Fluids and Haemodynamics

Question 0

Osmosis mechanism + control

Answer 0

H2O shift between ECF and ICF

Controlled by serum Na+ and glucose

Question 1

Total body water compartments

Answer 1

ECF (plasma, interstitial fluid)

ICF (cytosol)

Question 2

Edema definition

Answer 2

Increased fluid in interstitial space or body cavity

Can be Exudate/Transudate/Lymph

Question 3

Transudate vs Exudate vs Lymphadema

Answer 3

Transudate - protein and cell poor fluid in interstitial space/body cavity; alteration in Starling’s forces

Exudate - protein and cell rich (pus); acute inflammation with INCR vessel permeability

Lymphedema - damaged lymphatics - radical mastectomy, filariasis, inflammatory carcinoma (lymphatics plugged by tumour)

Question 4

Venous thrombosis pathology

Answer 4

fibrin clot with entrapped RBCs, WBCs, platelets.

Deep veins below knee (stasis)

Question 5

Examples of Increased in hydrostatic pressure –> edema

Answer 5

pulmonary edema in LHF; pitting edema in RHF; portal HTN

Question 6

Renal retention of sodium and water –> what does this cause?
What is this caused by??

Answer 6

Incr hydrostatic pressure
Decr oncotic pressure

• Decr cardiac output (activation of RAAS)
• primary renal disease

Question 7

Causes of Decr oncotic pressure (hypoalbuminaemia)

Answer 7

Kwashiorkor; nephrotic syndrome; cirrhosis

Question 8

Arterial thrombus pathology

Answer 8

endothelial injury; platelets held together by fibrin

Question 9

MCC cause of systemic thromboembolism

Answer 9

From left heart origin (AF)

Question 10

Fat embolus

Answer 10

long bone fractures; delayed symptoms 48hrs

thrombocytopenia, hypoxemia

Question 11

Amniotic fluid embolism features

Answer 11

DIC, lanugo hair in maternal pulmonary arteries

Question 12

Diving changes in atmospheric pressure

• Decompression sickness
• Dyspnoea, chest pain underwater
• Dyspnoea, chest pain rising to surface

Answer 12

1 atmospheric pressure with 33 foot descent into water. N2 gas dissolved into tissue

• release of N2 gas from tissue with rapid ascent; ischaemic damage; “the bends”
• pulmonary embolus
• spontaneous pneumothorax

Question 13

Findings in shock:

• Hypovolemic
• Cardiogenic
• Septic

Answer 13

Hypovolemic - Decr CO + LVEDP; Incr PVR
Cardiogenic - Decr CO; Incr LVEDP + PVR
Septic shock - Incr CO (Incr venous return); Decr PVR (vasodilation)

Question 14

Kidneys in shock:

Shock complications:

Answer 14

Most susceptible organ
- straight portion of PCT most susceptible to injury

Complications: Ischaemia ATN, multiorgan failure, Incr AG metabolic acidosis