abnormal routes such as emesis gastric suction and fistula drainage

Question 32

Causes of hypermagnesemia

Answer 32

increased magnesium intake or absorption (aspriation of seawater), decreased magnesium excretion (oliguric renal disease), adrenal insufficiency

Question 33

An excess of electrolytes in the plasma may be caused by:

Answer 33

• Increased electrolyte intake or absorption
• Shift of electrolytes from an electrolyte pool into the ECF
• Decreased electrolyte excretion

Question 34

A deficit of electrolytes in the plasma may be caused by:

Answer 34

• Decreased electrolyte intake or absorption
• Shift of electrolytes from the ECF into an electrolyte pool
• Increased electrolyte excretion
• Loss of electrolytes through an abnormal route

Question 35

Which hormones cause potassium to shift from the extracellular fluid into cells?

Answer 35

The hormones insulin and epinephrine (beta-adrenergic action)

Question 36

Proper potassium distribution is necessary for normal function of …

Answer 36

skeletal, cardiac, and smooth muscle

Question 37

The hormones _____ and ____ increase the urinary excretion of potassium.

Answer 37

aldosterone and cortisol

Question 38

Calcium-rich foods

Answer 38

• Milk, yogurt, cheese, and other dairy products
• Oranges, tofu, almonds, milk or semi-sweet chocolate
• Canned fish containing bones, such as salmon and sardines
• Dark green vegetables, such as broccoli, spinach, collard greens, bok choi, and nopales (prickly pear cactus leaves)

Question 39

Which 3 hormones control the amount of fluid excreteted in the urine

Answer 39

Antidiuretic hromone (ADH), aldosterone and natriuretic peptides (AN)), and minor hormones such as renal prostaglandins and the renal sympatheic nerves.

Question 40

factors that increase the release of ADH into the blood:

Answer 40

increased smolality of the extracellular fluid,
decreased circulating fjuid volume,
pain,
nausea and physiologic stressors

Question 41

What is the efffect of ADH

Answer 41

• causes reabsorption of water that dilutes the blood and other body fluids; reabsorption of water decreases the urine volume and makes it more concentrated.

Question 42

factores that decrease ADH release:

Answer 42

• decreased smolality of extracellular fluid and ethanol intake = a large, dilute urine volume

Question 43

What is/are the major stimulus(i) for the release of alosterone?

Answer 43

• angiotensis II (from the renin-angiontensi system, which is activated by decreased circulating blood volume
  and an increased concentration of potassium ions in the plasma

Question 44

What does aldosterone cause in the renal tubules?

Answer 44

• reabsorbtion of sodium and water (saline), which expands the extracellular fluid volume;
  htis decreases fluid excretion

Question 45

When aldosterone is secreted, the urine volume is ___; and decreased secretion of aldosterone causes a ____ urine volume.

Answer 45

more, larger

Question 46

Clinical manifestations of ECV deficit

Answer 46

sudden weight loss, postrual blood pressure decrease with concurrent increased heart rate, flat neck veins when supine, prolonged small-vein filling time, prolonged capillary refill time, lightheadedness, dizziness, syncope and oliguria

Question 47

Manifestations of slowly developing ECV

Answer 47

• decreased skin turgor, dryness of oral mucous membranes between cheek and gum, hard stools, soft sunken eyeballs, longitudinal furrows in toungue, no tears or sweat; dunken fontanel in infants.

Question 48

Possible causes of ECV deficit:

Answer 48

Gi exrection: emesis, diarrhea, gastric suction or intestinal decompression, fistula drainage
Renal excreation: adrenal insufficiency, salt-wasting renal disorders, extensive diuretic use, bed rest
other: hemorrhage, massive diaphoresis, 3rd space fluid accumulation; paracentesis and burns

Question 49

Causes of ECV excess:

Answer 49

Excessive IV infusion of sodium isotonic fluid: Normal saline (0.9%), Ringer injections, or Lactated Ringer injection;
Renal retention of sodium water: hyperaldosteronism, chronic heart failure, cirrhosis, acute glomerulonephritis, renal disease, cushing disease, corticoseroid therapy

Question 50

Clinical manifestations of ECV excess:

Answer 50

2 pound weight gain in 24 hours, edema, bounding pulse, neck vein distention in a person in the upright position, crackles in the lungs, dyspnea, orthopnea and frothy sputum of pulmonary edema

Question 51

Other terms used for hyponatremia

Answer 51

hypotonic syndrome, hypoosmolality and water intoxication

Question 52

Excessive or prolonged release of ADH cause kidneys to ….

Answer 52

retain too much water, which dilutes the blood and causes hyponatremia

Question 53

SIADH

Answer 53

Sindrome of inappropriate secretion of ADH

Question 54

Causes of Hyponatremia

Answer 54

Gain of more water than salt too much antidiuretic cormone, IV infusion of 5% dextrose in water, hypotonic irrigationg solutions, tap ater enemas, psychogenic polydipsia, forced excessive water ingestion, too much beer, near drowning in fresh water;
Loss of more salt than water: diuretics, salt-wasting renal disease

Question 55

Clinical manifestations of hyponatremia:

Answer 55

malaise, anorexia, nausea, vomiting and headache, confusion, lethargy, seizures and coma. even cerebral herniation