Congestion and Oedema

Question 1

Clinical pathology examples of congestion

Answer 1

Local acute congestion e.g. DVT
Local chronic congestion e.g. Hepatic cirrhosis
Generalised acute congestion e.g. congestive heart failure

Question 2

Pathophysiology of congestive Heart Failure

Answer 2

Decrease in CO
Decrease in GFR leading to increased Na and H20 retention
Increased amount of fluid in the body

Question 3

Effects of congestive heart failure

Answer 3

Heart cannot clear blood from ventricles and so back pressure into the system = blood damned back into the veins
Liver; central venous congestion, leads to RHF, increased JVP, hepatomegaly, peripheral oedema
Acute and chronic changes in the lungs lead to peripheral oedema

Question 4

Causes of vascular congestion

Answer 4

Deep vein thrombosis of the leg cause a vein to be blocked which causes localised acute congestion
Hepatic cirrhosis - example of a chronic congestive process

Question 5

Consequences of vascular congestion: systemic portal shunts

Answer 5

Oesophageal varices
Caput medusa (around umbilicus)
Haemorrhage risk very serious

Question 6

Exudate vs. Transudate

Answer 6

Transudate
- Alterations in the haemodynamic forces which act across the capillary wall
- Not much protein/albumin (few cells)
- Lots of H20 and electrolytes
- Low specific gravity
Exudate
- Part of inflammatory process due to an increased vascular permeability 
- Higher protein/albumin content (cells)
- H20 and electrolytes
- High specific gravity

Question 7

Three components affect net flux and filtration

Answer 7

Hydrostatic pressure
Oncotic pressure
Permeability characteristics and area of endothelium

Question 8

Oedema locations

Answer 8

1. Intercellular tissue compartments: Peripheral oedema (in tissues)
2. Body cavities: effusions
   - Pleural, pericardial, joint effusions
   - Abdominal cavities: ascites

Question 9

Pathophysiology of pulmonary oedema

Answer 9

TRANSUDATE = Hydrostatic pressure

1. LV Failure
2. In lungs: perivascular and interstitial transudate leading to oedema fluid in alveolar spaces

Question 10

Pathophysiology of peripheral oedema

Answer 10

1. RH failure: cannot empty ventricle in systole
2. Blood retained in systemic veins leads to peripheral oedema
   Congestive cardiac failure: both ventricles fail = pulmonary and peripheral oedema at the same time

Question 11

Pathophysiology of Lymphatic Blockage

Answer 11

Lymphatic obstruction leads to hydrostatic pressure upset - can lead to lymphedema

Question 12

Pathophysiology of oedema in abnormal renal production

Answer 12

1. Abnormal renal function results in salt and H20 retention
   Secondary in heart failure.
   Primary acute tubular damage e.g. hypotension
2. Results in oedema

Question 13

Pathophysiology of low protein oedema

Answer 13

TRANSUDATE

1. Hypoalbuminaemia results in increased filtration
   e. g. Nephrotic syndrome
   e. g. hepatic cirrhosis
   e. g. malnutrition

Question 14

Pathophysiology of permeability oedema

Answer 14

EXUDATE

1. Damage to endothelial lining
   e. g. acute inflammation such as pneumonia
   e. g. burns