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Symptoms of respiratory system > Subcutaneous tissue > Flashcards

Subcutaneous tissue Flashcards

1
Q

Osmolality

A

is of prime importance in maintaining homeostatic balance b/w ICF + ECF
- IS THE MEASULE OF SOLUTE CONCENTRATION AND IS DEFINED AS THE NUMBER OF THE OSMOLES OF SOLUTE PER KILOGRAM OF WATER ( osm/L)

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2
Q

Osmolarity

A
  • is the measure of osmoles of solute per liter of solution (osm/L)
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3
Q

Electrolytes

A

ionized substances which contribute most to the total solute concentration / ( osmolality ) of body fluids

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4
Q

From Vascular space -> Extracellular space

A
  1. Hydrostatic pressure from vascular system

2. Coloid oncotic pressure of interstitium

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5
Q

To vascular compartment

A
  1. Coloid - oncotic pressure ( plasma protein )

2. Hydrostatic pressure - Interstitial

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6
Q

Edema

A

Palpable swelling produced by expansion of the interstitial fluid volume

  • accumulation of fluid in intercellular spaces ( Interstitium )
  • clinical evident only after accumulation of a few liters
  • preceded by increased G with 4-5 kg ( PreEdema not evident at clinical exam -> loop diuretic decreases G )
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7
Q

From capillary arteriolar end to the interstitium

A

Return from interstitialto vascular space through :

  • venous capillary end
  • lymphatics
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8
Q

Edema

Mechanisms

A
  1. ↑ venous pressure
  2. ↓ plasma oncotic pressure
  3. ↑ capillary permeability
  4. obstruction venous and lymphatic vessel
  5. hydro-saline retention at kidney level
    Increased water and salt capital of the body
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9
Q

MECHANISMS: Imbalance between forces

EDEMA

A
  1. Obstruction of venous system → ↑ Capillary press. → edema
  2. 🡫 coloid oncotic pressure - in hypoalbuminemia
  3. capillary endothelium dysfunction- ↑ capillary permeability
    - injury by chemical agents , bacterial, thermal, mechanical
    - protein transfer to interstitium
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10
Q

Edema Lymphatic drainage

A
  1. Safety supplementary mechanism
  2. It takes on the albumin filtered through the capillary wall and the excess of the transudated fluid
  3. Reduces lymphatic flow
  4. Essential role in the production of lymphedema
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11
Q

EDEMA

CLINICAL ASPECT

A
  1. Swelling- Increased volume of a region
  2. Disappearance of anatomical reliefs
  3. Pitting edema (usually pressed on a bony plane)

occur in areas with lax connective tissue where
interstitial pressure is small (retromaleolar, face,
eyelid)

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12
Q

EDEMA: General Characteristics

A
  1. Initial stage (Preliminary stage)
    - Shiny & tight edematous skin
  2. The resorption stage
    - Fine longitudinal folds (“wrinkly” skin)
    - Stretch marks (thigh and abdomen)

Chronic Stage
- Thickening / rigidity of the tegument (hyperplasia of
subcutaneous cellular tissue ←↑ interstitial press over longtime)
- Lichenoid appearance (fibroblastic proliferation)
- Harsh to the touch
- Marked peeling
- Pit difficult to evoke→ pitting only after prolonged compression
- Dystrophic skin (cracks, wet ulcerations)

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13
Q

EDEMA: General Characteristics

A

COLOUR
Red: inflammatory and allergic edema
White: renal edema
Cyanotic (ocher dermatitis):cardiac & venous edema

LOCAL TEMPERATURE

Increased: inflammatory edema

Normal: renal edema

Reduced: cardiac edema

CONSISTENCY

Elastic, let the pit easily → renal & carential edema

Hard ~ non pitting→ inflammatory & venous edema

PAIN
Painless = most edema of general cause
Painful = inflammatory edema

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14
Q

Renal edema

A

🡫 coloid osmotic pressure

↑ capillary permeability

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15
Q

Hepatic edema

A

🡫 coloid osmotic pressure - due to hypoalbuginemia

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16
Q

CARDIAC EDEMA

A

↑ venous pressure (venous congestion)

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17
Q

CARENTIAL EDEMA

A

↓ oncotic pressurei by hypoproteinemia

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18
Q

ANASARCA

A 
Generalized edema
- Fluid effusion in body cavities associated
Biology: TRANSUDATE
- Serocitrine
- Low proteine level
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19
Q

ANASARCA- characteristics

A
  1. Generalized (not from the beginning)
  2. Start at lower limb (retromaleolar, anterior tibial)
  3. Infero intern area of thigh, just above the knee
  4. Abdominal wall (orange peel appaerance)
  5. Lumbosacral area
  6. Anterior thorax
  7. Posterior thoracx
  8. Uppr limbs (infero-intern & posterior, above the
    elbow)
  9. Face (eyelid edema)
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20
Q

PREGNANCY EDEMA

A 
Moderate edema
- White
- Soft
- Pitting Easy
- Lower limb usually
- In late pregnancy
- Pregnancy nephropaty – Eclampsia - Particular aspect : 
> Week 20
> Generalized Edema
> HTN
> Proteinuria
21
Q

CATAMENIAL EDEMA

A

Moderate Edema at lower limbs
In women in the second half of the menstrual cycle
Trigger hormonal

22
Q

MIXEDEMA

A

In severe hypothyroidism
Pitting
+ thickened skin

23
Q

IATROGENE

A

DRUG INDUCED

  • corticosteroids
  • estrogens
  • BP lowering drugs (dihidropiridine, α blockers)
24
Q

IDIOPATIC EDEMA –

Milroy Syndrome

A

Ussualy at the calves level
Womens > 30 y old
Chronic Edema with unknown etiology

25
Q

INFLAMATORY EDEMA

A
  1. Localized edema (tumor)
  2. Unilateral usualy
  3. Warm (calor)
  4. Painful (dolor)
  5. Redness of the skin (rubor)
  6. One of the signs of inflammation

Characterize: erysipelas, lymphangitis,
arthritis, abscess, cellulite, osteomyelitis,
phlebitis,..

26
Q

ALERGIC EDEMA

Characteristics

A

Colour: red

Temperature: warm

Painfull

Non-pitting !!!!

Sudden onset

Characteristic location:
- Face, eyelid, lips, tongue

Asociated symptoms

  • Pruritus
  • Urticaria
27
Q

ALERGIC EDEMA

Forms:

A 
Acute, Chronic, Recurrent
Quincke Angioneurotic Edema
- Sudden onset
- Disapearance: hours, days
- Without pruritus !!!!!!
Associated with:
- glotic edema
- asphyxia
- paroxysmal inspiratory dyspnoea caused by different
allergens (food, medicines)
28
Q

LYMPHEDEMA

A
  • Pale
  • Start asymetricaly
  • Soft initially, then it becomes card boarded with lichenifications
  • Unusual locations: dorsal area of the hand, feet

Mechanism:

  • Blockage of lymphatic circulation through
  • Malformations of the lymphatic vessels
  • Tumors
  • Metastases
  • Postoperative: resection of the lymphatics
  • After irradiation of the lymph nodes
  • In filariasis - grotesque aspect “elefantiazis arabicum”
  • Forms: congenital, acquired
29
Q

VENOUS EDEMA

A

Superficial thromboflebitis

  • Edema around the superficial afected vein
  • Present with inflammations signs

Deep vein thrombosis

  • Edema characteristics: white, painful spontaneously and with palpation, (positive Homans sign)
  • Swelling of the affected area (ex. calve, thigh)
  • Superficial vein network prominent
  • Superimposed arterial spasm may determine cyanosis
30
Q

VENOUS EDEMA

A

Chronic venous insuficiency

  • Secondary to varicose veins or
    repeated deep vein thrombosis
  • Unilateral or bilateral but uneven
  • Especially on the lower limbs
  • Accentuated in orthostatism
  • Cyanotic skin, with ocher dermis
  • Possibly complicated by ulcers
31
Q

EDEMA in superior cava vein syndrome

A

swelling in the face, neck, arms, and upper chest

sometimes with a bluish-red skin color

32
Q

EDEMA in superior cava vein syndrome

Mechanism

A
  • Obstruction of superior cava vein
  • ↑ venous pressure above the SCV obstruction
  • Colateral circulation associated
33
Q

DEPENDENT (GRAVITATIONAL) EDEMA

A
  • Determined by prolonged gravitation effect
  • Long duration trip
  • In patient with critical limb arterial ischemia due to
    prolonged sitting as attempt to diminish the related pain
  • Favored by hot season
34
Q

NEUROTHROPHIC EDEMA

A
  • Moderate edema
  • It affects the paralyzed limb
  • The typical appearance = “juicy hand” described by Marinescu
35
Q

DEHYDRATION

A

Clinical condition caused by a reduction in content water of the body

CLASSIFICATION

  • Cellular dehydration
  • Extracellular dehydration
36
Q

Cellular dehydration (1)

A
  • Determined by ↓ volume of intracellular water, due to the loss of water through: polyuria, perspiration, respiration (in coma)
  • It may accompany edema (extracellular hyperhydration) when the patient ↓ fluid intake, maintaining salt intake
  • May accompany extracellular dehydration resulting in global dehydration
37
Q

Cellular dehydration (2)

A

Clinical aspect

  • Thirsts (by stimulating the hypothalamic osmometer)
  • Nausea-free anorexia
  • Dry tongue and mouth due to decreased parathyroid secretion
  • Fever (by altering the thermoregulation)
  • Neurologic phenomena (cheyne-stokes breathing, delirium, drowsiness, coma)

Biology:
Natremia > 145 mEq/l
↑ plasma osmotic Pressure
Oliguria + ↑ urinary density

38
Q

Extracellular dehydration (1)

A

It is the consequence of the predominant losses of
sodium by the way:
- kidney (nephropathies, excess diuretics)
- digestive (vomiting, diarrhea)
- skin (profuse sweating) - drastically reducing the salt
intake

39
Q

Extracellular dehydration (2)

A

Clinical aspect:
- The patients are not thirsty

  • Persistent skin fold through the 🡫skin turgor
  • Eyeball hypotony
  • Colaps, hypotension, by reducing circulating volume
  • Tachycardia oliguria (with high urinary density)

Biology:

  • Natremia usually normal
  • Hemoconcentration !!!!!!!!!
  • Hyperazotemia !!!!!!

It can be associated with cellular hyperhydration by migrating water inside the cells, a state characterized by apathy, headache , vomiting ( cerebral edema )

40
Q

Launois-Bensaude Syndrome: A Benign Symmetric

Lipomatosis -Madelung disease

A

Multiple symmetrical lipomatosis, Launois-Bensaude
syndrome, cephalothoracic lipodystrophy, Madelung
disease, Brodie’s syndrome, Buschke’s disease, “Fat neck”

41
Q

Launois-Bensaude Syndrome: A Benign Symmetric
Lipomatosis -Madelung disease
Characteristics

A

occurs mostly in men between 30 - 60 y with known alcohol use

  • more common in Mediterranean countries
    -characterized by the presence of fat masses:
  • large size
  • located symmetrically in various parts of the body (but mainly in the cervical region)
  • slightly circumscribed (diffuse outline, no limiting
    capsule)
  • soft consistency
  • painless
  • it develops progressively in the subcutaneous tissue
  • in evolution, it often infiltrates neighboring structures
    histological: normal fatty tissue ,
  • benign disease, malignant transformation is exceptional
42
Q

Progressive lipodystrophy

Barraquer–Simons syndrome

A
  • rare form of acquired lipodystrophy
  • bilateral gradual symmetrical reduction of adipose tissue that begins at the face (by the disappearance of the Bichat’s bubble) and may variably progress to the neck, upper arms trunk and abdomen
    keeping intact the adipose tissue of the lower extremities associated with :
    autoimmune diseases in a minority of patients (systemic lupus erythematosus, autoimmune thyroiditis and/or metabolic diseases (Diabetes)
  • females are more affected than males
  • when it occurs in men, it occurs earlier
43
Q

Insulin lipodystrophy

A

Abnormal reactions in subcutaneous fat to insulin - in diabetic patients

44
Q

LIPOATROPHY is characterized by:

A
  • subcutaneous nodules alternating with areas of adipose tissue atrophy
  • cutaneous hypoaesthesia, possibly
  • considered an adverse effect with an immune mechanism
45
Q

LIPOHYPERTROPHY:

A

benign tumor like swelling of fatty tissue at the injection site secondary to lipogenic effect of insulin

46
Q

Rothmann Makai Syndrome

A
  • spontaneous paniculitis of children (very rare )
  • A variant of lobular panniculitis presenting with numerous large subcutaneous lesions
  • small, circumscribed, tender, erythematous subcutaneous nodules or plaques, most frequently occurring on the extremities and less commonly on the trunk and face
  • with no severe systemic involvement
  • version: lipophagic panniculitis-characterized by atrophy in lesions with skin depressions
47
Q

Weber-Christian Disease

A
  • idiopathic nodular panniculitis, which is characterized by subcutaneous nodules:
    > symmetrical, size 1-2 cm, sensitive, erythema associated their disruption expresses a brown oily liquid (liquefying paniculitis)

> characterised by exacerbations and remissions within a few weeks

> it heals with depression of the overlying skin
lesions are bilaterally symmetrical and are usually seen in the lower limbs

> systemic symptoms are associated: fever, asthenia,
nausea, vomiting, weight loss, myalgias, arthralgias

48
Q

Inflammatory disorders of the subcutaneous

tissue: cellulite and paniculitis

A
  • inflammation without necrosis of the skin and subcutaneous tissue
  • redness, tumor, heat, pain (rubor, tumor, calor, dolor)
  • the skin entrance gate can sometimes be identified
  • severe infection is suggested by the presence of:
  • altered general condition, fever
  • regional lymphangitis
  • purplish bullous lesions circumferential disposition
49
Q

Progressive hemifacial atrophy

Parry–Romberg syndrome (PRS)

A
  1. progressive shrinkage and degeneration of the tissues beneath the skin,
  2. usually on only one side of the face (hemifacial atrophy)
  3. evolves self-limiting with residual and mutilating hemifacial atrophy
  4. skin, subcutaneous tissue, underlying muscles, nerves, hair are affected
  5. rare disease
  6. higher prevalence in females

Symptoms of respiratory system (8 decks)

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