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Pathophysiology I > Fluids & Shock > Flashcards

Fluids & Shock Flashcards

1
Q

what is edema?

A

excess interstitial (tissue) fluid-may be localized or systemic

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2
Q

what can edema include?

A

excess fluid in body cavities (“third spaces”)

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3
Q

what is edema in the peritoneal cavity?

A

ascites

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4
Q

what is edema in the pericardial cavity?

A

pericardial effusion

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5
Q

what is excess cerebrospinal fluid?

A

hydrocephalus

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6
Q

what is edema in the testicular cavity?

A

hydrocele

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7
Q

what is edema in the uterine tube?

A

hydrosalpinx

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8
Q

what is edema in the small intestine?

A

ileus

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9
Q

what is edema between the epidermis and dermis?

A

blister

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10
Q

what is edema in a surgically-created space (wound)?

A

seroma

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11
Q

what is edema in the pleural cavity (hemothorax, empyema)?

A

hydrothorax

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12
Q

what are transudates composed of?

A

salt water, little to no protein content

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13
Q

what do transudates result from?

A

alterations in starling forces or lymphatic failure

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14
Q

what can cause transudates?

A 
heart failure
cirrhosis
renal failure
salt-indulgence
mechanisms can be complex
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15
Q

starling forces

A

things that contribute to fluid exchange across capillary walls

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16
Q

what causes fluid to go out of capillaries?

A 
hydrostatic pressure (BP) is higher than the pressure in the tissues (osmotic/oncotic pressure)
capillary hydrostatic pressure (BP), as fluid is lost BP goes down at venous end, capillary hydrostatic pressure drops on venous end
positive at end
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17
Q

what causes fluid to go into capillaries?

A

osmotic pressure is greater than capillary hydrostatic pressure

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18
Q

causes of transudative edema

A 
excess total body water
salt/fluid overloading
excess aldosterone (tumor, hepatic failure)
kidney failure from any cause
systemic veins (all)-R heart failure
pulmonary veins-L heart failure
leg veins-prolonged standing, pregnancy, valve failure
portal vein-cirrhosis
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19
Q

causes of transudative edema 2

A

cerebral capillaries-brain trauma
systemic capillaries-decreased plasma proteins (liver failure, malnutrition, nephrotic syndrome)
lymphatic obstruction-inflammation/scarring-filariasis “elephant man”, cancer, radiation

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20
Q

is treatment needed for transduative edema?

A

varies depending on cause

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21
Q

what are exudates composed of?

A

protein-rich salt water

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22
Q

what causes exudates?

A

overly leaky capillaries

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23
Q

what are exudates seen with?

A

inflammation
sepsis
burns
abnormal capillaries in tumors

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24
Q

what happens when exudates are created?

A

leaked proteins draw water into interstitial space or “third” space

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25
how would you tell transudate or exudate?
lab can distinguish from sample of fluid, protein content main determining factor
26
hemorrhage
loss of whole blood from blood vessels
27
where can hemorrhages be?
external, into tissues, or into "third" spaces
28
what are small hemorrhages?
petechiae <3mm
29
what are medium hemorrhages?
purpura 3-10mm
30
what are large hemorrhages?
ecchymosis >10mm "bruise"
31
hematoma
blood in tissues produces a mass
32
hematoma in thorax, pericardium, peritoneum
hemathorax hemopericardium hemoperitoneum
33
hemoptysis
coughing blood
34
hematemesis
vomiting lood
35
hematochezia
bright red blood per rectum
36
melena
black, tarry, digested blood per rectum
37
causes of hemorrhage
``` trauma diseases of blood vessels diseases around blood vessels lack of clotting factors lack of platelets ```
38
what determines significance of hemorrhage?
``` where and how much brain bleeds-devastating hemopericardium-rapidly fatal black eye-harmless 500mL in street no big deal, 500mL pericardial space means death ```
39
can hemorrhages be quantified?
yes if it is into tissues or external
40
class I hemorrhage blood loss
up to 750mL (1-15%)
41
class I hemorrhage clinical signs
minimal to none
42
class II hemorrhage blood loss
750-1500mL (15-30%)
43
class II hemorrhage clinical signs
tachycardia, tachypnea, anxiety
44
class III hemorrhage blood loss
1500-2000mL (30-40%)
45
class III hemorrhage clinical signs
tachycardia, tachypnea, hypotension, altered mental status
46
class IV hemorrhage blood loss
2000mL (>40%)
47
class IV hemorrhage clinical signs
tachycardia, hypotension, cold, clammy, severely altered mental status
48
what can class III and IV hemorrhages progress to?
irreversible shock
49
where can significant internal losses occur?
thoracic/abdominal cavities | thigh
50
shock
widespread hypoperfusion of body tissues
51
what does hypoperfusion lead to?
organ malfunction/failure
52
what can compensatory mechanisms do in hypoperfusion?
maintain blood pressure
53
what does anaerobic metabolism predominate in shock?
lactic acidosis release of inflammatory mediators further vasodilation decreased perfusion
54
hypovolemic shock
decrease in blood volume
55
what can cause hypovolemic shock?
``` hemorrhage-internal or external vomiting diarrhea burns third-space losses ```
56
cardiogenic shock
pump failurs
57
what can cause cardiogenic shock?
massive infarction (heart attack) rupture of ventricle or valve some rhythm disturbance
58
distributive shock ("warm" shock)
profound vasodilation, lack of venous return
59
what can cause distributive or warm shock?
``` sepsis anaphylaxis high spinal cord injury profpund anesthesia vasovagal (pain, emotion) newer war gases ```
60
obstructive shock
external compression of heart or its outflow
61
what can cause obstructive shock?
tension pneumothorax large pericardial effusion "cardiac tamponade" massive pulmonary embolism
62
what happens during compensated stage of shock?
blood shunted from kidneys, salivary glands, gut, skin maintains perfusion to heart and brain oliguria, dry mouth and skin BP is maintained
63
what happens during progressive stage of shock?
``` sympathetic compensatory mechanisms fail BP and cardiac output drop lung and kidney damage occurs survival becomes unlikely -tissue injury may not be reversible ```
64
what is the goal of treatment for shock?
``` restore tissue perfusion not simply raise BP control of bleeding fluids, fluids, fluids address underlying cause ```
65
how much fluid is adequate to treat shock?
1L in 5 minutes, repeat 2L over 10 mintes

Pathophysiology I (10 decks)

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