Gen Patho - Edema, Shock - MT

is the retention of fluid in the extracellular spaces

EDEMA

It is the fluid dynamics that happens in the capillary bed

this is where the fluid with dissolved nutrients are being distributed

microcirculation

regulates the flow of fluid; it constricts to regulate

muscular sphincter

pressure when LV contracts

the reason why we have blood pressure

HYDROSTATIC PRESSURE

pressure that causes the outward movement of fluid from arterial side of capillary out

existing pressure inside the blood vessels

HYDROSTATIC PRESSURE

Hydrostatic pressure is around

35 mmHg

plasma is composed of ___% water, 5% dissolved substances

95;5

Osmotic pressure can also be called as

plasma colloid oncotic pressure

it will push fluid from interstitial environment back to the vessels

HYDROSTATIC PRESSURE INTERSTITIAL FLUID

Hydrostatic pressure interstitial fluid is around

0mmHg

on the venous side, this pulls fluid palabas; nagiging 17 mmHg

HYDROSTATIC PRESSURE

on the venous side, this (25 mmHg) pulls fluid from interstitial environment back to blood vessels

OSMOTIC PRESSURE

Lymph may carry ___

antigens

(Lymph) On the arterial side, much of the fluid is _____ because of high hydrostatic pressure

moving out

(Lymph) On the venous side, much of the fluid is ______ because of higher osmotic pressure

There's high solute concentration

moving in

is the one that causes the fluid OUT.

Hydrostatic pressure

Higher extra force exerted by left ventricle =

Can spike up Blood pressure

where patients have very very high systolic pressure or diastolic pressure / high hydrostatic pressure

Hypertension

The pressure that the veins must exert in order to push blood back to the heart

Diastolic pressure

Albumin in the blood is produced by the

liver

Presence of albumin in the urine

ALBUMINERIA

Protein wasting na disease

NEPHROTIC SYNDROME

(T/F) should there be protein in urine?

False

proteins that move in the kidney tubules must be brought back to the circulation 100% including glucose, AA, some small proteins and lipids.

That process is called ___

TUBULAR REABSORPTION

Enlargement of bilateral or unilateral limbs

Upper limbs

ELEPHANTIASIS

Type of nematode (aka Round worm)

Common in tropical areas like PH, papa new guinea, Malaysia, Indonesia, South China, India, Caribbean

Filarial worms

(Filarial worms) specie for Bilateral Elephantiasis

Brugia Malayi

(Filarial worms) specie for unilateral Elephantiasis

Wuchereria Bancrofti

Carries the eggs of filarial worms

Mosquito (causes malaria & dengue)

if you cannot perfuse properly, there won't be proper distribution of blood to the tissues, this will lead to

ischemia

If ischemia is not corrected, it will lead to

hypoxia

Without any oxygen, the tissue will become _____ (dies) and eventually the organ will fail

necrotic

Inadequate tissue perfusion (means blood supply to the tissues)

Shock

Everytime the heart contracts, there is a certain amount of blood that is being pushed out, and we call that volume of blood ____

stroke volume

a normal ejection fraction should be

greater than 50%

Your cardiac output is also directly proportional to your

blood pressure

actual loss of blood/the loss of fluid

hemorrhagic loss

Blood force trauma/ sharp force trauma

Most common type of hemorrhagic loss

Physical Trauma/ Injury

When the abdominal aorta ruptures, the initial response of the heart is

increased heart rate

rupturing of the vessel

Aneurysm

The most common type of aneurysm

Brain aneurysm/Berry Aneurysm

Gastrointestinal Bleeding can cause

peptic ulcers

This is when the ova goes to the rectovesical pouch (pouch between the urinary bladder and uterus)

Ectopic pregnancy

is the one that makes the blood fluid.

Plasma

The most common cause of non-hemorrhagic loss, primarily due to burns

DEHYDRATION

epidermis; superficial burn; sunburn

(classification of burn)

1st degree burns

epidermis + part of the dermis. Blisters with fluid inside; paltos.

(classification of burn)

2nd degree burns

epidermis + dermis + hypodermis. (classification of burn)

3rd degree burns

skin layers + muscle tissues + bone.

(classification of burn)

4th degree burns

is a form of shock caused by severe hypovolemia.

It can be caused by severe dehydration or blood loss.

Hypovolemic shock

blood volume is ____ to the blood pressure

directly proportional

HOW DO YOU DEAL WITH HEMORRHAGIC LOSS

blood transfusion and IV fluids (normal saline solution and lactated Ringer's solution)

HOW DO YOU DEAL WITH NON-HEMORRHAGIC LOSS

IV fluids

The condition starts with the heart. The primary cause of cardiogenic is

heart failure

happens when your heart cannot contract properly.

Heart failure

Heart failure lowers down the

stroke volume

If the stroke volume becomes low the ___ will be also low

cardiac output

Only one coronary artery is affected.

Multiple Myocardial Infarction

refers to the hole in the heart

Septal Defect

Hole in heart in interatrial septum called

atrial septal defect (ASD)

Hole in heart interventricular septum called

ventricular septal defect (VSD)

The part of the heart with the highest pressure is the

left side of the heart

What is wrong is not really the heart but the organs and tissues around the heart.

OBSTRUCTIVE SHOCK

lining on surface of lung

Visceral pleura

adhered on the inner wall of chest

Parietal pleura

has a negative pressure (above -2 or -3mmHg)

Pleural space

makes inhalation and exhalation smooth especially during recoil

Negative pressure

In INHALATION, visceral pleura _____ the parietal pleura

pushes

In EXHALATION, visceral pleura ___ the parietal pleura

pulls down

Too much fluid around the pericardial cavity and the heart cant pump properly

CARDIAC TAMPONADE

Treatment for Cardiac tamponade

Cardiocentesis

is a dangerous blockage in a lung artery, usually from a blood clot that traveled from the legs (DVT)

Pulmonary embolism

Excessive velocity of nitrogen gas can cause bubbles to form in the bloodstream.

Emboli

Because emboli are mobile and can travel with the blood flow, if they are in the pulmonary artery or veins, they can go anywhere, then go to the heart and aorta, where they can get stuck. This results in obstruction because there's difficulty in blood flow

Pulmonary embolism

Super lowered systemic vascular resistance that leads to severe vasodilation of the arteries

DISTRIBUTIVE SHOCK

Primarily due to infective agents. High viral burden in the cells, specially in the lungs, di kinakaya ng immune system

Septic / sepsis

The endotoxin that will be released can actually influence the endothelial cells to produce certain substances that will be totally difficult to treat.

One which is going to stimulate the endothelial cell to produce, synthesize, or increase expression of a substance called

PAI type 1 (plasminogen activator inhibitor)

is a substance produced by the liver.

It is important after the clotting process

plasminogen

causes rupturing of endothelial walls causing blood to flow out

Direct destruction

because of this there was severe vasodilation, a drop in perfusion, a drop in blood flow to organs, ischemic, hypoxic, eventually necrosis then eventually organ system failure

cytokine storm

these are proteins that secreted by liver including plasminogen, C protein, etc

This indicates that when the level is high, there are many inflammatory processes occurring in the patient's body.

acute phase reactive proteins

Severe systemic hypersensitivity reaction

In short allergy

cause: allergen

ANAPHYLACTIC SHOCK (anaphylaxis)

mast cells contain cytoplasmic granules- granules granulate then release

leukotriene and histamine

Histamine causes _____ in the blood vessel that would lead to the pagbagsak ng systemic vascular resistance

vasodilation

starts in the central nervous system, specifically the spinal cord, and more specifically the region between T1 and L2.

Neurogenic shock

Neurogenic shock starts specifically between

T1 to L2

vagal nerve is ____% parasympathetic NS

90

The cluster of cell bodies of the SNS (Sympathetic Nervous System) is located in the pons - this is referred to as the ____

dorsal nuclei or vagus

happens when the vagus nerve is the only functioning nerve in the body

patients are sluggish, weak, have a low heart rate, tachycardia, lower heart contractility, vasodilation and if not corrected, it will lead to continuous perfusion, ischemia, necrosis and so on.

increased vagal tone