Hemodynamic Disorders I - Edema, Hyperemia, & Congestion

Reduced Plasame osmotic proteins seen in what sort of ppl?

Alcoholics and ppl not eating proteins+ renal failure.

Congestion and Edema

As a results of increased volumes and pressures, congestion commonly leads to edema. vascular congestion-->increased volume + pressure--> Edema. ** congestion is a passive process results in cyanosis. RBC stasis and accumulation of deoxy Hb. ** congestion results from reduced outflow of blood from tissue (venous).

Nephrotic Syndrome and Liver Disease MOA

Both have a decreased plasma osmotic pressure which leads to net movement of fluid into interstitial tissues. This reduced intravascular volumes leads to decreased renal perfusion activates RAAS but the resulting salt and water retention can't correct the plasma volume deficit b/c the primary defect is of low serum protein level.

What organs does Edema normally involve explain in all 3 organs what the most likely cause is

DVT caused by increased hydro. pressure. see in big veins (pop, femoral, etc). Pulmonary Edema: results of LHF Cerebral Edema: Inappropriate ADH

Causes of Edema: Regional increase in hydrostatic pressure In what veins will you see DVT? *** remember DVT is NOT Varicose veins

Deep venous thrombosis The big veins: Illic Popliteal Femoral

Hydrothorax define Examples:

Edematous fluid collection in thorax Examples: congestive heart failure, impaired venous return, stenosis, or mass pressing on major vessel

What causes will you see transudate What cases will you see exudate

Exudate protein >3 seen in inflammation ex: Pnemonia *** inflamation occurs when there is bacterial infections etc. Transudate: protein <3 Left Sided heart failure--> pulmonary congestion Right Heart Failure Protein deficiencies (kwashikoir,nephrotic syndrome, alcholism)

Chronic Passive Congestion

Hemosiderin Laden Macrophage bc eat iron of lysed RBC.

Concept Question

Identify the morphologic features and causes of congestion vs hyperemia.

Describe Chronic Pulmonary Congestion what will you see in choronic that you will not see in actue? If you preform a thoracentesis what fluid will you collect

In chronic you see fibrosis because its trying to repair. Notice that cells filled with fluid because of edema(transudate fluid).

Why are pulmonary Congestion and Edema seen together?

Increase in hydrostatic pressure in pulmonary vasculature.

Kwashiorkow common presentations?

Mother has multiple children all in a short time frame. Child is not being breast feed or stopped breast feeding early. ** If you preform a paracentesis would be transudate (clear liquid fluid). b/c no proteins.

Nephrotic syndrome will you see systemic edema or local edema?

Nephrotic Syndrome: Systemic edema because its a deficiency in protein. Will see protein in urine greater than 3.5 g/dcl so exudate (you would also see hydropericardioum since its nephrotic syndrome and is systemic.)

Bilateral Pitting edema most commonly caused by what

Nephrotic syndrome because remember deficiency in proteins leads to systemic edema.

Edema + Congestion w/0 inflammation leads to what

Please note that edema and congestion WITHOUT INFLAMMATION leads to a transudate (low protein and specific gravity). What conditions can cause a transudate in the lungs? Pulmonary hypertension etc

Describe Chronic Passive Congestion of Liver what heart failure right or left?

Right Heart Failure

Causes of Edema: Increased hydrostatic pressure leads to what? Where is fluid accumulating in LHF Where is fluid accumulating in RHF What is orthopenia?

Right-sided or left sided congestive heart failure LHF- pulmonary veins lungs (thats why patient will have trouble breathing) RHF- Backs up to organs and you see JVP Orthopenia - Can't breathe unless sitting up, LHF affected. Patient needs a lot of pillows.

For Pleural Effusion what test will you do to grab fluid this is an example of Hydrothroax

You will do a thoracentesis should NOT cause pain (remember VAN don't wont to hurt the vein). * fluid in lungs is transudate.

Hydroperitoneum/Ascites seen in what sort of ppl? what test will you do to collect fluid? What fluid would it be?

edematous fluid collection in abdomen Alcoholics Paracentisus The fluid is transudate less then 3mg. **she might change up the name of the test to confuse you so don't fall for that trick.

Hydropericardium examples

edematous fluid collection in pericardium Examples: Inflammation, pericarditis ** This inflammation is local won't be systemic takes place only in the heart area. **** ONLY loss of protein will you see systemic inflammation Seen in Nephrotic syndrome since its systemic inflammation.

Causes of Edema: Reduced plasma osmotic pressure:

net movement of fluid into interstitial space o Reduced albumin synthesis occurs in severe liver disease (Ex. cirrhosis) SEEN IN alcoholics o Loss of albumin: • Ex. Nephrotic syndrome (which can lead to these causes). proteinuria hypoalbuminemia, hyperlipidemia (liver makes more proteins - VDL, LDL), lipiduria (too much lipid in blood causes spilling into urine), anasarca. o Protein malnutrition (Ex. Kwashiorkow) o Protein losing enteropathy (Ex. celiac sprue, Crohns disease, etc.)

Causes of Edema: Chronic Lymphatic Obstruction

o Chronic inflammation with fibrosis Invasive malignant tumors Physical disruption Radiation damage (causes fibrosis and obstruction). certain infectious agents

Pulmonary Edema

o Left ventricular failure o Renal failure o Acute respiratory distress syndrome o Pulmonary inflammation or infection o Fluid collects in alveolar septa around capillaries o Impedes oxygen diffusion o Creates a favorable environment for bacterial infection

Describe Cerebral Edema What causes Cerebral Edema, what else will you see in this syndrome aside from cerebral edema

o Life-threatening o Brain stem vascular supply can be compressed Cerebral edema caused by inappropriate ADH, will also see hyponatremia. Inappropriate ADH you will NOT see peripheral edema.

Subcutaneous tissue edema

o Potential sign of underlying cardiac or renal disease o Impairs wound healing or the clearance of infection

Factors influencing fluid transit across capillary walls

remember this is on a microvasculature scale so we are not looking at carotid or aortic valves person will NOT die.

Anasarca

severe & generalized edema (widespread subcutaneous swelling). Possible causes: kwashiorkor

Chronic Passive Hepatic Congestion:

• Centrilobular regions o Grossly red-brown o Slightly depressed due to cell death o Accentuated against uncongested tan liver (nutmeg liver) o Centrilobular hemorrhage o Hemosiderin-laden macrophages o Regeneration of hepatocytes

Congestion

• Passive process • Results from reduced outflow of blood from a tissue (venous) • Can be systemic (cardiac failure) or local (deep vein thrombosis, DVT) • Manifests as a dusky reddish-blue color (cyanosis) • RBC stasis and accumulation of deoxygenated hemoglobin thats why bluish. ** VEIN is the problem b.c DVT/

List the types of Edema

• Pitting edema • Edema influenced by gravity (points to right sided heart failure) • Edema to renal dysfunction • Pulmonary edema

Hyperremia

•Is an active process in which arterioler dilation (ex @ site of skeletal muscle) leads to increased blood flow in affected tissue which turns red (erythema). Can by physiology or patholologic both stimulated the SNS which causes vasodilation increase in blood flow (arterial side) causes Erythema (redness). ** Histamine causes vasodilation and itching.