2. Fluid and Hemodynamic Disorders

3. Where’s my water? Intracellular Ions
Ion specific gates in cell membrane
Cellular proteins
Extracellular
Interstitial (between the cells) Lymph
Intravascular
Blood
Lymphatic fluid

4. Movement of water in the vascular system
Hydrostatic, the pumping pressure
Heart
Skeletal muscle action
Oncotic or osmotic, holds fluid in.
Proteins such as albumin
Cellular elements such as RBCs

5. Intracellular & Extracellular Water

7. Things can go wrong Heart failure Kidney failure Myocardial infarction
Pulmonary emobolus
Tissue congestion
Edema

8. Edema Too much extracellular fluid. Swelling Localized or Generalized
tumor
Localized or
Generalized
Dependent
action of gravity

9. Tansudate or Exudate? Exudate Inflammatory water
Part of the inflammatory reaction
Rubor, dolor, calor, tumor
Purposeful and intentional
Localized

10. Tansudate or Exudate? Transudate Leakage, not part of healing
Increased hydrostatic pressure
Heart failure
Lymphatic obstruction
Decreased oncotic pressure
Decreased albumin

11. Congestive Heart Failure

12. Congestive Heart Failure

13. Passive Congestion

14. Chronic Passive Congestion, Nutmeg Liver

15. Chronic Passive Congestion

16. Pulmonary Edema

17. Pulmonary Edema

18. Pulmonary Edema

19. Pitting Edema

20. Lymphedema

21. Papilledema

22. Water in Hollow Spaces Hydrothorax Hydropericardium Hydroperitoneum
Ascites

24. Healthy Blood Clotting
Platelets
Vessels
Clotting Proteins

25. Healthy Clotting

26. Clotting Factors

27. Factor Activation

29. Hematoma

30. Petechiae

31. Thrombosis A pathological clot
A clot forming in the fixed vascular system.

32. Thrombosis Endothelial damage Stasis and clotting factor activation
Clotting factor abnormalities
Too many clotting proteins
Pregnancy
Cancers
Too little inhibition
Abnormal factors
Leiden Factor (abnormal V)

33. Thrombosis

34. Thrombosis Arterial Side Thrombi Venous Side Thrombi
Platelet activation
Endothelial cell injury
Venous Side Thrombi
Stasis
Clotting factor activation

35. Coronary Artery Thombosis
Angiogram

36. Acute Myocardial Infarction

37. Mural Thrombus

38. Aneurysm with Thrombus

39. Deep Leg Vein Thrombosis

40. Airplane Travel
Gunner turret

41. Outcomes of a DVT

42. Embolus Space occupying mass moving in the fixed vascular system
Blood clot
Bone Fragments
Amniotic Fluid
Air

43. Pulmonary Embolus

44. Pulmonary Embolus

46. Infarction Anemic Hemorrhagic End artery supply No blood White
Venous occlusion
Loose tissues
Dual blood supply
Red

47. Anemic Infarct

48. Anemic Infarct

49. Cerebral Infarction

50. Hemorrhagic Infarct

51. Shock Poor perfusion Tissue hypoxia Tissue acidosis Many causes
Poor pumping by heart
Low blood volume
Loss of fluid
Overwhelming infections

52. Types of Shock Cardiogenic Hypovolemic Anaphylaxis Septic
Decreased output
Hypovolemic
Blood loss
Fluid loss
Anaphylaxis
IgE and histamine
Septic
Gram negative rods
Toxins

53. What Happens Next? Compensated Decompensated Irreversible Fluid shifts
Progression possible
Irreversible
No recovery

54. The Shock Spiral

55. Summary Fluid shifts Excessive tissue water Clot formation Thrombosis
Oncotic & Hydrostatic Pressures
Excessive tissue water
Exudate vs. Transudate
Clot formation
Vessels, platelets & proteins
Thrombosis
Pathological clot
Arterial = endothelial damage & platelet activation.
Venous = stasis and factor activation

56. Summary Infarction Ischemic = end artery organ
Hemorrhagic = venous or dual blood supply
Tissue vulnerability
Brain
Kidney
muscle