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MPharm 2 - PH2113 COPY > Unit 4 - Oedema > Flashcards

Unit 4 - Oedema Flashcards

1
Q

What is oedema?

A

Build up of excess fluid in extracellular spaces (interstitial spaces)

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2
Q

Give examples of types of oedema

A 
Cardiac
Hepatic
Nephrotic
Nutritional
Hormonal
Postural
Angioneurotic
Localised
Altitude
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3
Q

What are the two components of cardiac oedema?

A
  • backward failure theory

- forward failure theory

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4
Q

What is backward failure theory in cardiac oedema?

A

One of the ventricles fails to pump out all of its blood that comes into it.
Thus, ventricular filling pressure and systemic or pulmonary oedema increase

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5
Q

What is forward failure theory in cardiac oedema?

A

The heart is not pumping out enough blood to satisfy the needs of the cells of the body

  • excess fluid retention
  • oedema increase
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6
Q

What are the effects of backward failure in cardiac oedema?

A

Swelling of peripheral tissues
- often legs/ankles
- venous pressure is greatest
Skin becomes puffy

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7
Q

How does backward failure take place?

A
  • right side of heart fails and unable to clear returning blood
  • increase venous pressure
  • increase transudation of fluid into interstitial spaces
  • decrease in plasma volume
  • renin-angiotensin cascade activated
  • renal retention of Na+ and water
  • trying to replace plasma volume
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8
Q

How does forward failure take place?

A
  • left side of heart fails
  • decreases cardiac output
  • less perfusion of tissues
  • reduced renal blood flow decreases GFR
  • increase aldosterone release leads to Na+ and water reabsorption
  • increased plasma volume and capillary release
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9
Q

What are the effects of forward failure in cardiac oedema?

A
  • back pressure in the pulmonary artery
  • causes pulmonary oedema
  • reduction in respiratory function
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10
Q

What is hepatic oedema caused by?

A

Cirrhosis of the liver

  • chronic alcohol abuse
  • chronic viral hepatitis
  • hepatitis B
  • hepatitis C
  • fat accumulation in the liver
  • non-alcoholic liver disease
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11
Q

Why is the metabolism of aldosterone impaired in hepatic oedema?

A

Aldosterone is metabolised in the liver

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12
Q

What are the effects of hepatic oedema?

A
  • metabolism of aldosterone is impaired
  • increased Na+ retention
  • cirrhosis/portal obstruction increases hepatic portal vein pressure
  • causes excess fluid in peritoneum
  • ascites
  • increased intra-abdominal pressure
  • increased venous pressure in lower limbs
  • peripheral oedema
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13
Q

What is nephrotic syndrome?

A

Glomeruli within the kidney become ‘leaky’ and large amounts of protein leak from the blood into the urine

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14
Q

What is nephrotic syndrome characterised by?

A
  • albuminuria
  • hypoalbuminia
  • oedema
  • hyperlipidemia
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15
Q

What are the causes of nephrotic syndrome?

A 
Focal segmental glomerulosclerosis (FSGS)
- scar tissue in glomerulus
Membrane nephropathy
- immune system attacks kidney
Systemic disease
- diabetes
- lupus
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16
Q

What causes nephrotic syndrome?

A 
Loss of albumin
Increases oncotic pressure
less water into capillaries
Less water back into blood stream
- reduced oncotic pressure driving it
More water retained in interstitial space
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17
Q

What is albumin ?

A

Albumin is a protein made by your liver. Albumin helps keep fluid in your bloodstream so it doesn’t leak into other tissues.

18
Q

What is oncotic pressure or colloid osmotic pressure?

A

Osmotic pressure exerted by proteins and particularly albumin in plasma

19
Q

What effect does oncotic pressure have?

A

Pulls water into the circulatory system

20
Q

What effect does oncotic pressure have in nephrotic syndrome?

A 
Colloid OP reduces
- proteins lost to urine
Less water pulled into circulatory system
- plasma volume decreases
Aldosterone released
- Na+ and water retention
21
Q

How is nephrotic syndrome treated?

A

Protein rich diet to build up protein in blood
Lipid lowering drugs
Corticosteroid drugs

22
Q

What causes nutritional oedema?

A

Lack of protein in the diet

  • lowers colloid oncotic pressure
  • discourages water osmosis into plasma
  • reduced plasma volume leads to aldosterone release
  • results in oedema
23
Q

What is the treatment for nutritional oedema?

A

Protein rich diet

24
Q

When does hormonal oedema occur?

A

Pregnancy

Menstrual cycle

25
Q

What causes hormonal oedema?

A

Progesterone secretion
- ovaries
- placenta
Global gain of 500 - 900 mM of NaCl distributed between maternal and foetal circulations

26
Q

What is the effect of progesterone in hormonal oedema?

A

Multiple actions but antagonises aldosterone by binding to its receptor

27
Q

Why do new generation of oral contraceptives cause less hormonal oedema?

A

Oral contraceptives contain synthetic progesterone which can lead to oedema
- newer generation contain lower doses of progesterone

28
Q

What is the treatment for hormonal oedema?

A

Diuretics in severe cases

29
Q

What are the disadvantages of using diuretics in pregnancy?

A

Risk to foetus

30
Q

When might postural oedema be experienced?

A

During pregnancy

31
Q

What causes postural oedema?

A

Physical expansion of the tissue in abdomen causes

  • restricted venous from lower body
  • increased venous pressure and transudation
32
Q

What is angiotic oedema (angioedema)?

A

Syndrome of swelling of the lower layer of skin and tissue just under the skin or mucous membranes

  • face
  • tongue
  • larynx
  • abdomen or
  • arms and legs
33
Q

What causes angiotic oedema?

A

Allergic type reaction

- complicated immune chemical pathways

34
Q

What other symptoms are associated with angiotic oedema?

A
  • urticaria
  • nausea
  • vomiting
  • intermittent abdominal pain
  • shortness of breath
35
Q

What is the mechanism that causes angiotic oedema?

A
  • histamine (quicker)

- bradykinin

36
Q

What is the cause of localised oedema?

A
  • bites
  • stings
  • burns
  • scratches
37
Q

What is localised oedema?

A

Caused by an increased capillary permeability to plasma proteins and fluids due to an impaired barrier

38
Q

What is altitude oedema also known as?

A

Altitude sickness

39
Q

At what altitude does acute mountain sickness occur?

A

Above 2400 metres

40
Q

What does altitude oedema cause?

A
  • high altitude pulmonary oedema (HAPO)

- high altitude cerebral oedema (HACO)

41
Q

How does high altitude cause oedema?

A
  • hypoxia causes heart to pump more blood to lungs
  • causes pulmonary pooling to get more oxygen from rarified air
  • fluid leaks into extracellular spaces in lungs
  • FATAL
  • increase in extracellular fluid that can pass through the endothelium of Blood Brain Barrier either by increased pressure or by inflammation that makes the endothelium vulnerable to leaking

MPharm 2 - PH2113 COPY (39 decks)

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