Congestion

Question 1

What are three main types of congestion?

Answer 1

local acute
local chronic
generalised acute

Question 2

name an example of local acute congestion

Answer 2

DVT

Question 3

name an example of local chronic congestion

Answer 3

Hepatic cirrhosis

Question 4

name an example of generalised acute congestion

Answer 4

congestive heart failure

Question 5

Describe the pathophysiology of a DVT

Answer 5

• A thrombosis forms in the deep venous system
• This decreases the diameter of the lumen
• Less pressure gradient as the arterial pressure remains the same but the venous pressure increases
  therefore flow must decrease (flow=pressure/resistance)
• Less oxygen is being supplied
• Can result in ischaemia and infarction
• A sign of a DVT can be varicose veins

Question 6

Describe the pathophysiology of hepatic cirrhosis

Answer 6

• This occurs when the liver becomes damaged
• Liver cells regenerate to repair the damage but they dint grow back normally
• Fibrosis occurs as a result of altered blood flow ad abnormal architecture
• The portal veins (gut to the liver) have an increased pressure and cause an increased pressure downstream (in the gut)
• Therefore there is congestion in the liver, gut and spleen.
• Collaterals become dilated which can be a haemorrhage risk and can be visible sometimes.

Question 7

Name two ways the liver can become damaged

Answer 7

high alcohol intake

HBV

Question 8

When does congestive heart failure occur?

Answer 8

when the left and right ventricles cannot ump blood out effectively

Question 9

Describe the pathophysiology of generalised acute congestion.

Answer 9

there is a decreased cardiac output
BP is decreased
RAAS is activated in the loop of Henle to try increase the BP
this increases the permeability of the kidneys so more water is reabsorbed
this increases the plasma volume and can result in fluid over load and oedema because even with the increase of plasma volume, the heart can still not pump properly

Question 10

What does right heart failure cause

Answer 10

liver enlargement

less pre load, increase congestion in the liver

Question 11

What does left heart failure cause

Answer 11

pulmonary oedema, tachycardia

less blood leaving the heart, increased blood volume in the pulmonary circulation
the body increases the sympathetic tone to the heart to increase the contractibility of the heart to increase the cardiac output to normal as a rest of the baroreceptors having less stretch

Question 12

What is the macroscopic appearance of the liver if the patient has hepatic central venous congestion ?

Answer 12

spotty nutmeg: red/brown and pale

Question 13

What cells are red/brown and which cells are pale?

Answer 13

red/brown = pericentral 
pale = periportal

Question 14

What accumulates in the liver cells during congestion?

Answer 14

fat

Question 15

What appearance does the fat give to the liver cells?

Answer 15

yellow appearance

Question 16

What side of the heart has to fail to cause liver congestion?

Answer 16

right

Question 17

What are the three forces acting in a blood vessel?

Answer 17

hydrostatic - act outwards
oncotic - act inwards
endothelial permeability - act inwards