FLuid and Edema

In sepsis , what are 4 ways the secreted TNF-a mediates septic shock

1) directs cytotoxicity 2) enhancing the adherence of PMN leukocytes; 3) stimulation of the release of interleukin I (IL-1), a cytokine that injures endothelial cells 4) promotes the expression of procoagulant tissue factor, thereby leading to thrombosis and local ischemia.

what are the 4 stages of shock

1)Early or compensated shock 2)Impaired tissue perfusion (leading to decompensation): 3)Decompensated but reversible shock 4)Irreversible shock

total body water is what percent of our body weight

50-60% of body weight

what four important factors contribute to the pathogenesis of edema

=> increased Venous pressure => increased Vessel wall permeability => decreased Oncotic pressure of plasma because of low albumin concentration => Obstruction of lymphatics

What 3 potential causes of thrombosis does Virchow's triad consists of

Blood coagulability vessel wall changes stasis

what neoplasia causes DIC

Carcinoma of pancreas, prostate, lung, and stomach Acute promyelocytic leukemia

how does right side heart failure cause edema

Congestion in liver, spleen, and lower limbs . Causes ascites to occur and edema in legs.

what is a consequence of thrombus formation in the heart walls and valves

Consequence of thrombus formation is that some can break away and travel (called embolism).

what is edema

Excess fluid in the interstitial spaces or body cavities.

what is the primary pathogenesis of shock

acute respiratory distress syndrome

what the 7 sites of infarction

brain retina heart spleen kidney small intestine lower leg

what are the 4 sources of arterial emboli that are outside the heart

carotid artery aortic artheroslcerosis aortic aneurysm iliac artery aneurysm

how does a catheter become a source for venous emboli

changes atmosphere in veins allows for emboli to form around cath

describe the irreversible stage of shock

circulatory collapse, marked hypofusion of vital organs, loss of vital functions.

what is Disseminated Intravascular Coagulation (DIC)

condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets and clotting factors needed to control bleeding, which leads to excessive bleeding.

What is anasarca?

generalized edema

what bacteria usually causes endotoxic shock

gram -negative bacteria

what 5 infectious agents can cause DIC

gram negative sepsis meningococcemia Rocky Mountain spotted fever histoplasmosis aspergillosis malaria

where is the major place for thrombus formation

heart walls and valves

what 3 things can cause hypoperfusion of tissues

hemorrhage heart failure anaphylaxis

what are heart failure cells

hemosiderin + macrophages

what is the mechanism for oncotic edema

hypoproteinemia increased protein loss

In Virchow's triad , stasis refers to

immobility (more possibility of thrombus getting larger)

In Virchow's triad , blood coagulability refers to

increase in clotting factor

what are the 3 types of local edema

inflammatory obstructive allergic

what are ecchymoses

large hemorrhage (> 1 cm), subcutaneous hematomas

what are the 4 sources of arterial emboli that are within the heart

left atrium mitral valve aortic valve left ventricle

how are hemosiderins produced

left side heart failure causes lung congestion (passive hyperemia) ⬇️ leads to lung tissue changes ⬇️ RBC come out of circulation, breaks apart ⬇️ hemosiderin is released ⬇️ hemosiderin gets picked up by macrophage making a heart failure cell

what is the mechanism for allergic edema

local release of vasoactive substance ( histamine)

In Virchow's triad , changes in vessel wall refers to

loss of natural anti-thrombotic mechanism

what is the mechanism for obstructive edema

lymphatic obstruction venous obstruction

what is purpura? pupuras share pathologies with what else?

medium Hemorrhages (1 mm - 1 cm), similar pathologies as petechiae and trauma

in the hemostasis -coagulative cascade, what inhibits platelet activation and aggregation

prostacyclin is secreted by healthy vessels to inhibit platelet activation/ aggregation

what is the pathogenesis of a thrombus formation

prothrombin => thrombin ⬇️ fibrinogen => fibrin ⬇️ fibrin cover damaged endothelium ⬇️ endothelium activates factor 8 and clot formation occurs

how does general heart failure produce edema

reduced general circulation ⬇️ poor circulation to kidney ⬇️ lower using production ⬇️ activated renin/angiotensisn ⬇️ fluid retention

describe the decompensated but reversible shock stage of shock

reflex peripheral vasoconstriction fails progressive hypotension loss of consciousness

In sepsis caused by gram-negative bacterial, the lysis of the organisms releases what ?

releases endotoxin [LPS] into the circulation where it binds to LPS-binding protein (LBP).

what is the mechanism for hypervolemic edema? what is the cause of this edema?

retention of Na+ and H2O cause: too much aldosterone or kidney disease leading to too much renin released which causes sodium retention

What is petechiae? where are they found?

small hemorrhage (< 1 mm) on the skin, found on mucous membranes, serosal surfaces

as a result of infarction , where specifically is a classic sight for venous block

smooth muscle of intestine

what is shock a result of

systemic hypoperfusion of tissues with blood

formation of a thrombus is due to a defect in where

the endothelium

how do starling forces in the capillaries maintain the prevention of edema

there is pressure at the arterial end of a capillary for fluid to come out of the capillary ⬇️ at venous end , pressure by osmotic force due to proteins for fluid to enter the capillary ⬇️ net pressure will move fluidout into the intersticial fluid at the arterial end and on the venous end ⬇️ net fluid movement into venous end

when endothelial cells are injured what factor do they release and what does this factor do

they release Von Willebrand factor what it does: activates factor VIII and platelet adhesion to collagen

what is deep vein thrombosis

thrombus forms in large leg vein and some breaks off and can lodge in lung.

what is the function of thromboxane? what drug targets thromboxane?

vasoconstriction, promotes platelet aggregation drug: aspirin

what is the mechanism of inflammatory edema

vessel permeability + hyperemia

during drowning or heart failure , what is a typical place in the brain that is affected early due to hypo perfusion

watershed arteries. layers of the cortex start dying.

can liver disease and acute intravascular hemolysis cause DIC

yes

can shock cause DIC

yes

can snakebite cause DIC

yes

can tissue injury cause DIC

yes

What are transudates?

Non-inflammatory, protein poor, ultrafiltrate of plasma

can heat stroke , vasculitis , and aortic aneurysm cause DIC

YES

What is ascites? diseases in which organs can cause ascites

High swelling of the abdominal area is called ascites Ascites can be caused my liver, kidney, or heart disease

what is exudate? from where do they arise

Inflammatory, protein rich, where they arise : increased permeability of blood vessels

describe the impaired tissue perfusion stage of shock

Lactic acidosis cell necrosis, most apparent in the kidney, also shock lung (Adult respiratory distress syndrome -ARDS), liver, intestine leading to decompensation

what is a saddle embolism? what can it lead to ?

Large pulmonary embolism that straddles the bifurcation of the pulmonary trunk, lead to : shortness of breath , pain ,sudden death

how does left side heart failure cause edema

Left ventricle not working leads to pulmonary congestion( fluid backs up into the lungs) => Creates edema and a pleural effusion in lungs.

what 4 obstetric complications causes DIC

Septic abortion Retained dead fetus Toxemia Amniotic fluid embolism

what causes early or compensated shock stage? what are its associated symptoms

Stage 1: Compensatory mechanisms activated by decreased cardiac output: reflex sympathetic stimulation causing tachycardia (rapid thready pulse), vasoconstriction of peripheral arterioles (skin pale, cold and clammy) as blood pressure is maintained in vital organs), reduced urine output (oliguria, prerenal uremia)

in sepsis , The LPS-LBP complex binds to what ? what does this binding lead to

The LPS-LBP complex binds to CD14 on surfaces of monocytes/macrophages leads to : stimulated to secrete tumor necrosis factor a (TNF-a).

how does cirrhosis cause ascites

non-functioning liver can't produce albumin ⬇️ this makes osmotic pressure low. ⬇️ HTN in portal vein ⬇️ causes fluid to leak out into space between perinea.

what are the two types of generalized edema

oncotic hypervolemic