Edema - this ones really long :/ (that's what she said)

50-60%, 2/3, 1/3, 80, 20, veins

Lotta numbers:

The body is _____% water

what fraction of that water is intracellular?

What fraction is extracellular?

What percent of extracellular is in the interstitium?

What percent is in plasma?

The majority of blood in circulation is located in the _______

sympathetic innervation, local intrinsic stimuli

arterial lumen diameter is controlled by _________________ and ____________________

Starling equation: net filtration = K[(Pcap-Pint)-o(πcap-πint)]

Water distribution between plasma and interstitium determined by what?

K, P, O, π, cap, int,

symbol for capillary endothelial permiability constant

symbol for hydrostatic pressure

reflection coefficient symbol

symbol for colloid osmotic pressure

symbol for capillaries

symbol for interstitium

retention

normal conditions favor fluid [release/retention]

hydrostatic pressure

pressure exerted by fluid in a confined space

Pcap

_____: Pressure of the blood against the vessel wall

Pint

_____: Determined by the interstitial fluid volume and the compliance of the tissue interstitium

colloid osmotic pressure

form of osmotic pressure exerted by proteins

oncotic pressure

whats another name for colloid oncotic pressure

push fluid out

Hydrostatic pressure tends to [push fluid out of/pull fluid into] vessels

higher on arteriole, lower on venous

Is hydrostatic pressure higher on the arteriole or venous side in the capillaries?

relatively constant

Is hydrostatic pressure higher on the arteriole or venous side in the interstitium?

relatively constant

Is colloid osmotic pressure higher on the arteriole or venous side in the capillaries?

relatively constant

Is colloid osmotic pressure higher on the arteriole or venous side in the interstitium?

pulls fluid in

Osmotic pressure [pushes fluid out of/pulls fluid into] vessels

ALBUMIN, and other plasma proteins

What is responsible for the majority of colloid osmotic pressure?

sodium and chloride

what substance also contributes to colloid osmotic pressure, but less than albumin (and other proteins) because it is freely movable over membranes

"ugh, why can't you just put all the info here" - f*ck off man there's 69 slides in this ppt.

Read over slide 9 for more pressure timeline stuff in the vessels...

lymphatic vessels

fluid that is pushed out of arteries/veins but is not returned to venules enters what instead?

hypervolemia

___________________: movement of additional water into the interstitium and ultimately into the cell → cell swelling

hypovolemia

_____________: movement of water into plasma → cell shrinkage and decreased interstitial volume

edema

issues with the distribution between Intravascular and Interstitial compartments is most commonly manifested as ________________

edema

____________: The pathological accumulation of fluid in interstitial spaces or body cavities

Hydrostatic pressure, Colloidal osmotic pressure, Vascular integrity, Cell membrane integrity

important contributing factors to edema (4)

Clear to slightly yellow watery fluid that thickens and expands affected interstitium

what does edema look like morphologically (sorry)

maybe, either, nope

Do swollen organs or tissues ooze fluid?

Are they firm or are they gelatinous?

Is there notable pain/redness/heat?

hydrothorax

____________: fluid in the thoracic cavity

hydropericardium

____________: fluid in the pericardial sac

ascites

___________: edema/fluid in the abdominal cavity

pulmonary edema

_______________: fluid/edema in the alveolar lumens

submandibular edema/bottle jaw

What?

ventral edema/brisket edema

What?

pitting edema

__________: when an indentation remains after the swollen skin is pressed

pitting edema

Whats going on here?

intestinal submucosal edema

What

hydropericardium

What is this called?

ascites

what is this called?

pulmonary edema

What is this specifically?

cerebral edema, flat/wide gyri, narrow sulci

What does the brain on the right have here? It's subtle but how can you tell?

cerebral edema, foramental herniation

Whats up with this brain? (general issue and thing at the *)

Slightly granular, clear to eosinophilic, amorphous, interstitial

infiltrate/material

describe edema histological appearance

increased protesin, dilution of the proteins with fluid, fibrin, hemorrhage, empty space

on histology, edema may look more eosinophilic due to _________... but could also have reduced eosinophilia due to ________________

and you may also see ______ or __________ or just ___________

dilation

in edema, you may see [dilation/compression] of lymphatic vessels

perivascular edema (white space by veins)

what is this?

nope, so. much. white space.

Is this normal?

effusion

____________: Accumulation of excessive fluid in tissues of a body cavity secondary to escape of fluid from the blood vessels or lymphatics into the tissues or a body cavity

cell and protein pure

what does it mean if effusion is classified as "pure transudate"

intermediate levels of cell and protein

what does it mean if effusion is classified as "modified/protein rich transudate"

cell and protein rich

what does it mean if effusion is classified as exudate?

imbalanced hydrostatic/oncotic forces; decreased oncotic pressure

Pure transudate fluid has passed through a vascular wall as a result of _______________ and ____________________;

usually what is the more specific reason?

few, low, low (mostly albumin)

in pure transudate... describe:

cells?

specific gravity?

protein?

pure transudate

what type of effusion typically goes with hypoalbuminemia?

hepatic, renal, gastrointestinal disease

what may be some causes of hypoalbuminemia?

pure transudate

what type of pleural effusion is this?

increased hydrostatic pressure, or increased vascular permeability

What general issue typically causes modified/protein rich transudate?

fluid leakage from lymphatic or blood vessel

what specific mechanism causes modified/protein rich transudate?

cardiac disease, liver disease, neoplasia, vascular damage, organ strangulation

What specific diseases can cause modified/protein rich transudate

modified/protein rich transudate

this is the body cavity of an animal with FIP; what type of effusion is this?

increased vascular permeability caused by inflammation

exudates develop due to ______________________________

high,

cellular,

high

Describe exudates:

protein concentration?

What type of debris?

Specific gravity?

bacteria and other microorganisms

If there is a septic exudate, what is found in it?

bile, urine, pancreatic enzymes

if there is a non septic but infectious/inflammatory exudate... what is found in it?

exudate

what kind of effusion in this perotineal effusion?

exudate

what kind of effusion?

chylous effusion

effusion Composed of lymph and emulsified fat extracted from chyme by the lacteals

milky white/creamy pink

what color is chylous effusion?

obstruction of outflow of chyle from thoracic duct into vena cava

what causes chylous effusion?

thorax

where does chylous effusion usually occur?

chylous effusion

what is this?

increased microvascular permeability

increased intravascular hydrostatic pressure

decreased intravascular osmotic pressure

decreased lymphatic drainage

what are the four major mechanisms of edema? (KNOW THESE she said)

vasodilation, increased microvascular permeability

What is the initial microvascular reaction to inflammatory or immunologic stimuli

histamine, bradykinin, leukotrienes, substance P -> cytokines

what are the mediators of increased microvascular permeability?

inflammation, neovascularization, anaphylaxis, toxins, clotting abnormalities, metabolic abnormalities

what are the causes for increased microvascular permeability?

false; passive is more common

true/false: increased intravascular hydrostatic pressure can be active or passive but active is the more common form.

hyperemia

what is active Increased Intravascular Hydrostatic Pressure called?

congestion

what is passive Increased Intravascular Hydrostatic Pressure called?

arteriolar dilation

active Increased Intravascular Hydrostatic Pressure results from increased flow of blood into the microvasculature and is often associated with ___________________

decreased blood REMOVAL by venous dilation

passive increased intravascular hydrostatic pressure results from increased blood in tissues resulting from passive venous engorgement... this is usually associated with _________________

filtration, fluid absorption back into vessels

What is the end result of Increased Intravascular Hydrostatic Pressure?

increase __________ and reduced or reversed ___________

right sided heart failure (portal hypertension), left sided heart failure (pulmonary hypertension), generalized heart failure, fluid overload (iatrogenic or renal disease)

causes for increased intravascular hydrostatic pressure can be either generalized or localized... what are some generalized examples?

local inflammation, trauma (insect bites), venous obstruction

causes for increased intravascular hydrostatic pressure can be either generalized or localized... what are some localized examples?

congestive heart failure

______________: Inability to adequately empty the venous reservoirs

reduced cardiac output

What is the general result of congestive heart failure once there is loss of cardiac pumping efficiency

lungs and thoracic cavity

where are the effects of left sided heart failure seens?

chronic pulmonary congestion

What is this?

fluid buildup in the body

right sided heart failure leads to _______________---

left sided failure or pulmonary hypertension

right sided heart failure can occur secondarily to _______ or _______________

hydrostatic pressure, venous congestion

liver, abdominal cavity (hydrothorax rare but in cats), periphery and subcutis

systemic lesions that lead to right sided heart failure typically are because of increased ________________ due to _________________

and can cause secondary lesions in the "systemic circulation" which includes _____________________ (4)

Hepatic Chronic Passive Congestion

____________________: congestion of the sinusoids and vessels in the liver; leading to nutmeg liver

congested vessels and sinusoids around central veins

describe what hepatic chronic passive congestion looks like on histology

nutmeg liver/hepatic chronic passive congestion

what is this?

renal hypoperfusion, activation of RAAP (promoting more water retension), exacerbates fluid overload

congestive heart failure leads to generalized edema which in turn reduces the circulating plasma volume... What does this lower plasma volume lead to?

decreased ALBUMIN (really just plasma protein conc but mostly albumin)

what causes decreased intravascular osmotic pressure generally?

fluid filtration, absorption, generalized edema

decreased intravascular osmotic pressure leads to increased __________ and decreased ______________ generally ending in ___________________-

starvation, malnutrition, cachexia, chronic liver disease

hypoproteinemia that leads to decreased intravascular osmotic pressure can be due to decreased production by ____________ (4)

heavy parasitism*, severe burns, protein-losing enteropathy, protein-losing nephropathy

hypoproteinemia that leads to decreased intravascular osmotic pressure can also be due to increased loss due to ___________ (4)

haemonchus contortus/barber pole worm

which parasite is found in the abomasum of ruminants and feeds on blood causing sever anemia, hypoproteinemia, and decreased intravascular osmotic pressure leading to bottle jow

ostertagia (O. ostertagia in cows, Teladorsagia circumcinta in sheep/goats)

what reddish-brown worms can be found in the abomasum of ruminants that will expand and destroy glands and cause "leaky tight junctions", destroying the integrity of the mucosa

protein-losing gastroenteropathy and brisket edema

ostertagiosis tends to lead to __________ and ____________________