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Immunopathology > Lecture 9 > Flashcards

Lecture 9 Flashcards

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1
Q

Oedema

A

Accumulation of abnormal amounts of fluid in the extravascular and intercellular tissue spaces of the body

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2
Q

What are the major factors regulating fluid movement between vascular and interstitial spaces (capillary exchange)?

A

Blood Hydrostatic Pressure (BHP)

Colloid Osmotic Pressure (COP)

Normally, fluid outflow from the arterial end is balanced by inflow at the venous end, with excess interstitial fluid drained by lymphatics.

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3
Q

How does Blood Hydrostatic Pressure (BHP) influence capillary exchange?

A

Higher BHP pushes fluid out of capillaries into interstitial tissues.

Accumulation of fluid increases interstitial hydrostatic pressure, eventually halting fluid movement out of the capillary.

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4
Q

What role does Colloid Osmotic Pressure (COP) play in capillary exchange?

A

Blood Osmotic Pressure (BOP) increases at the venous end as fluid leaves the arterial end, drawing fluid back into the capillary.

Interstitial Fluid Colloid Osmotic Pressure (IFOP) is usually low and insignificant

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5
Q

Which pressures facilitate fluid movement out of and into the capillary?

A

Out of capillary: Blood Hydrostatic Pressure (BHP) and Interstitial Fluid Osmotic Pressure (IFOP).

Into capillary: Blood Osmotic Pressure (BOP) and Interstitial Fluid Hydrostatic Pressure (IFHP).

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6
Q

What are the pressure changes that contribute to the development of oedema?

A
  • BHP higher than IFHP
  • BOP is lower then IFOP
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7
Q

What are the causes of increased BHP?

A

Impaired venous outflow (congestion) that may develop in
a number of situations:
* Secondary to deep venous thrombosis (DVT)
* Late stage of pregnancy
* Right ventricular failure (RVF)
* Left ventricular failure (LVF)
* Long haul flights

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8
Q

Mechanism of Oedema in DVT

A
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9
Q

Mechanism of Oedema during long haul flights

A
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10
Q

Mechanism of Oedema in Late-Stage Pregnancy

A
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11
Q

Mechanism of Oedema in Right Ventricular Failure (RVF)

A
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12
Q

Mechanism of Oedema in Left Ventricular Failure (LVF)

A
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13
Q

What are some causes of decreased BOP?

A

Excessive loss or reduced synthesis of albumin
- Nephrotic Syndrome
- Chronic Liver damage

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14
Q

Mechanism of Oedema in Nephrotic Syndrome

A
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15
Q

Mechanism of Oedema in Chronic Liver Damage and Malnutrition

A
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16
Q

Causes of Increased tissue/Interstitial Osmotic Pressure

A

A rise in osmotic pressure -> draws water out of the vessel and into the tissues
- Inflammation

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17
Q

What causes impaired lymphatic drainage and lymphoedema?

A

Usually localized.

Often from surgical removal of lymph nodes (e.g., after breast cancer surgery, causing arm swelling).

Can also result from lymphatic obstruction by parasites (e.g., filariasis)

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18
Q

Salt and water retention contribution to oedema

A
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19
Q

Generalised Oedema

A

If there is insufficient albumin in blood -> then blood osmotic pressure will be low
everywhere -> Oedema will be generalised

Can also occur if there is a widespread increase in blood hydrostatic pressure.

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20
Q

Generalised Oedema Disorders**

A
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21
Q

Localised Oedema Disorders***

A
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22
Q

Peripheral Oedema

A

Localised oedema in the lower limbs or other dependent parts of the body

  • When occurring in subcutaneous tissues, the distribution of fluid depends on the cause
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23
Q

Subcutaneous Oedema

A

A build-up of fluid in the subcutaneous tissues, which are the layers of tissue beneath the skin

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24
Q

Pitting Oedema

A

Finger pressure over significantly oedematous tissue displaces the interstitial fluid and leaves a finger-shaped depression

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25
What are the effects of long standing oedema?
Trophic changes can occur -> oedema often becomes non-pitting. Impairment of delivery of nutrients and oxygen and inflammatory cells—skin more vulnerable to injury with slow wound healing. Reactive changes may occur in cells due to oxygendeprivation
26
Pulmonary Oedema
- Excessive collection of fluid in the lungs - Lungs typically 2-3x their normal weight - Causes dyspnoea and a cough with the possibility of death
27
Cerebral Oedema
- Abnormal accumulation of fluid within the brain - May be localised to sites of focal processes (abcess or tumour) or may be generalised (encephalitis or hypertensive crisis)
28
Ascites
Is localised oedema in the abdominal cavity.
28
Hydrothorax
Localised oedema in thoracic cavity
28
Angioneurotic Oedema
Localised oedema occurring as a result of allergy - Can be harmless or fatal
29
What prevents us from losing blood?
Haemostasis
30
What is haemostasis?
Physiological process preventing blood loss from circulation
31
What are the 5 stages of haemostasis
1. Vasoconstriction of the vessel 2. Formation of a platelet plug 3. Coagulation of blood 4. Clot retraction 5. Clot dissolution
32
Fibrinolysis
Breaks down insoluble firbrin to soluble products
33
What is loss of blood known as?
Haemorrhage
34
Types of bleeding
Internal and external
35
External Haemorrhage
- Chronic or recurrent external blood loss to the exterior of the body - Results in loss of iron and subsequent iron deficiency anaemia
36
Internal Haemorrhage
- Blood loss that remains in the body - As the red cells are retained, ireon can be reutilised for haemoglobin synthesis
37
How much blood can adults lose without adverse effects?
20% of blood volume
38
What is more important: the rate of blood loss or volume of blood lost?
rate of loss
39
Hypovolaemia
- Main effect of haemorrhage - Decreased blood volume - May cause = decreased cardiac output -> decreased BP -> brain and heart damage -> death
40
Hypovolaemic Shock
- Rapid removal of up to 20% of blood volume may cause this - Symptoms = fainting, dizziness, fatigue, blurring of vision, tachycardia, cold and clammy skin
41
Bleeding in subcutaneous tissues is:
Often trivial (minor)
42
Pericardial hemorrhage causes:
Fatal Cardiac Tamponade (blood in the pericardial cavity compresses the heart, hence cardiac output falls significantly)
43
Cerebral haemorrhage causes:
Fatal rise in intracranial pressure
43
How does the body atempt to compensate for blood loss?
1. Vasoconstriction (narrow) 2. Aldosterone production 3. Heart rate increases (Tachycardia)
43
Haemorrhage in brainstem is often:
Fatal, due to damage of the cardiovascular and respiratory centres
44
Vasoconstriction compensation for blood loss:
Increases peripheral resistance -> raises BP * can be localised to the site or can be generalised.
44
Tachycardia compensation for blood loss
cardiac output, thus increases oxygen delivery to tissues.
44
Why can we lose blood?
1. Trauma - Damage to blood vessel wall is common cause 2. Problems with platelets - Needed to make platelet plug and facilitate coagulation process
44
Aldosterone production compensation for blood loss?
is released by the adrenal gland -> increased absorption of sodium and water in the kidneys - increases blood volume - increases BP
44
Why can we lose blood: Defects of platelets
1. Decrease in number of platelets (called thrombocytopenia) - Idiopathic - following infection - Drugs - Decreased production of bone marrow 2. Defective functioning of platelets (called thrombasthenia) - Drugs - Bone marrow disease
45
Why can we lose blood: Defects of blood vessel walls
1. Congenital disorders 2. Acquired disorders - Infection - Drugs - Secondary systemic disease - Skin diseases - Simple easy bruising - Senile purpura
46
Why can we lose bloodL Defects in coagulation cascade
1. Congenital disorders - Haemophilias - Other congenital deficiencies 2. Acquired disorders - Vitamin K deficiency - Liver disease - Anticoagulant drugs - Malnutrition
47
Petechia
Very small spot of haemorrhage on skin or mucous membrane
48
Purpura
Area of bleeding into skin or mucous membrane, slightly large than petechiae
49
Haematoma
Large area of haemorrhage (bruise)
50
Ecchymosis
Large, subcutaneous haemotoma or purpura
51
Haemarthrosis
Bleeding into a joint
52
Haemothorax
Bleeding into the thoracic cavity
53
Haemoperitoneum
Bleeding into the peritoneal cavity
54
Haemopericardium
Bleeding into the pericardial cavity
55
Why does blood have different colours?
Extravasated blood excites an inflammatory response in the tissues. As blood haemoglobin is removed from the area of haemorrhage, it is broken down and the nutrients are recycled. The colour changes in the tissue reflect the breakdown of haemoglobin.
56
Colours of blood and what it means
- Bright red = oxygenated haemoglobin - Cherry red = deoxygenated haemoglobin - Orange yellow = bilirubin - Greenish = biliverdin - Brownish = hemosiderin

Immunopathology (16 decks)

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