Edema and Shock

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Questions and Answers

What is a major factor in maintaining normal fluid homeostasis?

Sodium retention

Lymphatic obstruction

Intravascular pressure

Endothelial function (correct)

Which of the following can cause decreased oncotic pressure?

Nephrotic syndrome (correct)

Malnutrition

Hypertension

Increased albumin production

What is the main difference between hyperemia and congestion?

Underlying mechanisms (correct)

Type of vessel involved

Amount of blood accumulated

Location of blood accumulation

What is the characteristic appearance of a liver with congestion?

Mottled with red-brown and tan areas Signup and view all the answers

What is the definition of hemorrhage?

The extravasation of blood from vessels Signup and view all the answers

Which of the following is NOT a cause of edema?

Increased blood viscosity Signup and view all the answers

What is an example of a physiologic hyperemia?

Skeletal muscle during exercise Signup and view all the answers

What is a potential consequence of heart failure?

Increased hydrostatic pressure Signup and view all the answers

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 Signup and view all the answers

A 35-year-old female presents with a high fever, chills, rapid breathing, and confusion. What type of shock should be suspected?

Septic shock Signup and view all the answers

What is the most common cause of hypotension in a patient with a history of myocardial infarction?

Cardiogenic shock Signup and view all the answers

What is the characteristic skin finding in a patient with septic shock?

Warm, flushed skin Signup and view all the answers

What is the most common laboratory finding in a patient with septic shock?

Leukocytosis Signup and view all the answers

What is the most common cardiovascular finding in a patient with cardiogenic shock?

Hypotension Signup and view all the answers

What is the primary cause of hemorrhage?

All of the above Signup and view all the answers

What is the result of losing a large amount of blood due to hemorrhage?

Hypovolemic shock Signup and view all the answers

What is the definition of shock?

A state of diminished cardiac output or reduced effective circulating blood volume Signup and view all the answers

What type of shock results from systemic vasodilation and increased vascular permeability?

Anaphylactic shock Signup and view all the answers

What is the final stage of shock?

Irreversible stage Signup and view all the answers

What is the likely cause of generalized edema in a 66 year old with hepatitis C?

Decreased Albumin synthesis Signup and view all the answers

Which of the following is an example of hyperemia?

Hematoma Signup and view all the answers

What is the primary cause of Petechiae?

Platelets problems Signup and view all the answers

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