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Fluid Balance and Shock
Fluid Balance, Disorders, and Shock - Malysz II
63
Medical
Graduate
04/16/2011

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Term
What is the fluid distribution of the body?
Definition
TBW = 60%, Intracellular = 40%, Extracellular = 20% (5% intravascular, 15% interstitial)
Term
Fluid balance depends on? (4)
Definition
Vessel wall integrity and endothelial function, Intravascular pressure, Oncotic pressure, Osmolarity within physiologic compartments
Term
What is edema?
Definition
Tissue overhydration due to extravasation of water from intravascular bed into interstitial space
Term
What is ascites?
Definition
Free fluid in peritoneal cavity
Term
Define hydrothorax
Definition
Free fluid in pleural cavity
Term
Define hydropericardium
Definition
Free fluid in pericardial cavity
Term
Name 5 causes of edema
Definition
Increased hydrostatic pressure,
Reduced plasma osmotic pressure (hypoproteinemia), Sodium retention, Lymphatic obstruction, Inflammation (increased vascular permeability)
Term
Lower extremity edema causes? Pulmonary Edema causes?
Definition
swollen extremities, shortness of breath
Term
Presentation of edema depends on?
Definition
localization of excess interstitial fluid
Term
What is Anasarca?
Definition
severe generalized edema with significant subcutaneous tissue swelling
Term
2 things that increase hydrostatic pressure
Definition
Impaired venous return, arteriolar dilation
Term
Name 3 ways venous return is impaired
Definition
CHF, Constrictive pericarditis, Venous obstruction or compression
Term
2 things that cause arteriole dilation
Definition
Heat
Neurohormonal dysregulation
Term
List 4 ways that plasma osmotic pressure is reduced
Definition
renal disease (nephrotic syndrome),
Liver cirrhosis (under production of proteins), Malnutrition, gastroenteropathy
Term
Name 4 causes of sodium retention
Definition
Excessive salt intake coexisting with renal insufficiency, Increased tubular reabsorption of sodium, Renal hypoperfusion, Increased renin-angiotensin-aldosterone secretion
Term
Role of lymphatics in edema?
Definition
they are supposed to drain the excess fluid
Term
List 4 ways that lymphatics can become obstructed
Definition
Postsurgical, Inflammatory, Neoplastic,
Post-irradiation
Term
Why do we have edema with inflammation?
Definition
inflammation causes increased vascular permeability
Term
What is exudate? associated with? specific gravity?
Definition
protein rich edema associated with inflammation, >1.020
Term
What is transudate? associated with? specific gravity?
Definition
protein poor edema associated with hydrodynamic derangements, < 1.012
Term
What is congestion? associated with?
Definition
obstruction of venous outflow, CHF or localized obstruction (like thrombosis)
Term
What does congestion do to venous pressure and venous return?
Definition
Increase in pressure, reduces return
Term
What is "nutmeg liver", c/o?
Definition
dark red spots with pale areas around, signs of congested liver
Term
What part of liver is most sensitive to hypoxia? why?
Definition
the centrilobular areas, blood flows from the periportal to the central zones
Term
What color are the congested areas of liver?
Definition
Red, centrilobular
Term
What color are the periportal hepatocytes in congested liver?
Definition
pale
Term
Why is liver congestion greatest around central veins and decrease toward portal triads?
Definition
dilation at maximum, back pressure opposite of normal flow
Term
Chronic lung injury retards flow to? and causes?
Definition
left side of heart (ventricle), pooling of blood in lung capillaries
Term
What are the dark brown discolorations in lung congestion?
Definition
microhemorrhages
Term
What can cause lung to feel stiff with congestion?
Definition
septal fibrosis
Term
What is induration?
Definition
The brown appearance of the congested lung?
Term
What is the microscopic appearance of a chronic congested lung?
Definition
vessel dilation, and hemosiderin laden macrophages
Term
What are the macrophages doing?
Definition
cleaning up the blood in the alveolar space
Term
What are the microscopic differences with acute lung congestion/edema?
Definition
more prominent alveolar septa (congested capillaries), more fluid in alveolar space
Term
Define shock
Definition
systemic hypoperfusion and widespread ischemic/hypoxic injury due to disproportion in oxygen supply and demand
Term
What causes shock?
Definition
Failure of cardiovascular system, supply can't keep up with demand
Term
Shock is a common final pathway for? (6)
Definition
Severe hemorrhage, Severe burns/fluid loss, Severe trauma, Large MI, Massive PE, Sepsis
Term
Describe cardiogenic shock
Definition
pump failure (MI), not enough pressure/flow to supply oxygen
Term
Describe hypovolemic shock
Definition
loss of fluid
Term
What is septic shock?
Definition
disproportion b/w circulatory bed (becomes too large) and volume (normal volume + loss of tone)
Term
Define neurogenic shock
Definition
spinal cord injury and loss of vascular tone
Term
What is anaphylactic shock?
Definition
IgE mediated hypersensitivity with systemic vasodilation and increased permeability
Term
septic shock caused by the spread of _____ into the bloodstream
Definition
infection
Term
What is the #1 cause of septic shock?
Definition
gram (-) bacilli endotoxin (cell wall)
Term
What are rigors?
Definition
Shaking
Term
Fever and leukocytosis are indicative of?
Definition
Infection
Term
Vegetations and bacterial endocarditis can cause?
Definition
Heart murmurs
Term
What are 3 complications of vegetations?
Definition
turbulent blood flow, valve insufficiency, and thrombosis-embolism
Term
Oliguria and Renal failure are signs of?
Definition
septic shock - low perfusion leads to failure of kidney
Term
What can cause bleeding at IV puncture sites?
Definition
disseminated intravascular coagulation
Term
What are vegetations made of?
Definition
large irregular and friable masses of thrombi
Term
Tricuspid endocarditis can be caused by organisms gaining access to ______ after using dirty ______
Definition
venous circulation, needles
Term
What do infected vegetations do?
Definition
Release pathogenic organisms into circulation
Term
In renal tubular necrosis caused by shock, the cortex is ____ and ____ while the medulla is _____, _____, and ____
Definition
pale and bloodless; darker, red, and congested
Term
In renal tubular necrosis caused by shock the proximal tubules show ____ of epithelium replaced with _____
Definition
epithelium, eosinophilic debris
Term
When the brain experiences shock, grossly it appears?
Definition
thinned and discolored
Term
Short term brain shock causes?
Definition
ischemia and confusion
Term
Severe prolonged brain shock leads to?
Definition
laminar cortical necrosis
Term
What is DIC?
Definition
disseminated intravascular coagulation
Term
What causes DIC?
Definition
an activation of the coagulation system
Term
In DIC what is the primary site of coagulation? causes?
Definition
microcirculation, multi-system organ dysfunction
Term
Why is there bleeding associated with DIC?
Definition
clotting factors have been consumed in microcirculation
Term
DIC in the adrenal gland shows _____ within vessels (micro)and is a complication of (3)?
Definition
microthrombi, endocarditis, septicemia, and septic shock
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