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Pathophys Edema
| Question | Answer |
|---|---|
| What is Edema? | increase in interstitial fluid |
| Examples of systemic or local? | local- injury systemic- lymphedema, cancer |
| What maintains intracellular and extracellular balance? | Na, K |
| What maintains intravascular and interstitial balance? | capillary dynamics |
| What is osmotic pressure? | pressure determined by conc. of proteins inside and outside blood vessels; synonymous with oncotic pressure (blood) |
| What is hydrostatic pressure? | pressure exerted by a fluid; Exampe: in blood vessels by heart and gravity, contrib. to movement of fluid into or out of vessels, lymphatics |
| Relationship of hydrostatic pressure, osmotic pressure and loss of fluid? | Usually hydrostatic pressure (pushing out) > osmotic pressure (keeping in) slight loss of fluid into interstitial space (taken up by lymph system) |
| What is contained in lymphatic fluid? | rich in protein, water and macrophages |
| osmotic pressure in blood is due to what? | proteins (gradient in and out of cell) |
| What causes hydrostatic pressure? | volume of blood present (heart and gravit, standing gravity causes fluid down) |
| Where is the pressure higher? | higher intravascular pressure |
| Situations that cause edema? | Na and H20 retention, increase capillary permeability, obstruction (DVT or CA), decreased muscle action, air travel, left ventricle malfunction, overwhelmed lyymphatic system, exercise or trauma |
| What happens with edema | Increased capillary hydrostatic pressure Increased interstitial osmotic pressure or decreased intravascular osmostic pressure Increased venule permeability Overwhelmed lymphatitc system that can’t accommodate for large fluid shift |
| WHat forces exist across capillary wall? | Hydrostatic Osmotic (oncotic) Capillary wall integrity Lymphatic integrity |
| what is filtration? | Filtration: forces favoring outward movement of fluid |
| What is reabsorption? | Reabsorption: forces favoring inward movement of fluid |
| Permeability of capillaries to water, protein, other solutes? | All capillaries are freely permeable to water Permeability to proteins is low Permeability to other solutes, such as glucose and electrolytes is variable |
| Clinical manifestation of edema?(edema and effusion) | Edema: excess fluid in the interstitial spaces and connective tissues between cells Effusion: excess fluid in potential fluid spaces of the body: pericardial sac, alveoli of lungs, jnt space, intrapleural spaces |
| Clinical manifestation of edema (ascites and anasarca) | Ascites: fluid in the perotineal cavity Anasarca: massive, generalized edema, through entire body |
| local manifestations of edema | increased girth and pitting edema |
| systemic manifestations of edema | increased girth, pitting edema, lung sounds, and weight gain |
| Lymph manifestations of edema | increased girth, pitting edema, and weight gain |
| What is lymphedema? | blocked or removal of lymph nodes; swelling caused by increased lymphatic fluid in interstitial space |
| What can cause lymphedema? | Low albumin Lymphatic obstruction Abnormal vessel distribution Reduced activity |
| Define lymph fluid | consisting of water, white blood cells, cellular debris and protein rich matter |
| what is a lymphatic plexus | groups of small lymphatic cells, located immediately below skin;acts as “sponge” to soak up and gather lymph fluid |
| define lymphatic vessels | known as collectors specialized channels located throughout the body one way valves; smooth muscle directed towards the heart |
| define lymph nodes | filtering bumps located in the lymph channels at 1-2cm intervals purifies lymph fluid of bacteria and viruses |
| where do nodes congregate? | neck, armpits, along trachea, lung near intestines, behind abdominal cavity, groin and pelvis |
| what is anastamosis? | area where left and right lymphatic channels connect |
| how many lymph trunks are in the body? | 6 major trunks, named for the region of the body |
| What is hypoplasia or aplasia? | Born with only a few lymphatic collectors in a particular limb |
| What is hyperplasia? | Collectors are enlarged; one way valves are incompetent |
| causes of primary lymphedema? | hypoplasia, hyperplasia and blockage |
| What can cause secondary lymphedema? | Collectors are enlarged; one way valves are incompetent |
| stages of lymphedema | 0: latent 1: spontaneously reversible 2: spontaneously irreversible 3: lymphatic elephantitis |
| characteristic stage 0 (latent) | Lymphatic vessels sustained damage, which isn’t yet apparent; transport capacity still sufficient |
| Characteristic of Stage 1 of lymphedema | Pitting stage; normal in am but increases size t/o day |
| Characteristic of Stage 2 lymphedema | Spongy consistency & non-pitting, beginning of hardening of the limbs w/ increasing size |
| Characteristic of stage 3 of lymphedema | Irreversible swelling, hard/fibrotic tissue, unresponsive |
| Grade 1 Lymphedema involves waht parts? | distal parts such as forearm and hand or lower leg and foot |
| Grade 2 lymphedema involves | an entire limb or corresponding quadrant of the trunk |
| Grade 3a edema involves what | present in one limb and its associated trunk quadrant |
| Grade 3b edema involves what | same as 3a except two or more extremities are affected |
| Grade 4 edema involves what | elephantitis |
| Decongestive therapy for lymphedema | Lymphatic massage Skin care Compressive garments Exercise |
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