Pathophysiology of Congestion and Oedema

Question 1

What is congestive heart failure?

Answer 1

Failure of both sides of the heart

Question 2

What causes vascular congestion?

Answer 2

Local/genarilised acute /chronic congestion

eg DVT (acute local)
Hepatic cirrhosis (chronic local)
Congestive Heart Failure (Generalised Acute)

Question 3

What is exudate?

Answer 3

Exudate - think Emergency EXIT!

In infection/inflammation, basically when the endothelial becomes more “porous”/gappy and so fluid (inc. bigger moleules eg proteins) can flood out to go and fight

Question 4

What is Transudate?

Answer 4

Transudate = Transferred fluid outside of vessel due to big pressure difference
Low protein/albumin/cells, high electrolytes and water.

Question 5

What do starling’s forces say about fluid movement across capillaries?

Answer 5

Movement is proportional to the pressures into(oncotic - think proteins, not water) and out of (hydrostatic) capillary as well as the permeability of the vessel wall to fluid

Question 6

How can disturbances in forces cause Oedema?

Answer 6

Increase in hydrostatic in comparison to oncotic pressure

Question 7

What is Darcy’s law?

Answer 7

Blood flow = change in pressure/resistance

Question 8

What is “congestion”?

Answer 8

THE BACKING UP OF BLOOD AND FLUID DUE TO A BLOCKAGE (usually)

Question 9

Is congestion passive or active?

Answer 9

Passive

Question 10

Is congestion primary or secondary?

Answer 10

sECONDARY

Question 11

Congestion = acute or chronic?

Answer 11

Can be both

Question 12

How does a dvt lead to ischemia?

Answer 12

DVT, blockage, decrease in pressure difference so drecrease in movement adnd flow of blood, tissue doesn’t recieve oxygen and so dies.

Question 13

What can cause Hepatic Cirrhosis and what is it?

Answer 13

Viruses, eg HBV, HEP C and HEP B and alcohol

Causes fibrosis and scarring of the liver

Question 14

How can Hepatic cirrhosis lead to chronic congestion?

Answer 14

Nodules of hepatocytes and Fibrosis, altered blood flow, blocked portal flow, congestion, increase in pressure and collateral circulation, chronic congestion

Question 15

Why is there a haemorrhage risk in liver cirrhosis?

Answer 15

The increase in collateral circulation from the blocked portal vein, high pressure through small capillaries, can easily burst

Question 16

Where are the main shunts around the portal circulation and what can be their complications?

Answer 16

Oesophageal varices, issue because if you eat something sharp, can puncture the increased collateral circulation and cause a major potentially fatal bleed.

Caput Medusae - cluster of swollen veins in your abdomen

Question 17

Can you have Ciongestive Cardiac failure due to iscemic heart disease and valve disease?

Answer 17

Yes

Question 18

How does Cardiac failure lead to congestion?

Answer 18

Cardiac failure = decreased CO = decreased Glomerular filtration rate (GFR), activation of renin-angiotensin-aldosterone system, increased Na and H2O retention, increased fluid in body, fluid overload in veins

Question 19

Treatment for congestive cardiac failure?

Answer 19

Diuretics

Question 20

What are the effects of congestive cardiac failure of the lungs?

Answer 20

Pulmonary oedema

Question 21

What are the effects of congestive cardiac failure on the liver?

Answer 21

Central venous cogestion, right heart failure, blood dams back to the systemic circulation, increased JVP, hepatomegaly, peripheral oedema

Question 22

Pc, Pi, 𝞹c, 𝞹i mean what?

Answer 22

Pc, = Capillary Hyrostatic pressure
Pi, = Interstital hydrostatic pressure
𝞹c = capillary oncotic pressure
𝞹i = interstial oncotic pressure

Question 23

WHat is the pressure inside and outside a capillary on the arterial side?

Answer 23

Inside = 35mmHg
Ouside = 25mmHg

Question 24

WHat is the pressure inside and outside a capillary on the venous side? so which direction of blood flow?

Answer 24

Inside = 25mmHg
Outside = 15mmHg

Question 25

What 3 characteristics affect net flux and filtration?

Answer 25

Oncotic pressure,
Hydrostatic pressure
Permeability characteristics of the endothelium

Question 26

What is Starlings equation?

Answer 26

JV=LP.S[(PC-Pi)-(C-i)]

(Net filtration = hydroic conduction x surface area x (hydrostatic pressure difference inside t outside (inside-outside) minus (-) capillary oncotic pressure difference)

** Don’t need to remember the eq **

Just remember it as the balance between hydrostatic, oncotic and permiability characteristics and area of endothelium.

Question 27

Effusion vs perhipheral oedema?

Answer 27

Effusion = fluid collection in body cavity

Perhiperal oedema = oedema in the tissue interstitium

Question 28

What is peritoneal effusion called?

Answer 28

Ascites

Question 29

What is transudate?

Answer 29

Trasnferred fluid, watery and electrolytes, no big bits as just down to increased in pressure forcing the water out (hydrostatic pressure) over oncotic pressure

Question 30

WHat is exudate?

Answer 30

Fluid that has EXIT as a result of inflammation, the endothelial wall becomes leaky and inflammatory cells and proteins etc flood out into the interstitial space, so high in proteins big bits ec

Question 31

Can you see costo phrenic angle in pulmonary oedema

Answer 31

No

Question 32

What is Lymphedema?

Answer 32

Blocked lymph system

Question 33

Why can radiotherapy for breast cancer lead to upper limb oedema?

Answer 33

Yes, radiation - fibrosis in axilla (lymph glands), blockage (decreased outflow) - oedema of upper limb

Question 34

Why can abnormal renal function lead to odema?

Answer 34

NaCl and H20 retential

Question 35

What can nephrotic syndrome/ hepatic cirrhosis/ malnutrition lead to?

Answer 35

Hypoalbuminaemia (low protein levels in blood), therefore decreased oncotic pressure, increased transudate

Question 36

What type of oedema is pneumonia/burns?

Answer 36

exudate