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Path SJSM > Hemodynamic disorders (Edema. Congestion, & Hyperemia) > Flashcards

Hemodynamic disorders (Edema. Congestion, & Hyperemia) Flashcards

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1
Q

Edema is described as

A

Increased fluid in the interstitial space

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2
Q

Hyperemia is described as

A

Increase in blood flow

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3
Q

Congestion is described as

A

Out flow obstruction

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4
Q

Hemostasis is described as

A

the formation of a blood clot that can prevent or limit bleeding

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5
Q

Thrombosis is described as

A

The clotting od a blood vessel

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6
Q

Embolism is described as

A

The detachment of a solid, liquid, or gaseous mass that gets carried away in the blood to another site
can cause an occlusion

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7
Q

Infarction is described as

A

Death of cells/tissue because lack of blood supply

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8
Q

Shock is described as

A

Circulatory failure/collapse

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9
Q

Starling’s forces:

Hydrostatic pressure in the capillary

A

Pushes fluid out of capillary

Increased in Venous obstruction/heart failure

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10
Q

Starling’s forces:

Hydrostatic pressure in interstitium

A

Pushes fluid in the capillary

increased in lymphatic obstruction

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11
Q

Starling’s forces:

Oncotic pressure in capillary

A

Pulls fluid into the capillary

Increased in liver failure, nephrotic syndrome, or protein malnutrition

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12
Q

Starling’s forces:

Oncotic pressure in interstitium

A

Pulls fluid into the interstitium

Increased in lymphatic obstruction

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13
Q
A

Normal
RA= 5mmHg
RV= 25/5mmHg
LA= 10mmHg
LV= 120/10mmHg
PA= 25/10
AA= 120/8
PCWP= 10mmHg

Abnormal = PCWP 30mmHg (pulmonary capillary wedge pressure)

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14
Q

The 6 mechanisms behind edema

A
  1. Increased hydrostatic pressure
  2. Decreased osmotic pressure (hypoproteinemia)
  3. increased vascular permeability (inflammation)
  4. Lymphatic obstruction
  5. Myxedema
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15
Q

Edema due to increased hydrostatic pressure can be due to 4 conditions associated with impaired venous return & 2 conditions associated with venous obstruction

A

Imp Venous return:
- CHF
- Constrictive pericarditis
- Cardiac tamponade
- Portal hypertension in cirrhosis (causes ascites)

Venous obstruction:
- Thrombosis
- Lower extremity inactivity + prolonged dependency

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16
Q

CHF & Edema in hypertension occurs due to

A

the decreased cardiac output decreases renal perfusion and triggers RAAS to reabsorb sodium and water to up the intravascular fluid volume.

The weekended heart can’t handle the extra load, so the ejection fraction reduces meaning end-diastolic volume increases, upping the pressure in the ventricles but not actually helping the heart push fluid out. The build up of pressure increases venous hydrostatic pressure causing fluid to leak (EDEMA)

Think of plugging a hose and the backward increase in pressure

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17
Q
A
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18
Q

Signs & symptoms of heart failure (name some)

A

Dyspnea
Resting Tachycardia
Jugular venous pressure elevation
Lung crackles
3rd heart sound
Peripheral edema
Ascites
Pink frothy sputum + cough

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19
Q

What are the horizontal, pleural-based linear densities seen on the patients chest x-ray

A

Kerley B lines (bat-wing like look)

Happens when pulmonary capillary pressure increases above 18-20mmHg causing pulmonary edema

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20
Q

You see a chest X-ray of a patient with the following markers, what is the likely diagnosis?

A

Pulmonary edema/congestion

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21
Q

Constrictive pericarditis induced edema:

Constrictive pericarditis is described as

A

A thickening fibrotic pericardium impedes normal diastolic filling

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22
Q

Coxsackievirus A+B, Echoviruses, & adenovirsues are common causes of what condition?

A

Viral pericarditis

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23
Q

Staphylococci, Group A & B streptococci, & gram-negative rods (pseudomonas or e.coli) are common causes for what condition?

A

Bacterial pericarditis

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24
Q

Pericarditis can be caused by

A

Constriction, bacterial infection, viral infections, or radiation exposure

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25
Jugular venous pressure wave form: Normal a wave x descent c wave x' descent v wave y descent
a wave (right atrium contracts) x descent (right atrium relaxes) c wave (tricuspid valve closes & right ventricle contracts) x' descent (end of right ventricular contraction & right atrium fills with blood) v wave (right atrium fills against a closed tricuspid) y descent (Tricuspid opens blood moves from RA to ventricle)
26
Jugular venous pressure wave form: Pathological Atrial fibrillation
Absent a-waves
27
Jugular venous pressure wave form: Pathological Pulmonary hypertension & Pulmonary stenosis
Large a-waves
28
Jugular venous pressure wave form: Pathological Complete heart block & ventricular arrhythmias/ectopics
Cannon a-waves
29
Jugular venous pressure wave form: Pathological Tricuspid regurgitation
Large v-waves
30
Jugular venous pressure wave form: Pathological Constrictive pericarditis
Rise in JVP during inspiration (Kussmaul's sign)
31
This x-ray indicates patient has what condition?
Constrictive pericarditis
32
Front chest x-ray shows ______ sign, which indicated ________
Water bottle sign which indicated pericardial effussion
33
Liver cirrhosis is described as
A consequence of chronic liver disease where liver tissue is replaced by fibrosis and causes portal venous obstruction This causes an increase in venous hydrostatic pressure & ascites Common causes are alcoholism, hep B & C, & fatty liver disease (diabetes/obesity)
34
Patient presents with __________
Lower extremity & chronic venous insufficiency and edema
35
Edema due to reduced plasma oncotic pressure (aka hypoproteinemia) is described as a deficiency in what protein?
Albumin
36
Edema due to reduced plasma oncotic pressure (aka hypoproteinemia) can be due to which conditions (4)
*Protein-losing glomerulopathies (nephrotic syndrome) *Liver cirrhosis (less albumin) *Protein-losing gastroenteropathy *Protein energy malnutrition (Kwashiorkor)
37
Process of nephrotic syndrome leading to edema
1. Hypoalbuminemia 2. Reduced intravascular oncotic pressure 3. Fluids move to interstitial space (edema) 4. less plasma volume triggers aldosterone secretion and decreased renal function = salt & water are retained (edema) 5. Kidneys make more albumin and lipoproteins to up serum triglycerides and LDL's = lipiduria
38
What are the 2 main outcomes of nephrotic syndrome?
Edema & Lipiduria
39
Protein-losing gastro enteropathies are described as
Excessive loss of serum proteins into the GI tract causing hypoproteinemia (hypoalbuminemia), edema, and sometimes pleural & pericardial effusions
40
What is a common cause of protein-losing enteropathy?
Celiac disease (gluten enteropathy)
41
Processes of heart failure leading to edema include
1. Heart failure 2. More capillary hydrostatic pressure (edema) 3. Less renal blood flow triggers RAAS to up Na & H2O retention upping blood volume (edema)
42
Processes of Malnutrition, decreased hepatic synthesis, & nephrotic syndrome cause edema are
1. A decrease in albumin reduces capillary oncotic pressure (edema)
43
Patient presents with the following, what is the likely diagnosis?
Kwashiorkor
44
What's the edema type
Cerebral edema - wide gyri, narrow sulci, & flat surface
45
What's the edema
Pulmonary edema
46
Edema due to increased vascular permeability (aka acute/chronic inflammation & angiogenesis) can be due to
Cellulitis Bee/insect stings
47
Edema due to lymphatic obstruction (lymphedema) is described as
Disrupted lymphatic vessels from trauma, fibrosis, invasive tumors, or infections that impair the clearance of interstitial fluid causing edema
48
Modified radical mastectomy or radiation can put patient at risk of which type of edema
Lymphedema
49
Wuchereria cancrofti puts patients at risk of what condition
Lymphedema in filariasis
50
Scrotal and vulvar lymphedema are due to which type of edema?
lymphogranuloma venereum
51
Blockage of subcutaneous lymphatics by malignant cells can cause which condition in breast tissue?
Breast lymphedema (inflammatory carcinoma)
52
Myxedema is described as
An increase in the production of ECM components (i.e glycosaminoglycans = swelling) because of T cell mediated cytokines which stimulate fibroblasts to make hyaluronic acid
53
Tissue swelling in Myxedema, Hypothyroidism, & Graves occurs because of increased production of which ECM components?
Glycosaminoglycans
54
Types of edema:
Pitting
55
Types of edema:
Non-pitting (hyperthyroid or lymphedema induced)
56
Anasarca is described as
extreme generalized peripheral edema
57
Lymphedema & Myxedema are both ________ edema
non-pititng
58
Hyperanemia vs Congestion: Both are caused from ________ in tissues
an increase in blood volume within tissues
59
Congestion commonly occurs in which 3 tissues?
Liver (acute/chronic), lung (acute/chronic), and brain
60
Describe the following histo slide condition:
Acute passive congestion in the lung (precedes acute pulmonary edema aka fluid in the alveoli)
61
What condition does the following histo slide describe?
Chronic passive congestion in the lung
62
Lung tissue with hemosiderin laden macrophages stained with Prussian blue are a good indication of what type of congestion?
Chronic passive congestion of the lung
63
Congestion of the liver: Liver congestion is described as
The liver is swollen and rubbery on the section surface with alternating red and yellow strips (tiger liver), Histo details will show centrilobular hemorrhage with hemosiderin-laden macrophages, and degenerated hepatocytes (fatty degradation)
64
What condition is most likely to present with congestion of the liver?
Right-sided heart failure
65
Describe the following histo:
Chronic passive congestion due longstanding obstruction to the venous flow
66
Patient presents with a "nutmeg" looking liver, what's the likely condition?
Congestion of the liver
67
Kwashiorkor is described as
Protein-energy malnutrition
68
Describe the pathology of Nephrotic syndrome
Patient has low albumin (hypoalbuminemia) which reduces intravascular oncotic pressure pushing fluid out of capillaries causing lipiduria (Albumin production & LDL production) and edema (via increased RAS + renal dysfunction)
69
Hypoalbuminemia is also known as
Protein-losing gastro enteropathy (aka loss of proteins into the GI tract causing hypoproteinemia = edema + pleural/pericardial effusions
70
Wuchereria bancrofti can lead to which condition?
Wuchereria bancrofti
71
Radical mastectomy and radiation therapy can result in ________?
Lymphedema
72
Hyperemia is due to what?
Increased inflow of blood (exercise/inflammation)
73
Congestion is due to what?
Decreased outflow (obstruction or CHF etc)
74
Describe the major features of Right sided heart
- Becks triad (hypotension, distended jugular veins, & heart murmurs) - Nutmeg liver
75
Describe the major features of Left sided heart
Pulmonary edema or effusion
76
hemolytic uremic syndrome
Due to E.coli 0157:H7 Most commonly in kids Common signs are petechiae, jaundice, oliguria, schistocytes, low platelet count, & normal PT (INR) Time
77
Thrombotic thrombocytopenic purpura
Deficient ADAMTS13 (vWF) Common in adults Common signs are neurological symptoms, fever, petechiae, fatigue/parlor, schistocytes, low platelet count, & normal PT (INR) **Positive Ristocetin test (agglutinated when plasma is added)
78
Immune thrombocytopenic purpura
Anti-platelet antibodies (GPIIb/IIa) Common signs are petechiae, purpura, epistaxis, menorrhagia, bleeding gums, normal platelet morphology, low platelet counts, & normal PT (INR)
79
Bernard Soulier
An adhesion party deficient GPIbIX an AUTO REC Common signs are petechiae, purpura, epistasis, menorrhagia, bleeding gums, giant platelets, & low platelet count ** Negative Ristocetin test (no agglutination with plasma)
80
What are the 2 major components of the intracellular adherence junctions?
Keratin (cytoskeletal filaments) & Cadherin (adhesion protein)
81
Dense bodies contain which factors?
Contain - ADP - Aggregating agents - Calcium Binding agents for vitamin K-dependent factors
82
a-granules contain what factors?
They contain - vWF - Fibrinogen - PDGF (Platelet Derived Growth Factor) - PF4 (Platelet Factor 4) These are heparin-neutralizing factors
83
Describe hyperemia
Increased blood flow (normal during exercise etc)
84
Describe congestion?
Outflow of blood is obstructed
85
High PCWP indicates what?
Left ventricular failure (an approximation of left ventricular EDV, normal being 10mmHg)
86
High hydrostatic pressure indicates which conditions (3)
Heart failure, Hypertension, & Embolism
87
Low osmotic pressure indicates which of the following conditions? (2)
Liver failure/cirrhosis & kidney failure
88
High vascular permeability (inflammation) is indicative of what conditions? (5)
SLE, TB infection, Rheumatoid arthritis, & Hep B/C
89
Myxedema (non pitting) is due to an increase in what contents? And which conditions can it be present in?
ECM contents i.e glycosaminoglycans & hyaluronic acid) Present in Hypothyroidism, graves disease, & Hashimoto's
90

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