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Pathophysiology Lecture 1 Exam 1

What are the 4 main causes of edema? 1) Inc. Capillary Plasma hydrostatic pressure 2) Dec. Capillary Plasma oncotic pressure 3) Inc. Capillary Plasma permeability 4) Lymphatic Obstruction
What is Edema? Fluid accumulation in ITF
What are the names of the two compartments body water exists in? Extracelluar(ECF) and Intracellular (ICF)
Total Body weight percentage for males and breakdown into IFC and ECF? 60% of body water ( 40% ICF and 20% ECF)
What regulate the movement of water between ICF and ECF? Osmosis
If you are obese will you have more or less TBW? Lean? Less. More will occur if you are leaner.
What are the two categories of ECF? 1) interstitial 2) intravasular
What is tonicity? osmotic pressure of a solution relative to plasma
What are two other names for Osmotic pressure? Solute Concentration, Oncotic Pressure
What does it mean if a solution is isotonic? equivalent solute concentrations S/L<1
What does it mean if a solution is hypotonic? less concentrated S/L<1
What does it mean if a solution is hypertonic? more concentrated S/L>1
Molarity solute concentration expressed as mass per volume. 1M=mass(gram MW(6x10^23 molecules)/Volume (liter))
What is osmolar concentration? osmotically-effective concentration
Osmolarity # of osmoles per L solvent
Osmolality # of osmoles per kg solvent
What is the primary cation in the ECF? Na+
What is the primary cation in the ICF? K+
What is the primary anion in the ECF? Cl-
What is an electrolyte? mineral that carries electrical charge
The anion and cation are _____ in the ECF and the ICF. Electrically neutral
Where does Oncotic and Hydrostatic pressure normally occur? The Capillary
Osmotic Pressure does what? pull in
Hydrostatic Pressure does what? push out
What do Osmotic and Hydrostatic Pressures do? Control movement of water, nutrients and metabolic wastes between A) capillary plasma and B) interstitial fluid (ITF)
What is net filtration? balance of forces that favor vs oppose filtration
Which two pressures are favoring net filtration? CP Hydrostatic and ITF oncotic pressures
Which two pressures are opposing net filtration? CP Oncotic and ITF hydrostatic pressures
What end of the capillary does filtration and which end does reabsorption? Filtration: arterial Reabsorption: venous
Example # of Mercury for a net filtration pressure ( given in the chart in the slides) of the arterial end of the capillary +10 mm Hg(subtract the net hydrostatic pressure and net oncotic pressure)
Example # of Mercury for a net filtration pressure ( given in the chart in the slides) of the venous end of the capillary -8 mm Hg ( subtract the net hydrostatic pressure and net oncotic pressure)
What is the breakdown of the Net Hydrostatic Pressure in the arterial end of the capillary? Cap. Hydrostatic pressure= 37 mm Hg Interstitial fluid hydrostatic pressure = 2 mm Hg Net Hydrostatic Pressure= 35 mm Hg
What is the breakdown of the Net Oncotic Pressure in the arterial end of the capillary? Cap. Oncotic Pressure = 25 mm Hg Interstitial fluid oncotic pressure = 0 mm Hg Net oncotic Pressure= 25 mm Hg
What is the breakdown of the Net Hydrostatic Pressure in the venous end of the capillary? Cap. Hydrostatic Pressure=20 mm Hg Interstitial fluid hydrostatic pressure= 3 mm Hg Net filtration pressure= 17 mm Hg
What is the breakdown of the Net Oncotic Pressure in the venous end of the capillary? Cap. Oncotic pressure= 25 mm Hg Interstital fluid oncotic pressure= 0 mm Hg Net Oncotic Pressure= 25 mm Hg
What causes Increased hydrostatic pressure? venous obstruction, salt and water retention, due to congestive heart or renal failure
What causes decreased plasma albumin levels? liver disease, protein malnutrition, hemorrhage, burns
What causes increased Capillary plasma permeability? inflammation/ immune responses
What causes lymph blockage( Lymphedema)? infection, surgery
Fluid movement into tissue causes what specifically? Increased Na and water retention--> edema
What does lymph obstruction specifically cause? Decreased absorption of interstitial fluid--> edema
Loss of plasma proteins form increased capillary permeability causes what? Increased tissue oncotic pressure --> edema
What are the two different types of Edema? Localized and Generalized
What is dependent edema(pitting edema)? type of generalized edema characterized by changes with posture( feet and legs while standing; buttocks while lying down)
What are signs of dependent edema? weight gain, swelling, puffiness, limited movement of affected area.
What are some things that impact dependent edema? decreased capillary flow and increased diffusion distance impedes wound healing; edema of specific organs can be life-threatening ( like the heart)
What are some treatments for dependent edema? symptomatic until underlying disorder is corrected; support measures include elevating affected limb , restriction of salt intake, administration of diuretics
What is Water Balance maintained by? anti-diuretic hormone (ADH) -physiological/ endocrine and thirst - behavioral
The desire to drink water ( thirst) occurs when _____. 1) fluid volume loss equals 2% of body water e.i. hypovolemia 2) hyperosmolality occurs
What is ADH? Secretion by the posterior pituitary gland.
What is ADH stimulated by? What does it do? The same factors as water( hypovolemia or hyperosmolality). It acts to enhance water reabsorption in kidney, thereby increasing urine concentration.
What stimulates thirst and AHD? CNS osmoreceptors
What specifically stimulates AHD? Peripheral baroreceptors and volume sensitive receptors
Where are peripheral baroreceptors located? aorta, carotid sinus, and pulmonary vessels
Where are the volume sensitive receptors located? atria and thoracic vessels
Decreased circulating fluid volume or increased plasma osmolality has what affect on the body? increases thirst and increased ADH secretion.
Increasing ADH secretion does what? Which in turn does what? decreases water excretion which increases water retention
Increased water retention has what effect on the body? It increases circulating fluid volume and decreases plasma osmolarity. These in turn lower thirst and ADH.
What does the brain osmoreceptors detect? lowered plasma volume and increase plasma osmolality
What does the volume receptors detect? lowered plasma volume
Osmoreceptors and volume receptors pass on their detected levels of dec. plasma volume and inc. plasma osmolality to ______. Hypothalamus
What is the Hypothalamic-Posterior Pituitary Axis? The Hypothalamus transfers information to pars nervosa of posterior pituitary when then acts on ADH which causes renal water retention
What regulates Na+ balance? Kidneys
What is Aldosterone? a mineralocorticoid steroid hormone secreted by the adrenal cortex.
What does Aldosterone do? acts on the kidneys to increase urinary Na+ reabsorption/ K+ excretion( opposite actions on Na versus K)
How is Aldosterone regulated? By the Renin- angiostensin cascade
What happens when blood volume is low? The kidney secretes the enzyme renin which catalyzes the production of angiotensin 1 (ANG-1). ANG-I is cleaved to ANG-II by angiotensin- converting enzyme in the lungs.
What does Angiotensin II do? 1) stimulates aldosterone secretion from the adrenal cortex 2) causes vasoconstriction in the blood vessels
Anti- Natriuretic Peptides are produced by ______. The heart, brain, and kidney
What do Anti-Natriuretic Peptides do? They act on the kidney to increase Na+ excretion and K+ reabsorption to decrease blood pressure. ( opposite actions to aldosterone on Na+,K)
What produces Angiotensinogen? Liver
What all can increase Renin production from the kidney? Dec. Renal perfusion, Dec. Serum Na+, Inc. Urine Na+, Dec. ECF, Dec. Blood Pressure