Pathophysiology: Fluid & Hemodynamic Disorders

Petechiae

Small hemorrhages, each less than 1 mm in diameter, in the skin or mucosae

Hydrostatic edema

The type of edema seen when hypertension increases ultrafiltration, or when a cirrhotic liver causes increased back pressure (blood pressure) in the hepatic portal vein

A. Increased hydrostatic pressure inside the blood vessels, such as might cause hydroperitoneum B. Physical obstruction of interstitial fluid drainage, e.g., worms that colonize the lymphatic vessels C. Increased tissue hydration due to sodium retention, as might be brought on by kidney problems D. Decreased oncotic pressure of the plasma, as might be precipitated by a failing liver (E.) (None. All of the above are common causes of transudation and edema)

Transudate may accumulate as edema for many reasons. Which ONE of the following is not a common cause of such transudation/edema?

False

True or False: About one-half as many people die in the U.S. each year from thrombi (or their complications) as do from cancer.

False: 2/3 of the body's water is intracellular

True or False: The majority of water in the human body is found in the blood plasma.

False

True or False:All emboli are derived from thrombi that have formed somewhere in the body.

False: Thrombi are unique

True or False:Hematomas and blood clots (scabs) are two examples of thrombi.

Active hyperemia

Type of hyperemia occurring after a faux pas; the resulting embarrassment causes facial blushing

Passive hyperemia

Type of hyperemia occurring as deep vein thrombosis leads to edema and congestion of the legs

Passive hyperemia

Type of hyperemia occurring as right-sided heart failure leads to congestive hepatomegaly

Reactive hyperemia

Type of hyperemia occurring when a skier, after spending hours in subzero temperatures, returns to a warm room and his/her ears turn beet red

lymphedema

occurs when lymphatics become blocked, so lymphatic pressures rise and force lymph back out into the interstitial space

hyperemia

refers to increased blood flow to an organ or tissue; it denotes accumulation of blood in the peripheral circulation

Hemorrhage (extravasation)

refers to loss of blood from the cardiovascular system.

Intermittent claudication

refers to pain, spasms, and discomfort in a limb (or organ) which appears at some level of exercise but disappears at rest

Inflammatory edema

A type of edema caused by an increased permeability of capillary walls, usually coupled with hyperemia

Obstructive edema

A type of edema caused by blockage of lymphatic vessels, which impairs fluid return to the CVS

Hypervolemic edema

A type of edema caused by retention of sodium and water, which expands the blood volume, raising blood pressure an d promoting hydrostatic edema

A. Heart B. Brain (C). Liver D. Lung E. Thyroid (hypofibrinogenemia)

Oncotic edema caused by reduction of the colloid osmotic pressure of the plasma is a typical feature of chronic failure of the:

Melena

Passage of stool containing dark, tar-like streaks of discolored blood; due to bleeding from the upper GI tract (stomach, duodenum)

Purpurae

Medium sized hemorrhages, 1 - 10 mm in diameter, in the skin or mucosae

A. Rectal ulcer D. Heart failure (B.) Gastric ulcer E. Venous thrombosis C. Skin ulcer

Melena is a typical consequence of:

A. Lungs B. Heart C. Upper extremities (D). Lower extremities E. Kidney F. Bowels G. Liver

Most venous emboli that of clinical significance originate in the veins of the:

Oncotic edema

A type of edema caused by a decreased concentration of plasma proteins, which therefore exert lower osmotic pressure in the plasma

Hydrostatic edema

A type of edema caused by an increase in blood pressure, which forces more fluid out of the capillaries

A. On the mitral valve B. On the tricuspid valve (C.) Somewhere in the pulmonary circulation D. Somewhere in the aorta or its tributaries E. In the tissue capillaries in the right leg F. Somewhere along the inferior vena cava

A 45-year old man is on a trans-Pacific plane flight; he sits in his seat the entire time, essentially motionless. Within two days, he has developed a thrombus in his right popliteal vein, which has embolized. Where is the most likely place for the embolus to lodge?

Hyperemia

A general term referring to excessive blood in an organ

Hematoma

A large mass of pre-existing blood which fills a pre-existing cavity

Thromboembolism formation

A piece of the thrombus may break off, traveling freely downstream until it lodges somewhere else in the CVS

Organization

After stimulating the ingrowth of inflammatory cells and vessels, the thrombus is ultimately reabsorbed and replaced with firm, collagenous tissue

A. Anasarca B. Ascites C. Hydrothorax (D). Hematopericardium E. Periorbital swelling F. (None. All of the above are examples of edema)

All of the following are examples of edema except:

Hemoptysis

Bleeding from the respiratory tract with blood in the sputum

Hemopericardium

Bleeding into the pericardium

Hemoperitoneum

Bleeding into the peritoneum

Hemothorax

Bleeding into the pleural cavity

Hematuria

Blood in the urine

Hematochezia

Bright red blood in the stools; due to bleeding from the lower GI tract

Passive hyperemia

Hyperemia resulting from an impediment to the exit of blood through normal venous pathways, i.e., engorgement of an organ with venous blood

Reactive hyperemia

Hyperemia resulting from an increased supply of arterial blood following a period of blood flow interruption

Active hyperemia

Hyperemia resulting from an increased supply of blood from the arterial system

Passive hyperemia

Hyperemia sometimes referred to as congestion

Ecchymoses

Large, botchy bruises (hemorrhages), over 10 mm in diameter, in the skin or mucosae

Increased hydrostatic pressure: Ascites from cirrhosis; edema from heart failure

List the four common mechanisms that cause in edema, and then give an edematous condition or disease that results from that mechanism. 1=

Decreased oncotic pressure: proteinuria

List the four common mechanisms that cause in edema, and then give an edematous condition or disease that results from that mechanism. 2=

Increased vascular permeability: Inflammation

List the four common mechanisms that cause in edema, and then give an edematous condition or disease that results from that mechanism. 3=

Lymphatic obstruction: Elephantiasis

List the four common mechanisms that cause in edema, and then give an edematous condition or disease that results from that mechanism. 4=

A. Right-sided heart failure (B). Left-sided heart failure C. Pulmonary saddle embolus D. Pulmonary fibrosis

Pulmonary edema is a typical consequence of:

Lung

The [brain / heart / lung / liver / kidney] is the organ where venous emboli are most likely to lodge.

A. Collagen B. Elastic fibers (C). Fibrin D. Fibrinogen E. Keratin F. Plasmin

The proteinaceous meshwork that holds a thrombus together is composed of:

Lysis

The thrombus may be broken up or dissolved by the potent antithrombic (thrombolytic) agents in the blood; most common fate for small thrombi

Propagation

The thrombus may grow in size, getting larger

Hypervolemic edema

The type of edema resulting from a kidney tumor hyper-secreting renin and therefore disrupting the normal renin-angiotensin-aldosterone axis

Inflammatory edema

The type of edema seen as the body reacts locally (NOT anaphylaxis) to a bee-sting or mosquito bite

Oncotic edema

The type of edema seen when a failing liver can no longer make adequate plasma proteins, or when kidney disease results in severe proteinuria

Oncotic edema

The type of edema seen when a weeping burn causes the loss of a large amount of plasma protein

Obstructive edema

The type of edema seen when filarial worms colonize the lymphatic vessels, causing elephantiasis

Metrorrhagia

Uterovaginal bleeding unrelated to menstruation

Hematemesis

Vomiting of blood

(A). At the junction of the brachiocephalic and internal jugular veins B. In the spleen C. In the liver D. The lymphatic vessels empty directly into the inferior vena cava E. In the aorta F. Via the coronary sinus in the right atrium

Where does the lymphatic system return excess fluid to the cardiovascular system?

A. In a nascent thrombus, the growing fibrin meshwork not only entraps blood cells but also anchors the thrombus to the underlying epithelial cells or vessel wall B. Typically thrombi form as an endothelial defect of some sort is covered over by fibrin and platelets C. Typically thrombi are composed of layers of fibrin and entrapped blood cells (D.) Typically thrombi are also infiltrated with cholesterol and collagen E. (None. All of the above are true regarding thrombi)

Which ONE of the following is NOT TRUE regarding thrombi?

(A). Changes in blood chemistry predisposing to lymphoma B. Occlusion of the lumen of a blood vessel, resulting in ischemia and infarction C. Thromboemboli, which may cause infarcts D. Narrowing of the lumen of blood vessels, causing downstream hypoxia E. (None. All of the above are common complications of thrombosis)

Which ONE of the following is NOT a common complication of thrombosis?

A. Blood stasis—blood that pools, stagnates, or otherwise moves slowly through a blood vessel B. Endothelial damage—caused typically by atherosclerosis or some other agent C. Hypercoagulability—blood that clots more easily/quickly than normal (D.) Hypercholesterolemia and hypernatremia—elevated blood levels of cholesterol or sodium E. (None. All of the above are predisposing factors for thrombosis)

Which ONE of the following is NOT a direct predisposing factor for thrombosis?

A. Capillary hydrostatic pressure pushes fluid out of the capillary and into interstitial areas (B). Oncotic pressure in the capillaries pushes fluid out into the interstitial areas(draws fluid in not out) C. Capillary hydrostatic pressure is capillary blood pressure D. Osmotic pressure is a synonym for oncotic pressure E. Typically, the lymphatic system returns several liters of fluid per day to the vascular system F. Areas with higher oncotic pressures draw fluids into or toward themselves G. Capillary hydrostatic pressures (in typical tissues) vary from about 36 mm Hg on the arterial side to about 17 mm Hg on the venous side of the capillary bed (H). Osmotic pressure of the interstitial fluid is approximately 26 mm Hg(capillary pressure not interstitial) I. Normally, more fluid is ultrafiltered on the arterial side of a capillary bed than is reabsorbed on the venous side

Which of the following is NOT TRUE regarding fluid partitioning and the forces that drive it? (See comment in Answers)

A. 500 mL B. 1000 mL (C.) 1500 mL D. 2000 mL E. 2500 mL F. 3000 mL

Which of the following is the smallest amount of blood loss that would still prove fatal for most people?

(A.) Ecchymoses>Purpurae >Petechiae B. Ecchymoses>Petechiae>Purpurae C. Petechiae >Purpurae>Ecchymoses D. Petechiae>Ecchymoses >Purpurae E. Purpurae>Ecchymoses>Petechiae F. Purpurae>Petechiae>Ecchymoses

Which of the following lists the hemorrhages in order from largest to smallest?

A. Brain (B). Lungs C. Liver D. Heart E. Kidney F. Bowels

Which of the following organs is most affected by venous embolism?

Thrombo-emboli

[ Liquid/ Solid particle/ Air/ Thrombo-] emboli are by far the most common emboli seen in the clinical setting.

Venous

[Venous/ Arterial/ Air ] emboli tend to lodge in the lungs and cause pulmonary infarcts.

Hyperemia

causes the reddened cheeks in a person who is blushing.

pulmonary

edema refers to fluid accumulation in the alveoli of the lungs

periorbital

edema refers to fluid accumulation in the tissues surrounding the eyes and eye sockets

Saddle

embolus is a massive thromboembolus that occludes the pulmonary trunk or one of its major branches; typically this proves rapidly fatal

Septic

embolus travels freely in the blood and is impregnated with bacteria

Embolism

is a freely movable, intravascular mass that is carried from one anatomic site to another by the blood

A thrombus

is an aggregate of coagulated blood containing platelets, fibrin, and entrapped cellular elements, which adheres to endothelial cells in an intact (and living) blood vessel.

Bulk flow

is the most important process involving fluid exchanges between the plasma and interstitial fluids.

Transudation

may result in pitting edema

anasarca

refers to a generalized edema of the body.

Exudate

refers to a plasma-derived fluid that contains high levels of proteins and many blood cells (leukocytes and platelets); this fluid is typical of inflammation.

Transudate

refers to a plasma-derived fluid that contains moderate levels of protein and few blood cells; this fluid is typical of many types of edema.

Edema

refers to an excess of fluid in the interstitial spaces or body cavities, i.e., a fluid imbalance favoring ultrafiltration over reabsorption.

hydropericardium

refers to fluid accumulation in the pericardium.

Ascites or hydroperitoneum

refers to fluid accumulation in the peritoneum.

hydrothorax

refers to fluid accumulation in the pleural cavity.

Nutmeg liver, or congestive hepatomegaly

refers to the mottled appearance of the liver when afflicted with passive hyperemia.

thoracic duct

returns lymph draining from the legs and most of the abdominal cavity to the cardiovascular system.

Microvascular

thrombi are found in the arterioles, capillaries, and venues of the microcirculation; they are typical of DIC

Intramural or mural

thrombi are found in the wall of the heart chambers (attached to the endocardium); they commonly overlie myocardial infarcts