Fluid and Hemodynamics

Water

A very vital substance in every living thing. Most abundant substance in the body.

Water

A very good solvent media for all nourishment substances, minerals within and outside of the cell.

Body Water

60% of the lean body weight.

Normal Fluid Homeostasis

The fluids are maintained in a normal hemostatic equilibrial state, called?

Cloudy Swelling

Accumulation of fluid in the intracellular space.

Edema

Accumulation of fluid in the interstitial space.

Normal Fluid Homeostasis

Requires dynamic movements and exchanges of fluid from one compartment to another (from intravascular to extravascular space) in a steady state and equilibrium.

Capillary Level

Exchange of fluid occurs in the microcirculation (_________ _____).

Arterial - Venular

Fluid is released at the _______ end into the interstitial space and reabsorbed back at the _______ end into the intravascular space.

Interstitial - Intravascular

Fluid is released at the arterial end into the ____________ space and reabsorbed back at the venular end into the ____________ space.

Lymphatic

Any leak/fluid remaining in the interstitial space is returned into the circulation by the _________ system to avoid accumulation.

Normal Homeostasis

Whatever is lost is reabsorbed back; therefore, there is no loss or gain in ______ ___________.

Endothelial/Vessel Wall Integrity

The normal blood vessel is fenestrated or interrupted with junctional gaps between cells to permit water escape.

Endothelial Wall

When the __________ ____ is disrupted, there is a great volume of water getting out of the blood vessel hence edema can follow.

Edema

When the endothelial wall is disrupted, there is a great volume of water getting out of the blood vessel hence _____ can follow.

Intravascular Pressure

Function of hydrostatic pressure.

Intravascular Pressure

The major pressure that allows the exit of water from intravascular to interstitial at arterial end.

Plasma Osmolarity (Oncotic Pressure)

Function of serum albumin.

Plasma Osmolarity (Oncotic Pressure)

The pressure that tends to draw fluid back intravascularly at venular end.

Pathologic - Dehydration

If there is excessive accumulation in the interstitium, then it becomes __________. If excessive loss, then there is ___________.

Hydrostatic Pressure - Oncotic/Osmotic Pressure

2 types of force that drive the normal fluid exchange.

Hydrostatic Pressure

Function of the arteriolar pressure at arterial end. Promotes outflow of water from intravascular to extravascular space.

Hydrostatic Pressure

(Pressure) Affected by: cardiac output, vessel wall elasticity, vascular tone, and blood volume.

Oncotic/Osmotic Pressure

(Pressure) Function of serum albumin. Maintained by protein level of blood.

Oncotic/Osmotic Pressure

The most important force that promotes reabsorption of water from the interstitium back to the intravascular space.

Arteriolar

At the __________ end: Hydrostatic pressure > Plasma oncotic pressure.

Venular

At the _______ end: Plasma oncotic pressure > Hydrostatic pressure.

Edema

Increased accumulation of fluid in the interstitium and body cavities. A pathologic process.

Increased - Diminished

Edema can be due to: _________ hydrostatic pressure or __________ colloid osmotic pressure.

Peri-orbital

Edema usually starts in the ___________ area (i.e. those with very loose or soft connective tissue) and in the dependent portion of the body.

Peri-orbital Swelling

This swelling is an important early sign of generalized edema.

Localized Edema

(Type) Situated in a particular area of the body. May be a transudate or an exudates.

Localized Edema

An obstruction of venous return in an extremity or blockade of a regional group of lymph nodes or lymphatics.

Localized Edema

(Type) Examples are hypopericardium, hypoperitoneum (ascites), subepidermal bullae.

Generalized Edema

(Type) Otherwise known as “Anasarca”. Edema located all over the body (from head to toe).

Generalized Edema

Represents an underlying non-localized metabolic process or a more serious cardiogenic problem.

Hydrops Fetalis

(Generalized Edema) In fetus - _______ _______: wet-looking and shiny due to accumulation of water.

Generalized Edema

Can also be seen in congestive heart failure, nephrotic syndrome, malnutrition.

Congestive Heart Failure

Alteration in hydrostatic pressure.

Increased Hydrostatic Pressure

Alteration in hydrostatic pressure.

Reduced Plasma Osmotic Pressure

Serum albumin is low. Seen in malnutrition, nephritic syndrome etc.

Lymphatic Obstruction

Removes the reabsorbing capacity of the lymphatic channel thus reducing drainage. By scarring and surgical removal of lymph.

Increase

Sodium and water retention results in hypervolemia —> ________ in hydrostatic pressure.

Generalized Edema

Significant reduction of the capacity of the blood vessel in the venular end to reabsorb fluid.

Decrease

Occurs when albumin, the major plasma protein, is not synthesized in inadequate amounts or is lost from the circulation -> generalized _______ in osmotic pressure.

Liver Cirrhosis

Liver is chronically damaged that decreases the synthesis of albumin. The normal parenchymal cells are replaced by fibrous scarred tissue.

Malnutrition (Kwashiorkor)

Can result to hypoalbuminemia and reduction in colloid osmotic pressure.

Secondary Hypoalbuminemia

Protein losing enteropathy (via GIT) → Small intestines are inflamed, protein absorptive capacity is diminished leading to?

Inflammation

Exudates due to the increase in vascular permeability as a result of increased interendothelial spaces. Usually localized.

Dependent Edema

This edema ends to gravitate in the dependent portions of the body (i.e., lower extremities).

Pitting Edema

(Edema) Applying a finger pressure on the edematous subcutaneous tissue leaves a depression behind due to loss of recoil.

Left Ventricular Failure

Most common cause of pulmonary edema.

Orthopnea

Fluid typically rests on the base of the lungs when the patient is upright.

Herniation

(Cerebal Edema) __________ to the foramen magnum can occur with increased intracranial pressure.

Pulmonary Edema

Left ventricular failure (eg, caused by a myocardial infarct) causes pump failure, and secondarily there is impaired flow of blood from the lung to the left atrium.

Transudate - Exudate

The fluid in pulmonary edema is a __________. Edema in inflammation is an _______.

Hyperemia

An active process. Increased blood flow to capillaries resulting from arteriolar dilatation.

Hyperemia

Affected tissues are redder than normal due to engorgement of vessels with oxygenated blood. It is always acute and transient.

None

Is there a chronic hyperemia?

Congestion

A passive process (passive hyperemia). Results from impaired outflow of venous blood from a tissue.

Congested

_________ tissues have an abnormal blue-red color (cyanosis) that stems from the accumulation of deoxygenated hemoglobin in the affected area.

Edema

As a result of the increased volumes and pressures, congestion commonly leads to?

Acute Congestion

Part of acute processes produced by vasoactive amines and other chemical mediators which can cause vasodilation.

Chronic Congestion

Long standing, unrelenting, persistent congestion.

Yes

Can congestion occur without edema?

Chronic Pulmonary Congestion

Involves long periods of time causing chronic hypoxia. Can lead to parenchymal cell degeneration or death.

Congestive Heart Failure

Chronic pulmonary congestion is most commonly seen in which condition?

Pulmonary Hypertension

Long standing complication of chronic pulmonary congestion.

Hepatic Fibrosis

Long-standing complication of chronic passive hepatic congestion.

Right-sided Heart Failure

What is the most common cause of chronic passive congestion of the liver?

Petechiae

1-2 mm in diameter. Hemorrhages in skin, mucous membrane or serosal surface. “Pin head” likeness.

Purpura

Slightly larger (3 to 5 mm) hemorrhages. Can result from the same disorders that cause petechiae.

Ecchymosis

1-2 cm subcutaneous hematomas (bruises). Extravasated red cells are phagocytosed and degraded by macrophages.

Trauma & Laceration

Majority of the cases of hemorrhage.

Atherosclerosis

Endothelial linings are damaged and there is fat deposition.

Hematoma

Large pools of blood. Accumulation of blood within tissue and body.