Patho Exam #2 pt. 1

Shift of fluid from vascular space to interstitial space.

This fluid is cannot be used by the body and manifests into edema.

Third Spacing

Extracellular Fluid (ECF) deficits due to decreased vascular volume, & interstitial volume is called

(Removal of sodium-containing fluid from the body)

Fluid Volume Deficets

Fluid Volume Deficits Etiology

-Vomiting

-Diarrhea

-Polyuria

-Third spacing

-Burns

Fluid Volume Deficits Manifestations

-Decreased skin turgor

-Sunken Eyes

-Dizziness

-Syncopy

Extracellular Fluid (ECF) increases due to an increase in plasma volume & interstitial volume is called

Fluid Volume Overload

Fluid Volume Overload Etiology

Heart Failure

Fluid Volume Overload Manifestations

-Sudden weight gain

-Bounding pulse

-Distended neck veins

-Orthopnea

Electrolyte that is the highest concentration in the intracellular fluid

Potassium

Hyponatremia Manifestations

-Cerebral Edema

-Lethargy/fatigue

Hypernatremia Manifestations

-Concentrated Urine

-Decreased muscle reflexes

Hypokalemia etiology

-GI losses

-Diuretics, Steroids, Insulin

Hypokalemia manifestations

-Arrhythmias (ECG changes)

-Skeletal muscles weakness

Hyperkalemia etiology

-Kidney Failure

-Deficient aldosterone

-Large trauma injuries

Hyperkalemia manifestations

-Arrhythmias (widened QRS complex)

-Non-specific vague muscle weakness

Hypocalcemia etiology

-Hypoparathyroidism & neck surgery (decreased PTH levels)

Hypocalcemia manifestations

-Tetany (increased nerve membrane excitability)

-Hyperreflexia

-Laryngeal spasms

Hypercalcemia etiology

-Hyperparathyroidism (make to much PTH)

-Malignancies (multiple myeloma, lymphoma, lung cancer)

-Breakdown of bones

Hypercalcemia manifestations

-Muscle weakness

-Decreased reflexes

-Confusion, lethargy, coma

Blood pulling in the saphenous vein due to incompetent valves that do not prevent back flow

Varicose Veins

Varicose Veins manifestations

-Distended & palpable veins

-Syncope

What is the main complication for DVT

Pulmonary Embolism

Thrombus VS Embolism

Thrombus- Blood clot that remains attached to the vessel wall

Embolism- Bolus of matter circulating in the blood stream

Abnormal thickening and hardening of vessel walls

Atherosclerosis

The initial stage of atherosclerosis is due to the accumulation of

LDL in the endothelium

Hypertension is characterized by what systolic & diastolic numbers

Systolic- Above 130 mm Hg

Diastolic- Above 80 mm Hg

Measured multiple times

Urgent Hypertension is characterized by what systolic & diastolic numbers

Systolic- Above 180 mm Hg

Diastolic- Above 120 mm Hg

Measured multiple times

Hypertension is connected to what system

RAAS stress response which increases vasoconstriction

Hypertension leads to what

Chronic damage to the heart, kidney, brain, eyes.

Cardiovascular disease leads to what

Left Ventricular Hypertrophy → Heart failure

Local dilation or outpouching of an artery vessel wall is called

Aneurysm

What is the etiology of an aneurysm

Atherosclerosis & Hypertension

Aneurysm are a key part of what syndrome

Marfan Syndrome

Clinical manifestations of an aneurysms

-Stroke

-Sudden severe pain radiating to abdomen or back

LDL

-LDL we want low because it is bad cholesterol

-High level of LDL increases risk for atherosclerosis

HDL

-HDL we want high because it is good cholesterol

-High levels of HDL protects against atherosclerosis

How to increase HDL

-Increase exercise

-Decreases with smoking, alcohol, diabetes.

Episodic vasospasm in arteries and arterioles of fingers, which changes skin color.

Goes from cyanotic → red

Raynauds Disease

Raynauds Disease is considered

Secondary to autoimmune disorders (SLE)

When does Raynaud’s disease flare up

Initiated by cold and emotional distress → So avoid cold and smoking

Peripheral Arterial Disease (PAD) is caused by what

Atherosclerosis of arteries

Acute arterial occlusion is due to

A thrombus or emboli lodged in arterial circulation

Acute arterial occlusion can lead to

Necrosis & possible amputation

Decrease in systolic and diastolic BP upon standing

Orthostatic Hypotension

Orthostatic Hypotension etiology

Hypovolemia

Impaired blood flow to coronary arteries that leads to acute insufficient delivery of oxygenated blood to myocardium

Coronary Artery Disease (CAD)

Chest pain that occurs with activity and is relived by rest

Stable angina

Chest pain that is not relived by rest

Unstable angina

Physiology of angina

Reduced O2 supply goes from aerobic metabolism to anaerobic metabolism.

Leads to lactic acid build up → pain

Clinical manifestations of angina are

-10/10 chest pain

-Pain radiating down left arm & jaw

-Feeling of impending doom

Large plaque build up in vessels that leads to a spontaneous rupture that blocks blood supply leading to ischemia.

Occurs with physical exertion

(Shoveling snow, moving furniture)

Myocardial Infarction (MI)

Increased levels of troponin indicate

Myocardial Infarction

NSTEMI VS STEMI

NSTEMI- Partial blockage of the coronary artery. ST wave depression.

STEMI- Complete blockage of the coronary artery.

ST wave elevation.

Inability of the heart to maintain sufficient cardiac output to meet metabolic demands of tissues/organs due reduced myocardial contraction which leads to progressive back up of systemic circulation

Heart Failure

Clinical manifestations of heart failure

Composed of backwards effects (pulmonary edema, SOB, less than 40% ejection fraction) & forward effects (Tachycardia & fatigue)

Acute Pericarditis Vs Constructive Pericarditis

Acute- Inflammation of the pericardium

Constructive- Chronic, healed stage of acute pericarditis

Acute Pericarditis Vs Constructive Pericarditis Manifestations

Acute manifestations- fever, chest pain, malaise, tachycardia, leukocytosis, friction rub

Constructive manifestations- Exercise intolerance, fatigue, heart failure.

Pericardial Effusion

Accumulation of fluid in between pericardial membranes

Large effusions can lead to external compression of the heart chambers which impairs filling of the heart.

Cardiac Tamponade

Cardiac Tamponade manifestation

-Muffled Heart sound

-Hypotension

-Tachycardia

Increased left atrial pressure is an indication of what

Mitral Valve Stenosis

Complications of Mitral Valve Stenosis

-RV Hypertrophy

-A Fib

-Chronic pulmonary HTN

Mitral valve prolapses (falls back into LA) which leads to back flow of blood from LV to LA during ventricle systole

Mitral Regurgitation

Mitral Regurgation manifestations

LA & LV hypertrophy

Accumulation of calcifications related to aging which obstructs the flow out of LV during systole

Aortic Stenosis

Infectious inflammation of the endocardium

Endocarditis

What factors lead to endocarditis

-Staph aureus

-IV drug use

-Implantable devices

-Immunodeficiencies

Endocarditis manifestatons

-Joint Pain

-Weight loss

-Night sweats

Cardiovascular system fails to perfuse tissues adequately which leads to widespread impairment of cellular metabolism

SEVERE HYPOTENSION

Shock

Shock manifestations

-Sluggish cap refill

-Cool skin

-Decreased urine ouput

Shock manifested by capillary leak, third spacing

Burn shock

Shock due to brain stem injury or spinal cord injury

Neurogenic Shock

Shock due to MI, heart failure, “pump failure”

Cardiogenic shock

Shock due to loss of fluid volume like dehydration or hemorrhages

Hypovolemic shock

Dysrhythmias etiolgy

-Hypoxia

-Potassium (electrolyte imbalance)

-MI

“-”

Heart Block

“bunch of nonsense”

V Fib

“shark teeth”

V Tach

“sinus spikey”

Sinus Tachycardia

“sinus slow”

Sinus Bradycardia

“mirror U’s”

A Fib

Associated- Embolic Stroke

“flap, flap, flap”

A Flutter

“-”

Normal Sinus

“Delta Wave”

WPW

“-”

Torsades

Associated- Hypomagnesium

What is the human average blood pH level

7.35-7.45

Metabolic acidosis ph & bicarbonate levels

Low pH (more acidic)

Low bicarbonate

Metabolic acidosis etiology

DKA & kidney failure

Metabolic acidosis compensatory response

Hyperventilation (excreting CO2)

Metabolic alkalosis ph & bicarbonate

High pH (less acidic)

High bicarbonate

Metabolic alkalosis etiology

NG suctioning

Metabolic alkalosis compensatory response

Hypoventilation (retaining CO2)

Respiratory Acidosis pH & CO2

Low pH (more acidic)

High CO2

Respiratory acidosis etiology

Lung diseases such as COPD → Hypoventalation

Respiratory acidosis compensatory response

Retain bicarbonate

Excrete acid

Respiratory alkalosis pH & CO2

High pH (less acidic)

Low CO2

Respiratory alkalosis etiology

Pain & Panic attack → Hyperventilation

Respiratory alkalosis compensatory response

Excrete bicarbonate

Retain acid