SFP: hemodynamic disorders I

Question 1

define homeostasis

Answer 1

a state of equilibrium in the body with respect to chemical compositions of fluids and tissues

Question 2

define edema

Answer 2

excess water in the interstitial space

Question 3

define anasarca

Answer 3

extreme generalized edema of subcutaneous tissues, cavities, and organs

Question 4

define hydrothorax

Answer 4

edema in the pleural cavity

Question 5

define hydropericardium

Answer 5

edema in the pericardial cavity

Question 6

define ascites

Answer 6

edema in the peritoneal cavity

Question 7

differentiate between transudate and exudate

Answer 7

transudate: protein-poor fluid resulting from non-inflammatory mechanisms

exudate: protein rich fluid resulting from increased vascular permeability during inflammation

Question 8

what are the 4 noninflammatory causes of edema

Answer 8

1. increased arterial hydrostatic pressure; lots of fluid leaving the arterial end of a capillary
2. decreased osmotic pressure; not as much fluid returning to the blood on the venous end of the capillary
3. lymphatic obstruction
4. sodium and water retention by the body

Question 9

what causes local edema

Answer 9

increased hydrostatic pressure caused by impaired venous return due to obstruction; the edema will be present distal to the obstruction

Question 10

deep vein thrombosis is an example of…

Answer 10

local edema

Question 11

what causes systemic edema

Answer 11

impaired venous return leads to a general increase in venous pressure

Question 12

congestive heart failure is a cause of ____ edema

Answer 12

systemic edema

Question 13

describe how congestive heart failure leads to systemic edema

Answer 13

• heart failure reduces cardiac output
• decreased output leads to less blood flow to the kidney. as a result, kidneys release renin
• renin leads to the formation of angiotensin and the release of aldosterone
• aldosterone causes the kidneys to reabsorb sodium and water, which increases plasma volume
• more blood is formed as a result of these effort, but the heart still isn’t capable of pushing out more blood. the increased blood with still limited pumping capacity causes systemic edema.

Question 14

describe pulmonary edema

Answer 14

a local edema caused by left ventricular failure. the left ventricle fails to pump, causing blood backup in the left atrium. this creates pressure in the lungs. there will be air, fluid, and RBC’s in the alveolar spaces.

Question 15

describe general systemic edema

Answer 15

caused by right ventricular failure. the right ventricle fails, causing blood to backup in the right atrium. this causes blood to back up in the inflow vessels, namely the inferior and superior vena cava. this leads to systemic edema.

Question 16

what is a primary cause of reduced plasma osmotic pressure

Answer 16

lowered levels of protein causing less fluid to be drawn back into the blood

Question 17

describe the mechanism of edema caused by reduced osmotic pressure

Answer 17

• a decrease in plasma volume due to lack of protein decreases cardiac output
• decreased output leads to less blood flow to the kidney. as a result, kidneys release renin
• renin leads to the formation of angiotensin and the release of aldosterone
• aldosterone causes the kidneys to reabsorb sodium and water, which increases plasma volume
• more blood is formed as a result of these effort, but there is still not enough protein. this will lead to edema

Question 18

describe the patterns of edema seen in reduced osmotic pressure

Answer 18

generalized edema, periorbital edema, ascites (belly full of fluid)

Question 19

what is kwashiorker?

Answer 19

a severe dietary protein deficiency that can cause edema via reduced osmotic pressure

Question 20

what are some causes of reduced protein that leads to reduced osmotic pressure

Answer 20

• nephrotic syndrome: loss of albumin at the glomerulus
• liver disease: reduced synthesis of albumin
• protein malnutrition: reduced synthesis of albumin

Question 21

describe the connection between alcoholic liver disease and edema

Answer 21

portal hypertension increases due to the blood struggling to travel through the liver as a result of scarring. this
coupled with reduced albumin synthesis in the liver increases hydrostatic pressure and causes edema

Question 22

describe lymphatic obstruction

Answer 22

is if often a response to filarial worms (elephantiasis). it occurs due to an inflammatory response to the parasite resulting in fibrosis/scar tissue

Question 23

what is a common cause of upper limb edema?

Answer 23

axillary node blockage or removal due to breast cancer

Question 24

describe sodium retention in relation to edema

Answer 24

it is often secondary to activation of aldosterone in response to a lowered volume reduction.

Question 25

what can acute renal failure cause

Answer 25

sodium retention and possibly edema as a result

Question 26

describe consequences of edema (generally, in the lungs, in the brain)

Answer 26

range from mild to severe; pulmonary edema can cause loss of ventilation, and edema of the brain can be fatal

Question 27

describe hyperemia

Answer 27

an active physiologic response to functional demand, hormonal or neurogenic trigger, or inflammation. the tissue appears red due to presence of oxygenated RBCs

Question 28

describe congesion

Answer 28

passive back up of blood due to venous obstruction; this can be local or systemic and is accompanied by edema. the tissue may appear blue (cyanosis) due to the RBC’s losing their oxygen while waiting to pass through the vessel

Question 29

differentiate between acute and chronic congestion in the lungs

Answer 29

acute: capillaries are filled with blood, slight edema, minute hemorrhage

chronic: thick alveolar septa and hemosiderin laden macrophages (heart failure cells) in the alveolar spaces

Question 30

describe chronic congestion in the liver

Answer 30

congestion surrounding central veins that take blood away from the liver may lead to blood backing up in the liver. this can cause centrilobular necrosis (blood losing its oxygen), hemorrhage, fibrosis

Question 31

what will be seen in liver cells with chronic hepatic congestion

Answer 31

lipofuscin and hemosiderin

Question 32

in what instance do we see a nutmeg liver?

Answer 32

chronic liver congesion

Question 33

what causes petechiae? what does it look like?

Answer 33

increased intravascular pressure, decreased platelet function or number, and decreased clotting factor. they look like tiny red spots on skin, mucosa, or serosa

Question 34

what causes purpura? what does it look like?

Answer 34

increased intravascular pressure, decreased platelet function or number, decreased clotting factor, trauma, and vascular inflammation. they look like red freckles

Question 35

rocky mountain spotted tick fever is known to cause…

Answer 35

purpura

Question 36

what causes ecchymoses? what does it look like?

Answer 36

increased intravascular pressure, decreased platelet function or number, decreased clotting factor, trauma. they vary in color, starting red from inflow of hemoglobin, turning blue-green due to bilirubin, and finally brown due to hemosiderin

Question 37

what is a hematoma?

Answer 37

hemorrhage collected within the body

Question 38

Differentiate the causes of local vs. systemic edema

Answer 38

they’re both due to increases in hydrostatic pressure, but local is typically caused by an obstruction and causes edema in a specific area, while systemic is an overall increase in venous pressure that causes overall edema