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Disease and Defense > Hemodynamic Basis of Disease > Flashcards

Hemodynamic Basis of Disease Flashcards

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1
Q

Extravasation of fluid into tissue –>

A

edema

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2
Q

Extravasation of fluid into spaces?

A

effusion

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3
Q

What results from increased hydrostatic pressure and reduced oncotic pressure?

A

transudate

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4
Q

what results from increased vascular permeability (inflammation –> endothelial cell contraction creates small gaps / direct damage to endothelial cells)

A

exudate

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5
Q

etiology of transudate

A

ultrafiltrate of plasma: incrased hydrostatic pressure and/or reduced oncotic pressure

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6
Q

etiology of exudate

A

increased vessel permeability due to inflammation

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7
Q

if our fluid has low specific gravity

A

transudate

low density

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8
Q

if our fluid has low LDH:serum

A

transudate

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9
Q

if our fluid has high specific gravity >1.020

A

exudate

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10
Q

if our fluid has high LDH:serum

A

exudate

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11
Q

if our fluid has many white blood cells

A

exudate

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12
Q

if our fluid has high glucose fluid:serum >0.5?

A

transudate

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13
Q

if our fluid has low protein?

A

transudate

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14
Q

if our fluid has high protein fluid:serum?

A

exudate

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15
Q

if our fluid has low glucose fluid:serum?

A

exudate

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16
Q

if our fluid has few white blood cells

A

transudate

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17
Q

this type of fluid usually results from inflammation / toxins / burns

A

exudate

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18
Q

this type of fluid usually results from heart failure / liver disease / venous obstruction / fluid overload

A

transudate

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19
Q 
transudate 
sg?
tp?
p f:s?
LDH f:s?
glucose f:s?
wbc?
examples?
A

sg 0.5
WBC non or few
e.g. hf / ld / venous obs / fluid overload

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20
Q 
exudate 
sg?
tp?
p f:s?
LDH f:s?
glucose f:s?
wbc?
examples?
A 
sg >1.02
tp > 3
p f:s >0.5
LDH f:s >0.6
Glucose f:s
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21
Q

Types of increased blood volume (2)

A

hyperemia (physiologic)

congestion (pathologic)

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22
Q

hyperemia?

A

physiologic (active) increase in blood volume
due to arterial dilation
oxygenated blood: red

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23
Q

congestion?

A

pathologic (passive) increase in blood volume
impaired venous outflow
deoxygenated blood: pale or red/blue

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24
Q

liver congestion

side of hf?

A

right

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25
gi tract varices | side of hf?
right
26
ascites | side of hf?
right
27
what is ascites
accumulation of fluid in the peritoneal cavity causing abdonminal swelling
28
splenic congestion | side of hf?
right
29
peripheral edema? | side of hf?
left?
30
pulmonary edema results from | side of hf?
left
31
pleural effusion | side of hf?
left
32
renal consequence of left hf?
decreased renal blood flow --> retention of na+ and water --> increased blood volume --> peripheral edema
33
hemorrhage
blood outside of the vasculature, due to vessel damage
34
causes of hemorrhage (3)
impaired integrity of vessel walls low level / function of platelets low level / function of coagulation factors
35
petechiae
1-2 mm blood dots from hemorrhage
36
purpura
>3mm blood dots from hemorrhage
37
ecchymoses
1-2cm blood dots from hemorrhage
38
hematoma
blood accumulation from hemorrhage within tissue
39
thrombosis: virchow triad
endothelial injury abnormal blood flow hypercoagulability
40
virchow triad | cause of endothelial injury?
hypercholesterolemia | inflammation
41
virchow triad | cause of abnormal blood flow? (2)
stasis (e.g. a-fib, bed rest) | turbulence (e.g. atherosclerotic vessel narrowing)
42
virchow triad | cause of hypercogulability (2)
inherited (e.g. factor V leiden) acquired (e.g. disseminated cancer)
43
most common type of embolus?
thromboembolus (DVT)
44
Risk factors for DVT (7)
``` Immobility / recent surgery estrogen pregnancy / post-partum previous or current cancer coagulation anomalies limb and/or orthopedic trauma obesity ```
45
thromboemboli - venous source/cause organ affected clinical
source - deep leg veins / arm veins organs - lungs clinical - respiratory insufficiency / chest pain
46
fat/bone marrow emboli source organ clinical
source - long bone fracture - vein damage organ - lung clinical - resp insufficiency
47
amniotic fluid emboli source organ clinical
source - torn placental membranes / uterine vein rupture organ - lungs/brain/vasculature clinical - resp insufficiency / shock / seizures / DIC 10% maternal deaths
48
tumor emboli source organ clinical
source - mucin secreting adenocarcinomas / liver / kidney organ - lungs clinical - resp insuff / chest pain
49
thromboemboli - arterial source organ clincal
source - heart / aorta / carotid organs - legs (75%) brain (10%) clinical - stroke / tissue necrosis in leg
50
atheroemboli source organ clinical
source - atherosclerotic plaque of aorta / iliac / carotid organ - legs / brain / GI / kidney clinical - stroke / tissue necrosis / GI pain or bleeding / acute kidney injury
51
gas bubble emboli source organ clinical
source - diving or IV organ - muscle / joints / lungs / heart clinical - bends (skeletal / joint pain) - chokes (lung edema and hemmorhage) - respiratory insufficiency / myocardial infarction
52
disseminated intravascular coagulation
thrombosis and hemorrhage can occur simultaneously
53
DIC underlying condition?
tissue factor release, endothelial damage
54
DIC we see systemic activation of ?
coagulation
55
systemic activation of coagulation in DIC leads to (2)
widespread fibrin deposition --> thrombosis consumption of platelets and clotting factors (bleeding)
56
DIC | symptoms?
``` from multiple organ systems - resp insufficiency - mental status changes / convulsions - acute renal failure - petechiae / purpura - GI / oral hemorrhage Shock ```
57
DIC blood work?
``` hemolytic anemia thrombocytopenia low fibrinogen elevated D-dimer other fibrin degradation products ```
58
infarction
tissue death (necrosis) caused by vessel occlusion
59
type of necrosis in infarction?
typically coagulative but liquefactive in brain
60
``` infarction: white insufficiency? blood supply? reperfusion? tissue type? organs? ```
``` insufficiency: arterial blood supply: single reperfusion: no tissue type: dense organs: heart / kidney / spleen ```
61
``` infarction: red insufficiency? blood supply? reperfusion? tissue type? organs? ```
``` insufficiency: venous blood supply: dual reperfusion: yes tissue type: loose organs: lung / liver / intestine ```
62
what is shock?
circulating blood volume or blood pressure is not adquate to perfuse body tissues --> multi-organ dysfunction / damage
63
cardiogenic shock -
myocardial pump failure | - myocardial damage, extrinsic compression, outflow obstruction
64
hypovolemic shock
low blood volume | - severe dehydration (vomiting / diarrhea), hemorrhage, burns
65
clinical manifestations of cardiogenic and hypovolemic shock?
low c.o and low b.p --> vasoconstriction increased heart rate renal conservation of fluid --> coolness and pallor of skin / tachycardia / low urine output
66
Systemic inflammatory response syndrome is seen in?
septic shock (microbial infection - bacteria/fungi)
67
what happens in SIRS
Immensely elevated inflammatory mediators --> fever / DIC / ARDS Arterial vasodilation --> hypotension / warm / flush vascular leakage --> hypotension / edema venous blood pooling --> reduced c.o. / increased H.R.
68
If someone is in shock and is cool and has pallor, think?
hypovolemic or cardiogenic
69
if someone is in shock and warm and flush think?
septic
70
does septic shock respond to IV fluids?
often not

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