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