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fluid balance, hemodyanmic disorders and Shock.
lecture
52
Medical
Professional
04/23/2011

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Cards

Term
60 40 20

15 and 5
Definition
body 60 water 40 icf
20 ecf

15 interstial
5
intravascular
Term
what determines normal fluid homeostasis.

function? pressure?
Definition
Vessel wall integrity and endothelial function
Intravascular pressure
Oncotic pressure
Osmolarity within physiologic compartments
Term
Normal fluid balance isthe net result of balance opposing effects of ________ hydrostatic pressure and ________ colloid _______ and _______ pressure
Definition
vascular
osmotic
oncotic
Term
higher hydrostatic pressure at which end

venous or arterial?
Definition
arterial
Term
edema is
Definition
tissue overhydration due to extravasation of water form itnravscular bed into intersitital space.
Term
body cavities fluid can collect in?
Definition
peritoneal, pleural, pericardial
Term
ascites
Definition
– free fluid in peritoneal cavity
Term
Hydrothorax
Definition
free fluid in pleural cavity
Term
hydropericardium
Definition
free fluid in pericardial cavity
Term
categories of edema (5)
Definition
1. increase hydrostat pressure

2. reduced plasma osmotic pressure/oncotic pressure
3. sodium retention
4. lymph obstruction
5. inflammation increased vascular perm
Term
T/F

clinical manifestation depend not depend on location of ex intersitaitl fluid
Definition
false. does depend
Term
locations of common edema: (3)
Definition
-lower extremity
-pulmonary
-anasarca
Term
anasarca
Definition
generalized edma w/ signicant sub q tissue swelling
Term
pulmonary edema. common symptom
Definition
shortness of breath b/c compormsied gas exchange.
Term
It is usually only one factor that causes an edema to begin T/F
Definition
false, usually combo of facts.
decreased oncotic pressure NAD local increased hydrostatic pressure.
Term
clinical signs of edema depend on both the location as well as the mechanisms causing it. T/F
Definition
T
Term
increase hydrostatic pressure (2)
-impaire venous return
Definition
CHF: heart cant pump well, slower flow, extend time of exposure where exchange happens. more fluid seeps out.

-constrictive pericrditis
-venous obstruction or compression
Term
increase hydrostatic pressure

(arteriolar dilation_
Definition
heat, neurohormonal dysregulation
Term
increase hydrostatic pressure
Definition
heat, neurohormonal dysregulation
Term
causes of reduced osmotic pressure
Definition
1. protein loosing renal disease
2. liver cirrhosis: underproduction of various proteins
3. malnutrition
4. protein loosing gstroenteropathy
Term
sodium retention
Definition
excessive salt intake + renal insufficiency
-increase tubular reabsorption of sodium
-renal hypoperfusion
-increase renin-angiotensin-aldoesteorn secretion
Term
lymph obstruction
Definition
Postsurgical

Inflammatory

Neoplastic

Post-irradiation
Term
inflammatory edema
Definition
Primarily due to increased vascular permeability

Associated with both acute and chronic inflammation
Term
exudate in terms of inflammatory edema
Definition
, which is protein rich
Term
transudate in terms of edema
Definition
with hydrodynamic derangements: low protein.
Term
congestion
Definition
resistance or obstruction to outflow of venous blood
Term
when does congestion occur?
Definition
chronic heart failure (congestive heart failure) or localized obstruction to venous flow such as in venous thrombosis

return to venous system will be decrased
Term
liver congestion
Definition
back up flow around central vein
Congestion and accompanying sinusoidal dilatation are maximum in and around central veins and decrease progressively toward portal triads

This is due to back pressure opposite to the direction of normal blood flow in the hepatic lobule
Term
lung chronic passive venous congestion
Definition
Any chronic lung injury retards the outflow of pulmonary venous blood from the lungs to the left side of the heart (e.g. chronic mitral valve stenosis)

Pooling of blood in the lung capillaries is associated with micro-hemorrhages producing dark brown discoloration

Septal fibrosis causes the lung to become stiff and feel firm
Term
shock =
Definition
cardiovascular collapse
Term
definition of shock
Definition
systemic hypoperfusion and widespread ischemic/hypoxic injury due to disproportion in oxygen supply and demand


DISPROportion of demand and availability
Term
clinical events commonly leading to shock
Definition
-Severe hemorrhage
Severe burns/fluid loss
Severe trauma
Large MI
Massive PE
Sepsis
Term
types of shock (3 common) 2 (less common)
Definition
cardiogenic
hypovolemic
septic

less common:
neurogenic
anaphylactic
Term
cardiogenic
Definition
(pump failure, e.g. myocardial infarction, ventricular rupture, cardiac tamponade). Cant pump enough blood to make high enough pressure.
Term
Hypovolemic
Definition
(loss of blood or plasma volume, e.g. vomiting, diarrhea, burns, severe trauma)LOSS OF VOLUME nomrla tone.
Term
Septic
Definition
loss of normal pressure regulation – circulatory bed becomes “too large” for the volume). Lossof natural tone but normal volume.
Term
neurogenic
Definition
spinal cord injury with loss of vascular tone)
Term
anaphylatic
Definition
(IgE mediated hypersensitivity with systemic vasodilation and increased vascular permeability)
Term
pathogenesis of septic shock
Definition
Spread of initially localized infection (abscess, peritonitis, pneumonia) into the bloodstream
Term
in most instances septic shock is caused by...?
Definition
endotoxin produced by gramnegative bacilli. --> causes vessel dialtion and loss of pressure.
Term
shock leads to. (the 2 H's)
Definition
hypoperfusion and hypoxia.ischemia eventually.
Term
low blood pressure
Definition
decreased urine output
Term
non sterile needles can lead to
Definition
triscupid endocarditis
Term
_____ or _____- form due to an underlying damage to the valvular endocardium (endocarditis)
Definition
vegatations or thrombi.

can be caused typically by bacteria, that gain access to venous circulation.
Term
acute tubular necrosis due to shock.
Definition
Decrease Bp, abnormal flow thru kideny and ischmeiic kideny. Acute tubular necrosis decrease urine output.
Term
brain, cortical laminar necrosis
Definition
More severe, prolonged, and irreversible shock can lead to laminar cortical necrosis

neurons need lots of blood
Term
disseminated intravascular
Definition
thrombohemorrhagic disorder
Term
DIC can be triggered by variety of disease and usually leads to extravascular activation of coagulation system T/F
Definition
F, intravascular activation
Term
primary site cause DIC
Definition
microcirculation is primary site of coagulation leading to multisystem organ dysfunction
Term
secondary result of DIC
Definition
bleeding b/c of deficiency.

the intravascular activation makes platelets become sticcky, form microthrombosis. this leads to deficit later on in caogulation factors.
Term
ischemia
Definition
lack of perfusion to tissue
Term
hypoxia: lack of oxygen to tissue
Definition
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