Bio 570 Test1 _Lecture 5_

Front 1

What is edema?

Back 1

=The accumulation of fluid within the interstitial spaces.
=”water balance”-can indicate fluid excess or sequestered fluids.

Front 2

Define mechanism of “forces” causing edema.

Back 2

= (forces favoring fluid movement from the capillaries or lymphatic channels into tissues)

Front 3

Name the forces or causes of edema.

Back 3

=increased hydrostatic pressure, lowered plasma oncotic pressure, increased capillary membrane permeability, lymphatic obstruction.

Front 4

Describe causes of increased capillary hydrostatic pressure Pc.

Back 4

venous obstruction, salt and water retention (Pc-favoring force, L heart failure, fluid moves across from blood side to interstitial side).

Front 5

Name the causes of venous obstruction.

Back 5

=, thrombophlebitis, hepatic obstr, tight clothing, prolonged standing

Front 6

Name the causes of salt and water retention

Back 6

=CHF, renal failure (causing vol overload and edema)

Front 7

Define decreased capillary oncotic pressure c?

Back 7

lost or diminished plasma albumin production (decreased oncotic attration of fluid within the capillary causes fluid to move into interstitial spaces. ) ie. If this press decreases, more water goes across cell wall

Front 8

Name primary causes of decreased capillary oncotic pressure

Back 8

liver disease, protein malnutrition, loss via : glomerular kidney dz, serous drainage via open wounds, hemorrhage, burns (permeability changes), cirrhosis. )

Front 9

What causes increased capillary membrane permeability?

Back 9

=inflammation and immune responses, trauma like burns or crushing, neoplastic dx, allergic rxns.

Front 10

Describe the mechanism of edema caused by increased capillary membrane permeability.

Back 10

=proteins escape from the vasc bed via loss of capillary oncotic and interstitial fluid protein accumulation.

Front 11

Describe lymphatic obstruction edema.

Back 11

Lymphatic system normally absorbs interstitial fluid and sm amnt proteins.
-blocked channesl or surgical removal causes proteins and fluid accumulation in interstitial space. Ie. Wont dreain interstitial compartment, interstitial oncotic pressure increases and pulls fluid=edema

Front 12

Give examples of mechanisms that cause Lymphatic obstr

Back 12

=lymphedema of arm or leg occurs ater sufg femoval of axil/fem lymph nodes for ca tx
=inflammation or tumors

Front 13

Clinical manifestations of edema?

Back 13

=localized (site of trauma) or generalized (cerebral, pulmonary, pleural eff, pericardial eff, ascites.

Can have dehydration with edema; it is in the 3rd space and unavail for metabolic processes ie, sequestering with burns reducing plasma vol causing shock.

Front 14

Sodium, Chloride, and Water balance

Back 14

water follows the osmotic gradients established by changes in salt concentration, therefore, sodium and water balance are intimately related.

Front 15

What is water balance primarily regulated by?

Back 15

=ADH, anti-diuretic hormone or vasopressin, and the perception of thirst.

Front 16

What is sodium regulated by?

Back 16

Aldosterone

Front 17

When is thirst stimulated?

Back 17

=when water loss equals 2% indv body weight, or when there is an increase in osmolality.

Front 18

Name three receptors that trigger you to drink fluid.

Back 18

=osmoreceptors (thirst), volume sensitive receptors, and baroreceptors (pressure)

Front 19

Define osmoreceptors –

Back 19

=neurons in the hypothalamus which are activated by hyperosmolality and plasma volume depletion causing thirst.

Front 20

What causes ADH secretion?
(water balance is controlled by ADH secretion)

Back 20

=stimulus for release of ADH is sensed by the hypothalamus.
=1)when plasma osmolality increases (the higher the osmolality, the more nervous system discharges to pituitary to release ADH
2) circ blood vol decreases and bp drops.

Front 21

When does increased plasma osmolality occur and what does it result in?

Back 21

=occurs with water deficit or sodium excess in relation to water. ,
=results in a fall in extracellular and interstitial fluid vol, stimulating hypothalamic osmoreceptors.

Front 22

In addition to causing thirst, what do osmoreceptors stimulate?

Back 22

=stimulate the posterior pituitary gland to release ADH to the kidney/

Front 23

What is the function of ADH?

Back 23

=increases the permeability of 2 parts of nephron (distal tubule and collecting duct) to water causing water reabsorption (aquaporin flos) into plasma.

Front 24

What results in secretion of ADH?

Back 24

=increased urine concentration (>290-300mOsm), decreased plasma osmolality returning it to normal

Front 25

What happens if osmolality in blood is dilutes?

Back 25

ADH will not be released (need to rid water) and you need to reabsorb sodium (urine will become dilute (100mOsm)

Front 26

Define Baroreceptors.

Back 26

=nerve endings that are sensitive to changes in volume and pressure.

Front 27

When do baroreceptors and volume-sensitive receptors kick in and what do they stimulate?

Back 27

=Dehydration from vomiting, diarrhea, excessive sweating.
=stimulate pituitary to release ADH

Front 28

Where are the volume receptors located?

Back 28

=r and l atria, thoracic vessels,

Front 29

Where are the baroreceptors found?

Back 29

=aorta, pulm a., carotid sinuses

Front 30

Name other causes of ADH secretion which promotes reabsorption of water causing restoration of plasma volume.

Back 30

=ABP drop, decreased blood vol,

Front 31

What is the functional unit of the Kidney

Back 31

Nephron
??

Front 32

what is controled by adh?

Back 32

water balance. adh inserts aquaporins (water out to decrease blood osmolalilty)
ADH r/b pituitary, increases water permeability of distal tubule and collecting duct

Front 33

describe hypothalmus activity through adh activity

Back 33

-hypothalmus senses thirst mechanism via osmoreceptors
-stim pituitary to secrete adh= released by post pituitary into bloodstream,
-goes to kidney, =increased water permeability at collecting duct and distal tubule in the nephron.=
-ADH leads to aquaporin insertion and water flow
-at these 2 areas back to bloodstream-
-urine could reach 1200 mOsm if needed

Front 34

what else.........

Back 34

-with the presence of adh, you reabsorb water and produce a concentrated urine (greater than in blood (290-300mOsm)
-if osmolality in blood is dilute, adh will not be released (you need to rid water and reabsorb sodium. urine will be dilute (100 mOsm)

Front 35

insert weird diagram

Back 35

here

Front 36

what are the major ions in the ECF

Back 36

-sodium (cation)=90%of cations in ECF
-chloride (anion)=major anion, follows the cation (NA) wherever it goes.

Front 37

What is NA regulated by?

Back 37

ALdosterone in the adrenals. with low na or high k (countertransported via the na-k pump leading to release of K=

Front 38

what are the char of aldosterone?

Back 38

is increased socium reabsorbtion in distal tubule and collecting duct.

Front 39

what are the char of aldosterone?

Back 39

-low NA or high K is detected in blood
-adrenals are stimulated to release aldosterone
-aldosterone goes to distal and collecting duct to cause..
-increases Na eabsorption (& usually water follows NA) by distal tubule and collecting duct
-K+ then gets moved out and into urine decreasing serum k+
-this increases osmolality back to normal

Front 40

Give example

Back 40

If your blood volume and BP are high, your kidney should be stimulated to get rid of volume. you have to have a mech to lose the sodium and have water follow.
-ie atrial stretcing/high volume
-ie. natriuretic hormone (from atrial muscle) promotes NA excretion

Front 41

List Abnormalities in Tonicity

Back 41

1)Isotonic (no change in cell volume)
2) Hypertonic (cell shrinks)
3)Hypotonic (cell swells)

Front 42

Describe in detail Isotonic alteration

Back 42

-have to lose equal amnts of solute/Na and water. Mechanism is gain or loss of ECF, so osmolality hasnt changed, volume should not change

Front 43

What are the causes of depletion in isotonic alterations?

Back 43

-Hemorrhage
-hypovolemia
-Hypovolemic shock
=loss of osmolytes and water

Front 44

What are the causes of Excess in isotonic alterations?

Back 44

-Conn's disease(affects aldosterone)/tumors, excess IV=hypervolemia which causes Pulm edema, wt gain decreased hct
-

Front 45

What constitutes hypertonic abnormality/

Back 45

def=
NA gain, water loss
causes
=hyperosmotic saline
=hyperaldosteronism (lots reabsorbed NA, water not following-peeing it)
-=hypovolemia

Front 46

What are the results of hypertonic abnormalities?

Back 46

-RESULT
=water moves to ECF due to gradient set up by sodium movement to ECF
=dehydration in your cells (cells shrink)
=convulsions and edema due to intracellular dehydration

Front 47

describe hypertonicity caused by hypernatremia

Back 47

def=NA gain, above 147, resultinng in water loss in icf, causes =
hyperosmotic saline
-hyperaldosteronism increased ald causes na reabsorbtion water not following so pee it out
- hypovolemia

Front 48

what are electrolyte states in hypertonicity

Back 48

high sodium-hypernatremia
water defecit inside cell
hyperchloremia

Front 49

what does hypernatremia hypertonic state result in?

Back 49

-water moves to ecf due to gradient so dehydrated cell
--cell shrinks due to na to ecf with water following
-dehydration in cells
-convulsions and edema

Front 50

IN water deficit hypertonicity, what is the definition?

Back 50

Increased water clearance (leads to Na levels higher outside of the cell-causing water to move out)

Front 51

IN water deficit hypertonicity, what are the causes?

Back 51

Renal desease
DI

Front 52

IN water deficit hypertonicity, what does it result in?

Back 52

hypovolemia intracellularly

Front 53

IN Hyperchloremia hypertonic state, what is mechanism?

Back 53

-With too much NA (CL follows), or deficit of HCO3 (if u have ecf deficit of hco3, it has movede into the cell, cl is then countertransported out of the cell.

Front 54

what does hyperchloremia result in?

Back 54

Increases in CL (& NA) result in increased osmotic pressure, pulls fluid,=cellular dehydration=convulsions and edema.

Front 55

what are the characteristics of hypotonic abnormailities?

Back 55

sodium less than 135
water gain or solute loss
causes cell to swell

Front 56

Name 3 types of hypotonic abnormal states

Back 56

1) hyponatremia
2)water excess
3) Hypochloremia

Front 57

Describe results of Hyponatremia

Back 57

-contracts ECF, hypovolemia, brain swells, systemic edema

Front 58

What causes hyponatremia

Back 58

vomiting, diarhea

Front 59

Wath causes water excess

Back 59

excessive water intake, renal failure, heart failure, siadh

Front 60

what causes hypochloremia

Back 60

is the result of low sodium or excess bicarb
to much bicarb or too little sodium so prob with renal function

Front 61

Name the two potassium alterations

Back 61

hypokalemia=ECF<3.5 mMol
hyperkalemia=ECF>5.5 mMol

Front 62

what are causes of hypokalemia

Back 62

-decreased intake
-increased k entry-more k moving into than supposed to as in alkalosis. u can decrease your ph, correct your alkalosis, via bringing protons out of the cell, via k-proton exchanger (k in, proton out)
-increased k loss via vomitting and diarrhea

Front 63

what does hypokalemia lead to?

Back 63

-impaired renal function
-decreased neuromuscular excitability (k involved neuromusc systems) so cant contract
-skeletal muscle weakness
-dysrythmias

Front 64

Char of Hyperkalemia?

Back 64

k+>5.5
-increased intake
-decreased excretion
-increased secretion (in renal but unlikely)
-increased (k exit from cells) going to ECF

Front 65

what does hyperkalemia lead to?

Back 65

-muscle weakness
-paralysis
-fibrilation
-cardiac arrest