22 Questions
What is a major factor in maintaining normal fluid homeostasis?
Endothelial function
Which of the following can cause decreased oncotic pressure?
Nephrotic syndrome
What is the main difference between hyperemia and congestion?
Underlying mechanisms
What is the characteristic appearance of a liver with congestion?
Mottled with red-brown and tan areas
What is the definition of hemorrhage?
The extravasation of blood from vessels
Which of the following is NOT a cause of edema?
Increased blood viscosity
What is an example of a physiologic hyperemia?
Skeletal muscle during exercise
What is a potential consequence of heart failure?
Increased hydrostatic pressure
What is the likely diagnosis for a 60-year-old male with a sudden drop in blood pressure, confusion, and cold clammy skin, who has a history of myocardial infarction?
Cardiogenic shock
A 35-year-old female presents with a high fever, chills, rapid breathing, and confusion. What type of shock should be suspected?
Septic shock
What is the most common cause of hypotension in a patient with a history of myocardial infarction?
Cardiogenic shock
What is the characteristic skin finding in a patient with septic shock?
Warm, flushed skin
What is the most common laboratory finding in a patient with septic shock?
Leukocytosis
What is the most common cardiovascular finding in a patient with cardiogenic shock?
Hypotension
What is the primary cause of hemorrhage?
All of the above
What is the result of losing a large amount of blood due to hemorrhage?
Hypovolemic shock
What is the definition of shock?
A state of diminished cardiac output or reduced effective circulating blood volume
What type of shock results from systemic vasodilation and increased vascular permeability?
Anaphylactic shock
What is the final stage of shock?
Irreversible stage
What is the likely cause of generalized edema in a 66 year old with hepatitis C?
Decreased Albumin synthesis
Which of the following is an example of hyperemia?
Hematoma
What is the primary cause of Petechiae?
Platelets problems
Study Notes
Edema
- Edema is an increased fluid in the interstitial tissue spaces
- Normal fluid homeostasis is maintained by vessel wall integrity, intravascular pressure, and osmolarity within certain physiologic ranges
- Causes of edema:
- Increased hydrostatic pressure (e.g. heart failure, venous obstruction)
- Decreased oncotic (osmotic) pressure (e.g. decreased albumin due to liver failure, malnutrition, or nephrotic syndrome)
- Lymphatic obstruction
- Sodium retention
- Inflammation
Hyperemia and Congestion
- Hyperemia refers to an active process of increased blood volume within a tissue, resulting from arteriolar dilation and increased blood flow
- Congestion refers to a passive process of increased blood volume within a tissue, resulting from impaired outflow of venous blood
- Examples of hyperemia: physiologic (e.g. skeletal muscle during exercise), pathologic (e.g. acute inflammation)
- Examples of congestion: venous obstruction (e.g. ovarian torsion), cardiac failure
Liver Congestion
- Gross examination: areas of red-brown and slightly depressed tissue (nutmeg liver)
- Microscopic examination: centrilobular congestion with hepatocyte necrosis
Hemorrhage
- Hemorrhage is the extravasation of blood from vessels, often due to damage to blood vessels or defective clot formation
- Causes of hemorrhage: problems in blood vessels, platelets, or coagulation factors
- Types of hemorrhage:
- External
- Internal: hematoma, petechiae (1-2 mm), purpura (3-5 mm), ecchymoses (bruises, 1-2 cm)
- Clinical significance: depends on volume, rate, and site of hemorrhage, can lead to iron deficiency anemia, hypovolemic shock, and death
Shock
- Shock is a state of diminished cardiac output or reduced effective circulating blood volume, leading to tissue perfusion and cellular hypoxia
- Types of shock:
- Hypovolemic shock
- Cardiogenic shock
- Anaphylactic shock (systemic vasodilation and increased vascular permeability due to immunoglobulin E-mediated hypersensitivity reaction)
- Neurogenic shock (loss of vascular tone associated with anesthesia or spinal cord injury)
- Stages of shock:
- Non-progressive stage: vital organ perfusion is maintained
- Progressive stage: tissue hypoperfusion, worsening circulatory and metabolic derangement, and acidosis
- Irreversible stage: cellular and tissue injury is severe, and survival is not possible even if hemodynamic defects are corrected
Learn about edema, its causes, and its relation to shock. Understand the normal fluid homeostasis and the factors that affect it.
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