[combination] spcon module 1

Enumerate everything under FLUID AND HEMODYNAMIC DERANGEMENTS

● Edema

● Hyperemia and congestion

● Hemorrhage

● Hemostasis and thrombosis

● Embolism

● Infarction

● Shock

What condition is this

● Increase fluid in the interstitial tissue spaces

● Hydrothorax, hydropericardium, hydroperitoneum

● Encountered in subcutaneous tissue (most common), lungs, brain

EDEMA

What condition is this

● Increase fluid in the interstitial tissue spaces

EDEMA

What condition is this

● Hydrothorax, hydropericardium, hydroperitoneum

EDEMA

What condition is this
● Encountered in subcutaneous tissue (most common), lungs, brain

EDEMA

What are the types of Edema?

SUBCUTANEOUS EDEMA

PULMONARY EDEMA

CEREBRAL EDEMA

What type of edema is this?

• Different distributions

• Edema on dependent parts of the body

  • Prominent feature of CHF (particularly RV)

• All parts of the body (equally)

  • Renal dysfunction (nephrotic syndrome)

• Peri-orbital edema

SUBCUTANEOUS EDEMA

What type of edema is this?

• Different distributions

SUBCUTANEOUS EDEMA

What type of Edema is this?

• Edema on dependent parts of the body

  • Prominent feature of CHF (particularly RV)

SUBCUTANEOUS EDEMA

What type of edema is this

• All parts of the body (equally)

  • Renal dysfunction (nephrotic syndrome)

SUBCUTANEOUS EDEMA

What type of edema is this?

• Peri-orbital edema

SUBCUTANEOUS EDEMA

What is the prominent feature of CHF (particularly RV)?

Edema on dependent parts of the body

If there is renal dysfunction, what parts of the body will be affected?

All parts of the body (equally)

What type of edema is this?

○ sets in the left ventricular failure and in renal failure or adult respiratory distress

PULMONARY EDEMA

What type of edema is this?

○ Can be generalized (encephalitis, meningitis)

CEREBRAL EDEMA

What condition is this?

● Indicates local increase of blood volume in a particular tissue

HYPEREMIA and CONGESTION

○ An active process resulting from augmented tissue inflow because of arteriolar dilatation. The affected tissue is redder because of the engorgement with oxygenated blood

HYPEREMIA

○ A passive process resulting from impaired outflow from a tissue. Tissue is blue-red color (cyanosis) due to accumulation of deoxygenated hemoglobin in the affected tissues

CONGESTION

What condition is this?

● Indicates extravasation of blood due to vessel rupture

● From trauma, atherosclerosis, inflammatory, neoplastic erosion of the vessel wall

● May be external or enclosed within a tissue (HEMATOMA)

HEMORRHAGE

What condition is this?

● Indicates extravasation of blood due to vessel rupture

HEMORRHAGE

What condition is this?
● From trauma, atherosclerosis, inflammatory, neoplastic erosion of the vessel wall

HEMORRHAGE

What condition is this?

● May be external or enclosed within a tissue (HEMATOMA)

HEMORRHAGE

● Result of well-regulated process

● 2 important functions

● Maintain blood in a fluid, CLOT-FREE state in normal vessels

● Induce a rapid and localized hemostatic plug at site of vascular injury

HEMOSTASIS

● Result of well-regulated process

HEMOSTASIS

● 2 important functions

HEMOSTASIS

● Maintain blood in a fluid, CLOT-FREE state in normal vessels

HEMOSTASIS

● Induce a rapid and localized hemostatic plug at site of vascular injury

HEMOSTASIS

● Pathologic opposite of hemostasis

● Inappropriate activation of normal hemostatic process such as formation of a blood clot (THROMBUS)

THROMBOSIS

● Pathologic opposite of hemostasis

THROMBOSIS

● Inappropriate activation of normal hemostatic process such as formation of a blood clot (THROMBUS)

THROMBOSIS

What are the 3 components of Thrombosis and Hemostasis?

○ vascular wall

○ Platelets

○ coagulation cascade

What are the 3 PRIMARY INFLUENCES PREDISPOSING TO THROMBUS FORMATION

○ Endothelial injury – dominant influence (circulation)

○ Stasis or turbulence of blood flow – major factor in the development of venous thrombi

○ Blood hypercoagulability – alteration in the coagulation pathway

dominant influence (circulation)

○ Endothelial injury –

major factor in the development of venous thrombi

○ Stasis or turbulence of blood flow –

alteration in the coagulation pathway

○ Blood hypercoagulability –

● Detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from its origin

● 99% represents some parts of the dislodged thrombus

Emboli

● Detached intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant from its origin

Emboli

● 99% represents some parts of the dislodged thrombus

Emboli

What are the types of embolism?

PULMONARY THROMBOEMBOLISM

SYSTEMIC THROMBOEMBOLISM

FAT EMBOLISM

AIR EMBOLISM

A type of embolism

○ Venous emboli originates from deep leg vein above the level of the knee

○ Passes through right side of the heart into the pulmonary vasculature

○ Clinically silent

○ Right heart failure (sudden death) cor pulmonale

PULMONARY THROMBOEMBOLISM

A type of embolism

○ Venous emboli originates from deep leg vein above the level of the knee

PULMONARY THROMBOEMBOLISM

A type of embolism

○ Passes through right side of the heart into the pulmonary vasculature

PULMONARY THROMBOEMBOLISM

A type of embolism

○ Clinically silent

PULMONARY THROMBOEMBOLISM

A type of embolism

○ Emboli travelling within the arterial circulation

○ Major sites of arteriolar embolization: LOWER EXTREMITIES (75%) BRAIN (10%)

SYSTEMIC THROMBOEMBOLISM

A type of embolism

○ Emboli travelling within the arterial circulation

SYSTEMIC THROMBOEMBOLISM

A type of embolism

○ Major sites of arteriolar embolization: LOWER EXTREMITIES (75%) BRAIN (10%)

SYSTEMIC THROMBOEMBOLISM

A type of embolism

○ Fat globules found in circulation after fracture of long bones

○ 90% severe skeletal injuries

FAT EMBOLISM

A type of embolism

○ Fat globules found in circulation after fracture of long bones

FAT EMBOLISM

A type of embolism

○ 90% severe skeletal injuries

FAT EMBOLISM

A type of embolism

○ Gas bubbles within the circulation obstructing the blood flow

AIR EMBOLISM

What condition is this?

● Area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage in a particular tissue. 99% of all of this condition results from thrombotic and embolic event

INFARCTION

What are the factors that influence the development of an infarct?

○ Nature of the vascular supply

■ Availability of an alternative blood supply will determine whether the occlusion a vessel will cause damage

○ Rate of the development of the occlusion

■ Slowly developing occlusion less likely to cause infarction

○ Vulnerability of a tissue to hypoxia

○ Oxygen content of blood

What condition is this?

● Cardiovascular collapse

● Final common pathway of potentially lethal clinical events

● Systemic hypoperfusion owing to reduction wither in cardiac output or in the effective circulating blood volume

SHOCK

What condition is this?

● Cardiovascular collapse

Shock

What condition is this?
Final common pathway of potentially lethal clinical events

What condition is this?

● Systemic hypoperfusion owing to reduction wither in cardiac output or in the effective circulating blood volume

SHOCK

What is the end result of Shock?

End result:

○ Hypotension

○ Impaired tissue perfusion

○ Cellular hypoxia

In Shock, what are the characteristics of Hypovolemic and Cardiogenic?

Hypovolemic and cardiogenic

○ Hypotension

○ Weak and rapid pulse

○ Tachypnea

○ Cold clammy and cyanotic skin

● Occurs when either ECF or ICF gains or loses body fluids or electrolytes causing a fluid excess or deficit

● Sodium – major ion that influences water retention and water loss

● Deficit occurs with an excessive loss of body water or an inadequate compensatory intake

● Excess causes water retention into the body Fluid Imbalance

Fluid Imbalance

● Occurs when either ECF or ICF gains or loses body fluids or electrolytes causing a fluid excess or deficit

Fluid Imbalance

● Sodium – major ion that influences water retention and water loss

Fluid Imbalance

● Deficit occurs with an excessive loss of body water or an inadequate compensatory intake

Fluid Imbalance

● Excess causes water retention into the body Fluid Imbalance

Fluid Imbalance

major ion that influences water retention and water loss

Sodium –

What are the 2 types of Fluid Imbalance?

FLUID VOLUME EXCESS

FLUID VOLUME DEFICIT

○ Overabundance of water in the interstitial spaces or body cavities (edema) or within blood vessels (hypervolemia)

○ Inability to excrete fluids (renal, heart)

○ Characterized by weight gain and edema of extremities

○ Dyspnea, engorged neck veins, bounding pulse

● FLUID VOLUME EXCESS

○ Overabundance of water in the interstitial spaces or body cavities (edema) or within blood vessels (hypervolemia)

● FLUID VOLUME EXCESS

○ Inability to excrete fluids (renal, heart)

● FLUID VOLUME EXCESS

○ Characterized by weight gain and edema of extremities

● FLUID VOLUME EXCESS

○ Dyspnea, engorged neck veins, bounding pulse

● FLUID VOLUME EXCESS

○ Decreased vascular volume

○ Decrease BP, increase pulse, tachycardia

○ Oliguria – common sign

○ Causes: blood loss, burns, loss of body fluids

○ Can result into shock and requires and immediate medical treatment

FLUID VOLUME DEFICIT

○ Decreased vascular volume

FLUID VOLUME DEFICIT

○ Decrease BP, increase pulse, tachycardia

FLUID VOLUME DEFICIT

○ Oliguria – common sign

FLUID VOLUME DEFICIT

○ Causes: blood loss, burns, loss of body fluids

FLUID VOLUME DEFICIT

○ Can result into shock and requires and immediate medical treatment

FLUID VOLUME DEFICIT

What is a common sign found in Fluid Volume Deficit?

Oliguria

What are under electrolyte imbalance?

Sodium

Potassium

Calcium

Magnesiuim

○ Chemical substances that separates into electrically charged particles called ions

Electrolytes

affects osmolality of blood and influences blood volume, pressure and retention of water

○ SODIUM –

helps in maintaining Na-K pump that is essential for normal muscle contraction (heart, intestines and respiration

○ POTASSIUM –

influences permeability of cell membranes that regulates neuromuscular activity; electrical excitation of cardiac cells

○ CALCIUM –

intracellular activator of >300 enzymatic processes (nervous system); maintains correct level of electrical excitability in the nerves and muscle

○ MAGNESSIUM –

What are under Systemic Effects of Pathology?

Inflammation

• Acute

• Chronic

● Complex reaction of blood vessels

● Accumulation of fluid and leukocytes in the extravascular tissue

● Serves to destroy, dilute or wall-off injurious agents

● Protective response

● Goal is to get rid of the organism

★ Acute

★ Chronic

INFLAMMATION

● Complex reaction of blood vessels

INFLAMMATION

● Accumulation of fluid and leukocytes in the extravascular tissue

INFLAMMATION

● Serves to destroy, dilute or wall-off injurious agents

INFLAMMATION

● Protective response

INFLAMMATION

● Goal is to get rid of the organism

INFLAMMATION

• Initial response of tissues to injury

• Short duration (lasting for minutes, hours, days)

• Characterized by

  • Exudation of fluid and plasma proteins (edema)

  • Migration of leukocytes

• Systemic effects

  • Fever, tachycardia, local swelling, redness, erythema

• 3 major components

  • Increase in blood flow

  • Permits plasma proteins and leukocytes to leave circulation

  • Neutrophil emigration

• Increase in Vascular permeability

  • Hallmark of an acute inflammation

• Results to inflammatory extravasation of fluid

ACUTE INFLAMMATION

• Initial response of tissues to injury

ACUTE INFLAMMATION

• Short duration (lasting for minutes, hours, days)

ACUTE INFLAMMATION

• Characterized by

  • Exudation of fluid and plasma proteins (edema)

  • Migration of leukocytes

ACUTE INFLAMMATION

• Systemic effects

  • Fever, tachycardia, local swelling, redness, erythema

ACUTE INFLAMMATION

• 3 major components

  • Increase in blood flow

  • Permits plasma proteins and leukocytes to leave circulation

  • Neutrophil emigration

ACUTE INFLAMMATION

• Increase in Vascular permeability

  • Hallmark of an acute inflammation

ACUTE INFLAMMATION

• Results to inflammatory extravasation of fluid

ACUTE INFLAMMATION

What are the four caridnal signs/symptoms of inflammation?

Erythema

Heat

Edema

Pain

Which among the 4 cardinal signs is this?

Vasodilation and increased bloodflow

Erythema and Heat