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Block 5 > Fluid And Hemodynamic Disorders > Flashcards

Fluid And Hemodynamic Disorders Flashcards

(47 cards)

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1
Q

Increased interstitial fluid

A

Edema

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2
Q

Where is hydrothroax? Hydropericardium? Hydroperitoneum and other name for this?

A

Thoracic cavity
Pericardial sac
Peritoneal cavity- ascites

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3
Q

Causes of edema?

A 
Increased hydrostatic pressure
Reduced plasma osmotic pressure
Lymphatic obstruction
Sodium retention
Inflammation
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4
Q

What causes increased hydrostatic pressure?

A

Impaired venous return and arteriolar dilatation

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5
Q

Causes of impaired venous return?

A

CHF
Constrictive pericarditis
Ascites
Venous obstruction or compression

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6
Q

Causes of arteriolar dilatation?

A

Heat

Neurohumoral dysregulation

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7
Q

What causes venous obstruction or compression?

A

Thrombosis
External pressure (mass)
Lower extremity inactivity

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8
Q

What leads to reduced plasma osmotic pressure?

A

Protein-losing glomerulopathies
Cirrhosis (ascites)
Malnutrition
Protein-losing gastroenteropathy

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9
Q

What leads to lymphatic obstruction?

A

Inflammatory
Neoplasticism
Postsurgical
Postirradiation

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10
Q

What leads to sodium retention?

A

Excessive salt intake with renal insufficiency
Increased tubular reabsorption of sodium
Renal hypoperfusion
Increased renin-angiotensin-aldosterone secretion

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11
Q

Active process, arteriolar dilation leads to increased blood flow and engorgement of vessels with oxygenated blood

A

Hyperemia

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12
Q

Passive process, reduced outflow of blood (heart failure, venous obstruction, etc.) causes increased volumes of deoxygenated blood, increased pressure, and stasis

A

Congestion

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13
Q

What are the 3 classic sites of congestion?

A

Lungs (acute and chronic)
Liver (acute and chronic)
Extremities (venous obstruction)

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14
Q

A release of blood into the extravascular space?

A

Hemorrhage

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15
Q

Hemorrhage in skin, mucous membranes, or serosal surfaces:
1-2mm
More than 3mm
More than 1-2cm

A

Petechiae
Purpura
Ecchymosis

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16
Q

What will extensive hemorrhage result in?

A

Shock

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17
Q

What does the clinical significance of hemorrhage depend on?

A

The volume and rate of blood loss

  • Rapid loss less than 20% total blood volume or slow loss of larger amounts may have little impact
  • small hemorrhages in certain locations may be devastating (cerebral hemorrhages)
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18
Q

What type of hemostatsis occurs when exposed subendothelial ECM causes platelet adherence and activation to form a platelet plug?

A

Primary hemostasis

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19
Q

What type of hemostasis occurs when tissue factor with factor VII activates coagulation cascade to generate thrombin which converts fibrinogen to fibrin to form a mesh work to stabilize the platelet plug?

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A

Secondary hemostasis

20
Q

What type of thrombi occurs at sites of endothelial injury and are typically non-occlusive?

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A

Arterial

-coronary, cerebral, and femoral arteries

21
Q

What type of thrombi occurs in sites of stasis and are almost ALWAYS OCCLUSIVE?

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A

Venous

-90% involve veins of lower extremities

22
Q

What are thrombi on heart valves called?

23
Q

What happens to thrombi? (Life cycle of a thrombi)

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A 
Propagate
Embolism
Dissolve
Organize/recanalize
Microbial seeding (rare)
24
Q

Detached intramuscular solid, semisolid, or gaseous mass carried by the blood to a site distant from the point of origin

25
Accounts for about 200K deaths/year in US. Can cause sudden death and right heart failure. Tend to be hemorrhagic because of dual blood circulation, results in parodic all emboli in atrial or ventricular septal defects. Small lead to infarction. Large lead to death. Multiple ones causes pulmonary hypertension with right heart failure. Usually originate from DVT of leg above knee
Pulmonary emboli
26
Usual cause is from marrow of broken long bones. Somethings is accompanied by a rash. Cause be seen in various organs along with marrow elements following CPR.
Fat emboli
27
Can be a consequence of decompression sickness from gas (esp. nitrogen) bubbling in tissues. Most common iatrogenic cause is introduction of greater than 100cc air into a vessel during procedure.
Air emboli
28
What are the 3 components of Virchow's Triad?
Endothelial injury Stats is or turbulent blood flow Hypercoagulability
29
Grave, but uncommon complication of labor/delivery. High maternal mortality rate (80%). Caused by rupture of membranes and concurrent tear of uterine vessels. Items present in amnion are present in embolus and are pathognomonic.
Amniotic fluid embolism
30
Caugulation necrosis corresponding to a particular vascular distribution caused by either arterial or venous occlusion. 99% are thromboembolic in nature.
Infarcts
31
What type of infarct is generally venous, in loose tissues, tissues with dual circulation (liver, lung, bowel), in congested tissues, and can occur when flow is re-established to a site of previous arterial occlusion and necrosis?
Red (hemorrhagic)
32
What type of infarct is generally arterial and in more "solid organs"?
White (occlusive)
33
The following factors influence what? - nature of vascular supply - rate of development of the occlusion - tissue vulnerability to hypoxia - oxygen content of blood
Factors that influence the development of an infarct
34
What represents circulatory collapse with resultant hypo-perfusion and decreased oxygenation of tissue?
Shock - 2 causes 1. Decreased cardiac output as occurs in hemorrhage or severe left ventricular failure 2. Widespread peripheral vasodilation, as occurs in sepsis or severe trauma, with hypotension often begin a prominent feature
35
What are the 3 major types of shock?
Hypovolemic Cardiogenic Septic
36
Circulatory collapse resulting from he acute reduction in circulating blood volume caused by severe hemorrhage or massive loss of fluid from the skin, from extension burns or from severe trauma OR loss of fluid from the GI tract through severe vomiting or diarrhea.
Hypovolemic shock
37
Circulatory collapse resulting from pump failure of the left ventricle most often caused by massive MI.
Cardiogenic shock
38
Most characteristically associated with gram-negative infections, which cause gram-negative endotoxemia; also occurs with gram-positive and other infections.
Septic shock
39
What type of shock is most often associated with severe trauma and reactive peripheral vasodilation?
Neurogenic shock
40
What are the stages of shock?
nonprogressive (early) stage progressive stage irreversible stage
41
Which stage of shock is associated with compensatory mechanisms, including increased heart rate and increased peripheral resistance to maintain perfusion of vital organs?
nonprogressive (early) stage
42
What stage of shock is characterized by tissue hypoperfusion and the onset of circulatory and metabolic imbalance including metabolic acidosis from lactic acidemia?
progressive stage- compensatory mechanisms are no longer adequate
43
What stage of shock is associated with organ damage and metabolic disturbances that are so severe that survival is not possible?
irreversible stage
44
What is the most important anatomic finding with shock?
acute tubular necrosis of the kidney which is potentially reversible with appropriate medical management
45
What are the causes of DIC?
``` major trauma- esp crush injuries overwhelming infections (gram neg.) obstetric complications (abruption, amniotic fluid emboli) mucin-secreting adenocarcinomas prostatic surgery venomous snake bites ```
46
Treatment for DIC?
eliminate underlying causes if possible, otherwise therapy is supportive
47
Related disorders characterized by diffuse microvascular occlusion of arterioles and capillaries by thrombi mainly composed of platelets, not fibrin.
thrombotic thormbocytopenic purpura/hemolytic uremic syndrome

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