21. Mechanism of Edema
1.
Increase Intra-capillary
pressure ex. congestive heart
failure
2.
Decrease osmotic
pressure or decrease
albumin in plasma : ex.
Protein malnutrition
Hepatic failure , Hepatic cancer
Cirrhosis ( Decrease protein
synthesis )
Nephrotic syndrome ( Loss
protein in urine )
22. Mechanism of Edema
3.
Increase permeability : ex. Inflammation , Allergic
reaction , Endothelium anoxia , Toxin
4.
Lymphatic duct obstruction : So call “Lymphedema”
Elephantiasis from Filaria parasite infection (ex.Wuchereria
bancrofti , Brugia malayi and etc)
Metastasis malignancy ex.Lung cancer
Superficial lymphatic channels in Local invasion of malignancy
ex. Breast cancer may be show skin lesion call Orange peel
“peau d’orange”
5.
Sodium and water retension
33. Transudate
extravascular fluid
collection that is
basically an ultrafiltrate
of plasma with little
protein and few or no
cells. Fluid appears
grossly clear
ของเหลวใส หรื อไม่มีสี ไม่มีกลิน ไม่แข็งเป็ นก้อนเมือตั#งทิ#งไว้ (coagulate) มีโปรตีนน้อยกว่า 3 g% และความถ่วงจําเพาะ
น้อยกว่า 1.017
34. Exudate
extravascular fluid collection that is rich in protein and/or cells.
Fluid appears grossly cloudy
ของเหลวขุ่นหรื อใสมีสิงเจือปน มีหลากหลายสี บางครั#งมีกลิน และจะจับตัวเป็ นก้อนแข็งเมือตั#งทิ#งไว้ มีโปรตีนมากกว่า 3 g% และ
ความถ่วงจําเพาะมากกว่า 1.017
35. Effusions into body cavities can be
further described
1.
2.
3.
4.
Serous: a transudate with mainly edema fluid and few cells.
Serosanguinous: an effusion with red blood cells.
Fibrinous (serofibrinous): fibrin strands are derived
from a protein-rich exudate.
Purulent: numerous PMN's are present. Also called
"empyema" in the pleural space
51. Right side heart failure or Right
ventricular failure
Congestion in Superior , Inferior vena cava and
Hepatic vein
Sign and symptom
Nutmeg liver Result from congestion of central vein in
liver lobules
Cardiac cirrhosis
Ascites
Edema at legs or arms
52. Left side heart failure or Left
ventricular failure
Sign and symptom
Increase pulmonary wedge pressure can cause to
Pulmonary edema
Pulmonary congestion and edema
Heart failure cell หรื อ “Hemosiderin laden macrophage” in
pulmonary edema
Dyspnea and Orthopnea
62. Clinical correlation
Loss of 10-15% of total blood volume can be endured
without clinical sequelae in a healthy person, and blood
donation typically takes 8-10% of the donor's blood
volume
400-450 cc
63. Mechanism of hemorrhage
1.
Rhexis : Rupture of blood vessel
2.
Diapedesis : Leukocytes migrate along a chemotactic
gradient towards the site of injury or infection
65. Cause of hemorrhage
1.
2.
Trauma
Diseases of blood vessels themselves ex.scurvy ,
syphilitic , aortic aneurysm
3.
Diseases around blood vessels ex.local infections,
metastasis cancer
4.
5.
6.
Lack of clotting factors
Lack of platelets
High blood pressure ex.Stroke or cerebro-vascular
accident
66. Clinical finding of hemorrhage
1.
Petechial or Petichia hemorrhage (Petechiae) :
small spots of hemorrhage ( 1-3 mm)
2.
3.
Purpura : medium size of hemorrhage ( 3-10 mm)
Ecchymosis (Bruise or contusion wound ) : large size of
hemorrhage (>10 mm)
4.
Hematoma : Collection of blood
85. Major Causes of Excessive Bleeding
Platelet Deficiency
1.
1.
2.
Clotting Factor Deficiency
2.
1.
2.
3.
quantitative (thrombocytopenias)
qualitative (von Willebrandís disease)
single, i.e. hemophilia A (VIII) , B (IX), C(XI)
multiple, i.e. Vit. K deficiency –II ,VII , IX , X
Fibrinolytic hyperactivity
86. Thrombosis
Thrombosis is the formation of a clot or thrombus
inside a blood vessel, obstructing the flow of blood
through the circulatory system
88. Factor to induce Thrombosis
1.
Endothelium injury ex.vasculitis , hypertension,
smoking , electrocution , radiation injury
2.
Alterations in normal blood flow : Mean to
Turbulence blood flow or Static blood flow. Result from Cardiac
arrhythmia, Turbulence blood flow in Aneurysm , Valvular heart
disease , Prolonged bed-rest or immobilization
3.
Hypercoagulability state
89. Hypercoagulability state
Polycythemia vera
Hyperlipidemia
Malignancy : thrombogenic factor
Oral contraceptive use
Late pregnancy
Smoking
Sickle cell anemia
Congenital factor deficiencies : Lack of antithrombin III ,
protein S , Factor V-Leiden
Nephrotic syndrome : loss of protein S in urine
94. Embolism
embolism occurs when an object (the embolus,
plural emboli) migrates from one part of the
body (through circulation) and cause(s) a
blockage (occlusion) of a blood vessel in
another part of the body
95. Type of embolism
1.
Thrombotic embolus : embolus result from Thrombus
2.
Air embolism : Caisson disease
Oil/Fat embolus ex.Bone marrow embolism , fat embolism
Foreign body embolism
Neoplastic embolism
Amniotic fluid embolism
3.
4.
5.
6.
98. DIC
is a pathological process in the body where the blood starts to coagulate throughout the
whole body. This depletes the body of its platelets and coagulation factors, and there is
a paradoxically increased risk of hemorrhage. It occurs in critically ill patients,
especially those with Gram-negative sepsis (particularly meningococcal sepsis )
เป็ นภาวะทีมีการกระตุนขบวนการแข็งตัวของเลือด ทําให้เกิดลิมเลือดเล็ก ๆ
้
จํานวนมาก ซึงส่ วนใหญ่จะประกอบด้วยเกล็ดเลือด และไฟบริ น ไปอุดตัน
ตามหลอดเลือดขนาดเล็กของอวัยวะต่าง ๆ เช่นหัวใจ ปอด ตับ ม้าม ไต ลําไส้
ผิวหนังหรื อสมอง เป็ นต้น
106. Sign and symptom of shock
1.
2.
3.
4.
5.
Oliguria
Rapid pulse and weak
Thirsty
Rapid shallow breathing
Cold skin : but in Septic shock may be Warm skin
