Ch4-Hemodyn

Ch4-Hemodyn - HEMODYNAMIC DISORDERS Jv = ([Pc Pi] [c i])...

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HEMODYNAMIC DISORDERS J v = ([ Pc Pi ] − σ[π c − π i ])
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Hemodynamic Disorders Thromboembolic Disease Shock
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Overview Edema (increased fluid in the ECF) Hyperemia (INCREASED flow) Congestion (INCREASED backup) Hemorrhage (extravasation) Hemostasis (keeping blood as a fluid) Thrombosis (clotting blood) Embolism (downstream travel of a clot) Infarction (death of tissues w/o blood) Shock (circulatory failure/collapse)
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EDEMA ONLY 4 POSSIBILITIES!!! Increased Hydrostatic Pressure Reduced Oncotic Pressure Lymphatic Obstruction Sodium/Water Retention
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WATER 60% of body 2/3 of body water is INTRA-cellular The rest is INTERSTITIAL Only 5% is INTRA-vascular EDEMA is SHIFT to the INTERSTITIAL SPACE HYDRO- -THORAX, -PERICARDIUM, -PERICARDIUM EFFUSIONS, ASCITES, ANASARCA
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INCREASED HYDROSTATIC PRESSURE Impaired venous return Congestive heart failure Constrictive pericarditis Ascites (liver cirrhosis) Venous obstruction or compression Thrombosis External pressure (e.g., mass) Lower extremity inactivity with prolonged dependency Arteriolar dilation Heat Neurohumoral dysregulation
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REDUCED PLASMA ONCOTIC PRESSURE (HYPOPROTEINEMIA) Protein-losing glomerulopathies (nephrotic syndrome) Liver cirrhosis (ascites) Malnutrition Protein-losing gastroenteropathy
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LYMPHATIC OBSTRUCTION (LYMPHEDEMA) Inflammatory Neoplastic Postsurgical Postirradiation
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Na+ RETENTION Excessive salt intake with renal insufficiency Increased tubular reabsorption of sodium Renal hypoperfusion Increased renin-angiotensin-aldosterone secretion
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INFLAMMATION Acute inflammation Chronic inflammation Angiogenesis
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Jv = ([ Pc Pi ] − σ[π c − π i ])
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CHF EDEMA INCREASED VENOUS PRESSURE DUE TO FAILURE DECREASED RENAL PERFUSION, triggering of RENIN- ANGIOTENSION-ALDOSTERONE complex, resulting ultimately in SODIUM RETENTION
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HEPATIC ASCITES PORTAL HYPERTENSION HYPOALBUMINEMIA
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ASCITES
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RENAL EDEMA SODIUM RETENTION PROTEIN LOSING GLOMERULOPATHIES (NEPHROTIC SYNDROME)
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EDEMA SUBCUTANEOUS (“PITTING”) “DEPENDENT” ANASARCA LEFT vs RIGHT HEART PERIORBITAL (RENAL) PULMONARY CEREBRAL (closed cavity, no expansion) HERNIATION of cerebellar tonsils HERNIATION of hippocampal uncus over tentorium HERNIATION, subfalcine
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“Pitting” Edema
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Transudate vs Exudate Transudate results from disturbance of Starling forces specific gravity < 1.012 protein content < 3 g/dl, LDH LOW Exudate results from damage to the capillary wall specific gravity > 1.012 protein content > 3 g/dl, LDH HIGH
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HYPEREMIA/(CONGESTION)
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HYPEREMIA Active Process CONGESTION Passive Process Acute or Chronic
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CONGESTION LUNG ACUTE CHRONIC LIVER ACUTE CHRONIC CEREBRAL
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ACUTE PASSIVE HYPEREMIA/CONGESTION, LUNG
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Kerley B Air Bronch- ogram
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HYPEREMIA/CONGESTION, LUNG
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Ch4-Hemodyn - HEMODYNAMIC DISORDERS Jv = ([Pc Pi] [c i])...

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