Hemodynamic Disorders Lecture 1

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Questions and Answers

What is the primary skin manifestation of infiltration of superficial lymphatics by breast cancer?

Ecchymoses

Pitting edema

Peau d’orange (correct)

Petechiae

Which condition may cause periorbital edema?

Nephrotic syndrome (correct)

Breast cancer

Heart failure

Hemorrhagic shock

What distinguishes purpura from petechiae?

Purpura are larger in size (correct)

Purpura are only due to vascular inflammation

Purpura are smaller than petechiae

Purpura are caused solely by thrombocytopenia

What can lead to increased hydrostatic pressure resulting in edema?

Axillary lymph node resection Signup and view all the answers

What is the effect of rapid blood loss of up to 20% of total volume in healthy adults?

Usually negligible effect Signup and view all the answers

Which type of hemorrhage is characterized by larger subcutaneous hematomas?

Ecchymoses Signup and view all the answers

Which factor does NOT contribute to the severity of hemorrhagic shock?

Age of the individual Signup and view all the answers

What is the main cause of microhemorrhages, such as petechiae?

Defective platelet function Signup and view all the answers

What type of edema is dependent and often found in the legs and sacrum?

Subcutaneous edema Signup and view all the answers

Which statement regarding hemothorax is accurate?

It can lead to significant respiratory distress. Signup and view all the answers

What is the primary characteristic of hyperemia?

Increased blood inflow due to arteriolar dilation Signup and view all the answers

Which condition is known to cause generalized edema?

Congestive heart failure Signup and view all the answers

What is the result of lymphatic obstruction due to conditions like filariasis?

Massive edema in the affected areas Signup and view all the answers

Which of the following is not a cause of increased hydrostatic pressure leading to edema?

Increased plasma albumin Signup and view all the answers

What is a distinguishing feature of congested tissues?

An abnormal blue-red color Signup and view all the answers

Which of the following accurately describes the difference between transudate and exudate in edema?

Transudate is protein-poor; exudate is protein-rich Signup and view all the answers

Which factor is associated with reduced plasma osmotic pressure leading to edema?

Reduced plasma albumin due to liver disease Signup and view all the answers

What is the clinical term for severe, generalized edema?

Anasarca Signup and view all the answers

Which of the following conditions can lead to local edema through impaired venous return?

Deep venous thrombosis Signup and view all the answers

In which scenario would you likely observe a cyanotic tissue color?

Impaired outflow of venous blood Signup and view all the answers

Study Notes

Hemodynamic Disorders 1

Lectures cover hyperemia, congestion, edema, hemorrhage, infarction, shock, hemostasis, thrombosis, and embolism.

Aims and Purpose of Lectures

Topics include hyperemia and congestion, edema, hemorrhage, infarction, shock, hemostasis and thrombosis, and embolism.

Hyperemia and Congestion

Hyperemia: An active process caused by arteriolar dilation and increased blood flow. Tissues appear red due to oxygenated blood.
Examples: Inflammation sites, exercising skeletal muscle.
Congestion: A passive process where venous blood outflow from tissues is impaired. Tissues appear blue-red (cyanotic) due to deoxygenated blood.
Examples: Systemically (e.g., cardiac failure), locally (e.g., venous obstruction).

Edema

Edema is the accumulation of interstitial fluid within tissues.
Extravascular fluid can accumulate in body cavities: pleural cavity (hydrothorax), pericardial cavity (hydropericardium), peritoneal cavity (hydroperitoneum or ascites).
Anasarca is severe, generalized edema. Fluid can be protein-poor (transudate) or protein-rich (exudate).

Causes of Edema

Increased Hydrostatic Pressure: Impaired venous return (e.g., heart failure, deep vein thrombosis (DVT)), arteriolar dilation (e.g., heat, early inflammation).
Increased Vascular Permeability: Inflammation.
Reduced Plasma Osmotic Pressure: Decreased albumin synthesis (e.g., liver disease, protein malnutrition), increased albumin loss (e.g., nephrotic syndrome, protein-losing gastroenteropathy).
Lymphatic Obstruction: Localized obstruction due to inflammatory or neoplastic conditions. Parasitic infection (filariasis) can cause massive edema (elephantiasis). Infiltrations (e.g. breast cancer) can cause edema (peau d'orange). Lymphedema can result from therapies like axillary lymph node resection/irradiation.
Sodium and Water Retention: Increased hydrostatic pressure, reduced plasma osmotic pressure.

Increased Hydrostatic Pressure

Local: Impaired venous return (e.g., deep vein thrombosis) can cause edema in the affected area.
Generalized: Systemic edema, most commonly linked to congestive heart failure.

Reduced Plasma Osmotic Pressure

Albumin loss from circulation or insufficient synthesis.
Nephrotic syndrome: loss of albumin in urine leads to generalized edema.
Protein-losing enteropathy (malabsorption): reduced albumin synthesis associated with liver disease (e.g., cirrhosis) or protein malnutrition.

Morphology of Edema

Most common: subcutaneous tissues, lungs, and brain.
Subcutaneous edema: Legs, sacrum, dependent edema (pitting edema).
Periorbital edema: Nephrotic syndrome.
Pulmonary edema: Left-sided heart failure.

Hemorrhage

Extravasation of blood from vessels.
Accumulates within tissue as a hematoma.
Large bleeds into body cavities (hemothorax, hemopericardium, hemoperitoneum, hemarthrosis).

Appearances of Hemorrhage

Petechiae: Minute hemorrhages (1-2 mm) in skin, mucous membranes, or serosal surfaces. Causes include low platelet counts, defective platelet function, or vitamin C deficiency.
Purpura: Slightly larger hemorrhages (3-5 mm). Associated with trauma, vasculitis, increased vascular fragility.
Ecchymoses: Larger subcutaneous hematomas (bruises, 1-2 cm). Color changes due to hemoglobin breakdown (red-blue to blue-green to golden-brown hemosiderin).

Clinical Significance of Hemorrhage

Volume of blood lost: Rapid losses of up to 20% of blood volume may not cause significant impact, but larger losses can cause hypovolemic shock.
Rate of bleeding: Slow, prolonged bleeding may have less immediate impact than rapid loss, but can still indicate underlying problems.
Site of bleeding: Bleeding in vital areas (e.g., brain) can be life-threatening.
Chronic bleeding: Can lead to iron deficiency anemia (e.g., peptic ulcer, heavy menstruation).

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Description

This quiz covers essential concepts of hemodynamic disorders, including hyperemia, congestion, edema, hemorrhage, infarction, shock, hemostasis, thrombosis, and embolism. Test your understanding of these critical topics in cardiovascular physiology and pathology.