Fluid and Hemodynamics

Question 1

What is the definition of edema?

Answer 1

Too much interstitial fluid in the tissues or outside individual cells

Question 2

What is Anasarca?

Answer 2

Generalized, severe edema

Question 3

What is an effusion?

Answer 3

Liquid in the pericardial, pleural, peritoneal, or joint cavities

Question 4

What is Ascites?

Causes?

Answer 4

Effusion in the peritoneal cavity

Causes- Liver dz (hepatitis, cancer, cirrhosis), CHF, severe pancreatitis

Question 5

What is Empyema?

Answer 5

Pus or purulent effusion in the pleural cavity

aka pyothorax

Question 6

What is an Ileus?

Answer 6

Too much fluid in the small bowel

Question 7

What is a Seroma?

Answer 7

Non-infected fluid in a surgical incision

Question 8

What is a Loculated effusion?

Answer 8

Effusion in more then one compartment due to scarring, harder to drain

Question 9

What is the difference between Bulla and Vesicles?

Answer 9

Bulla: Big blisters
Vesicles: Little blisters

Question 10

What are the mechanisms in which transudate edema can form?

Answer 10

1. Excess total body fluid
2. Increased pressure in small veins
3. Decreased total plasma protein/albumin
4. Lymphatic vessel obstruction

Question 11

What causes edema in liver failure?

Answer 11

Increased portal venous pressure and low serum albumin (ascites, caput medusa)

Question 12

What usually causes lymphedema?

Answer 12

Cancer

Other causes: Surgery, radiation therapy (i.e. agressive mastectomy)

Question 13

What is Milroy’s disease?

Answer 13

Malformed lymphatics-> produces lifelong lymphedema, worst in legs

Question 14

What is the difference between transudates and exudates?

Answer 14

Exudates- protein-rich fluid accumulations

Transudates- low-protein fluid accumulation

Question 15

What does orange peel skin indicate?

Answer 15

Plugging of dermal lymphatics- probably by breast cancer

Question 16

What does thrombin do?

Answer 16

Converts fibrinogen into fibrin
Activates factor XIII (cross links fibrin)
Promotes neutrophil adhesion
Induces platelet, monocyte, lymphocyte activation

Question 17

What does plasmin do?

Answer 17

Breaks down fibrin

Activates fibrinolysis

Question 18

What is the Virchow triad?

Answer 18

1. Endothelial injury
2. Stasis (turbulent blood flow)
3. Hypercoagulability of blood

Question 19

What is primary hemostasis?

Answer 19

Formation of platelet plug

Induced by vWF, collagen

Question 20

What is secondary hemostasis?

Answer 20

Deposition of Fibrin meshwork

Consolidation of clot (essentially, the clotting cascade)

Question 21

What are genetic factors of hypercoagulable blood?

Answer 21

Factor V-Leiden
Prothrombin G20210A
Protein S, C, and AT-III deficiency
High homocysteine

Question 22

What should be considered when edema around the eyes is observed?

Answer 22

Total body water overload (pools in periorbit first)

Possibly from low blood albumin/renal edema

Question 23

A patient presents with abdominal edema. What should you consider first?

Answer 23

Primary liver disease

Low albumin + resistance to portal venous flow

Question 24

A patient presents with edema in the feet after standing. First differential you should consider?

Answer 24

Heart failure- cardiac edema

Question 25

A patient presenting with lower eyelid petechiae should be worked up for what?

Answer 25

Bacterial endocarditis (cardiac)

Question 26

In patients with platelet deficiencies, what are the most feared consequences?

Answer 26

GI and brain bleeds | CN: may be diagnostic petechiae

Question 27

What does thrombin do when it is bound to thrombomodulin?

Answer 27

Stops activating fibrinogen, activates protein C instead Prevents/stops clotting (Thrombomodulin modulates thrombin)

Question 28

What are lines of Zahn?

Answer 28

Lines that form on a thrombus ante-mortem | Thrombi without lines of Zahn occurred after death

Question 29

What is recanalization?

Answer 29

Thrombi turn into granulation tissue, and contract | This opens little channels

Question 30

What can cause an injured vessel endothelium?

Answer 30

Smoking, HTN, MI, indwelling lines, radiation/electrical injury, ruptured atherosclerotic plaques, inflamed heart valves

Question 31

What can cause altered blood flow (stasis)?

Answer 31

MI, Afib, aneurisms, arterial branch points, viscous blood, immobilization, ruptured atherosclerotic plaques, vascular malformations

Question 32

What are non-genetic causes of hypercoagulable blood?

Answer 32

Pre/Post-partum, post-trauma, nephrotic syndrome, tumors producing prothrombotic products, APL syndrome, old age

Question 33

What is white clot syndrome/heparin induced thrombocytopenia?

Answer 33

Illness caused by antibodies to heparin & platelet factor IV. Masses of platelets become white clots, existing thrombi extend, moderate thrombocytopenia

Question 34

What is Disseminated Intravascular Coagulation?

Answer 34

Excessive clotting then excessive bleeding, both platelet/clotting factor consumption and plasmin activation Histo: will see schistocytes, thrombocytopenia

Question 35

What causes of DIC cause thromboplastin to get into the bloodstream?

Answer 35

OB emergencies, cancer, APL, infarcts, hemolysis, snakebites

Question 36

What causes of DIC damage the epithelium?

Answer 36

Rickettsial dz, meninococcemia, vasculitis, toxemia of pregnancy

Question 37

What causes DIC via epithelial damage AND increased thromboplastin into the bloodstream?

Answer 37

Massive trauma, large infarcts, shock, Gm- sepsis, burns, heat stroke, emerging infectious diseases (i.e. ebola, marburg)

Question 38

What kind of edema will pit? | What can cause this?

Answer 38

Edema due to transudates- excess total body fluid and increased venous hydrostatic pressure CHF, Liver dx, Kidney kz

Question 39

What is hyperemia?

Answer 39

Increased blood flow to and organ- arterioles dilated more then venules. Typically red, throbs. i.e. blushing

Question 40

What is congestion?

Answer 40

Decreased blood flow from an organ due to impaired venous drainage. Purple. i.e. Tourniquet

Question 41

What is nutmeg liver?

Answer 41

Congestion of blood in the liver due to pooling of blood post-mortem