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Fluid in the interstitial tissue space or body cavities; hydrothorax, hydroperitoneum, hydropericardium, hydrocele
Give the definition of edema and its content
Anasarca
What do u call severe and generalized edema?
normal hydrostatic pressure in the arterial end drives fluid from the lumen of the blood into the interstitial space
Explain the pathophysiology of edema: about the normal hydrostatic pressure and what is the function of the hydrostatic pressure
it will absorb back the fluid in the venous end of the capillary
Normal function of the plasma colloid osmotic pressure
small amount of extra fluid in the interstitial space is absorbed by the lymphatic via the thoracic duct > then to the left subclavian vein > the blood circulation
what is the function of the lymphatics?
It will promote edema
When u have disturbance from normal hydrostatic pressure, osmotic pressure, and lymphatic pressure like increased in hydrostatic pressure, decreased in osmotic pressure, and lymphatic obstruction, what will happen?
edema
increased in hydrostatic pressure
edema
Decrease in osmotic pressure
Deep vein thrombosis in LE, external pressure
Give examples of a local increased in hydrostatic pressure
Localized edema of the leg
Effect of deep vein thrombosis
Because of increase in hydrostatic pressure
Mechanism behind the deep vein thrombosis
Congestive heart failure and constricted pericarditis (decreases cardiac output)
What will cause the generalized increased in hydrostatic pressure?
Systemic edema
Effect of generalized increased in hydrostatic pressure
Deep vein thrombosis in the LE and external pressure (an example of which is mass causing pressure on lymphatics)
Give a clinical example of clinical condition that will produce a local increased in the hydrostatic pressure
Localized edema of the LE
What is the effect of deep vein thrombosis in the LE?
Congestive heart failure, constrictive pericarditis
Give a clinical condition producing generalized increase in hydrostatic pressure
Congestive heart failure
Give the most common condition
Edema
What is the effect when u have generalized increased in hydrostatic pressure?
It has to decrease. Reduction of osmotic pressure promotes movement of fluid into interstitial tissues
What will have to happen to the plasma colloid osmotic pressure in order to produce edema?
Edema
What does decrease plasma colloid osmotic pressure lead to?
Nephrotic syndrome, liver cirrhosis, malnutrition
When do u see decreased in plasma colloid osmotic pressure
Hypoproteinemia
What is the common denominator if these 3 diseases (nephrotic syndrome, liver cirrhosis? malnutrition)
Serum protein/albumin
What maintains the colloid osmotic pressure?
Decrease of the plasma colloid osmotic pressure leading to movement of fluid into interstitial space
When there is decrease synthesis of albumin, what will happen?
When there is obstruction to the lymphatics
What will happen to the lymphatics to produce edema?
Inflammatory, neoplastic, postsurgical, post irradiation
Give clinical conditions to produce lymphatic obstruction
Increased in hydrostatic pressure, reduced plasma colloid osmotic pressure, lymphatic obstruction
What are the 3 abnormalities that will bring about edema?
Subcutaneous tissues, lungs, brain
Where is edema commonly found?
Dependent parts of the body
Where can u find subcutaneous edema?
Periorbital edema
In the eyes, the water will accumulate in the area wherein the connective tissue matrix is loose
Pulmonary edema
In the lungs, the water will accumulate in the area wherein the connective tissue matrix is loose
Left ventricular failure, renal failure, adulty respiratory distress syndrome, pulmonary infections, hypersensivity reaction
What clinical conditions will produce pulmonary edema?
Abscess, neoplasm, or tumors
What condition will produce localized brain edema
Endephalitis, hypertensive crisis, obstruction to brain’s venous outflow
What conditions will produce generalized brain edema
Trauma
When do u see both localized and generalized (referring to brain edema)
Swollen
What will the brain look like grossly if there is an edema?
Narrowing of the sulci and flattening of the gyri
Swollen is in the form of what
Brain herniation (abnormal protrusion of an organ)
What is dreaded complication in brain edema
More increased in tissue blood flow, hyperemia
What will happen if u have arteriolar dilatation?
Because it is engorged with blood
Why will the affected tissue be red?
Skeletal muscle during exercise, sites of acute inflammation which manifest rubor or redness
Give a clinical condition that will produce hyperemia
Increased blood flow because of arteriolar dilatation
What is the cause of hyperemia?
Impaired venous outflow from the tissue / Impaired outflow from tissue
What is the cause of congestion?
active process
hyperemia is a what process?
passive process
congestion is a what process?
The tissue will appear cyanotic indicative of the lack of oxygen
What will happen with the blood gets stuck in the vein?
Arteriolar dilatation (increase blood flow to the tissue) = hyperemia
impaired venous outflow = congestion
Give the differentiating point between hyperemia from congestion
red
how does the tissue look like in hyperemia?
blue-red or cyanotic
how does the tissue look like in congestion?
cardiac failure, venous obstruction
Clinical condition that will give rise to congestion
Acute Pulmonary Congestion
alveolar capillaries engorged with blood (intraalveolar hemorrhages)
Chronic Pulmonary Congestion
no blood, heart failure cells in alveolar spaces (hemosiderin-laden macrophages)
Acute hepatic Congestion
central vein and sinusoids are distended (swollen) with blood
Chronic passive congestion of liver
central regions of hepatic lobules will appear grossly red brown against the surrounding zones of uncongested tan liver
uninvolved liver
tan in color
It is term used to describe blood loss. It is caused by extravasation of blood due to the ruptured blood vessel
What is hemorrhage and why is there hemorrhage?
menstrual cycle
Example of external hemorrhage
hematoma
What do you call it when there’s an accumulation of hemorrhage?
-Petechiae (1-2mm)
-Purpura (>3mm)
-Ecchymoses (>1-2cm)
Give the 3 sizes of hemorrhage
-Minute-sized
-1-2 mm hemorrhage into the skin mucous membrane or serosal surfaces
What is petechiae?
- Increased intravascular pressure which leads to Rupture
-Decreased Platelet count (thrombocytopenia)
-Clotting factor defects
When do u see petechiae?
Slightly larger hemorrhage, greater or equal to 3 mm
Define purpura
Larger, greater than 1-2 cm subcutaneous hematomas
What is ecchymoses
After trauma (erythrocytes leave blood vessels. Once outside, they undergo breakdown which occurs in a macrophage (several days after), that engulfs the RBC)
When do u see ecchymoses
degraded erythrocytes that are phagocytosed by macrophages
What are responsible for color changes?
red blue
.What is color of hemoglobin
Because of breakdown of iron from hem which leads to from hemoglobin
what is hemoglobin due to?
From red, blue to blue-green is due to both the biliverdin and bilirubin
What is next to hemoglobin?
hemosiderin
Gold-brown in color, what is it due to?
Because of the breakdown of the RBC to form hemoglobin / Formation of hemoglobin w/c is derived from RBC
Why is it your skin will appear red, blue?
Due to biliverdin and bilirubin
What is responsible for the blue-green color?
Because of hemosiderin
Before healing, why will it appear golden yellow?
hemo
Accumulation of blood, what is the prefix
hydro
prefix for edema
Hydrothorax
edema in pleural cavity
Hydropericardium
pericardial sac
Hydrocele
scrotal sac
Hydroperitoneum
peritoneal/ abdominal cavity
Hemothorax
Blood in the thoracic cavity, what is it called
hemopericardium
Blood in the pericardium
hemoperitoneum
blood in the peritoneum
hemarthrosis
blood in the joints
hemocele
blood in the scrotal sac
Depends on the volume and rate of blood loss, site, amount of iron lost / iron loss
What is the clinical significance of hemorrhage
brain herniation
What is dreaded complication of hemorrhage
not serious
When u have subcutaneous bleeding (Subchorionic hemorrhage), is it serious or not
serious
When u have bleeding in ur organs or brain, is it serious or not?
-Vascular wall (endothelium)
-Platelets
-Coagulation cascade
Three components of thrombus (clot) formation
-endothelial injury
-alterations in normal blood flow
-hypercoagulability of blood
main factors of thrombus formation or what is Virchow’s triad that may predispose to thrombus formation
seen in trauma or inflammation
When do u see an endothelial injury?
When there is a statis or inactivity, or when there’s turbulence or instability in blood flow
Give an example of alteration in normal blood flow
Hypercoagulability of blood
When do you have increase concentration of fibrinogens and is prone to thrombus formation?
increased concentration of fibrinogens
What happens in Hypercoagulability of blood?
Any place in the circulatory system: cardiac chambers, heart valves, arteries, veins, capillaries
Thrombosis occurs in
They usually begin at a site of endothelial injury, turbulence in vessel bifurcation (ex. atherosclerotic plaque)
Where does arterial or cardiac thrombi commonly form?
Occur in sites of stasis
Where does arterial or cardiac thrombi commonly form?
to grow in a retrograde direction from the point of attachment
How does arterial thrombi propagate?
Extend in the direction of blood flow (toward the heart)
How does venous thrombi propagate?
-Living clot has a point of attachment to the vessel wall but a post-mortem clot usually does not have point of attachment to the vessel wall
-Living clot’s color is usually pinkish while a post-mortem clot is usually dark red in color
Differentiate a living clot to post-mortem clot
LC pinkish in color vs PMC dark red in color
Differentiate living clots from post-mortem clots
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