Hemodynamic discorder, thrombosis, shock

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