Hemodynamic DisordersHemodynamic Disorders

Hyperemia and CongestionHyperemia and Congestion• Increased blood volumeIncreased blood volume in a certain tissue in a certain tissue

• Hyperemia is an Hyperemia is an activeactive process characterized by: process characterized by:– Increased blood flow due to Increased blood flow due to arteriolar dilatationarteriolar dilatation

• Congestion is a Congestion is a passivepassive process characterized by: process characterized by:– impaired blood flow from the tissueimpaired blood flow from the tissue

HyperemiaHyperemia

Tissue is Tissue is redred due to engorgement by due to engorgement by oxygenatedoxygenated blood blood

CongestionCongestion

Tissue is Tissue is blueblue due to engorgement by due to engorgement by deoxygenateddeoxygenated bloodblood

Pulmonary Congestion Pulmonary Congestion MorphologyMorphology

• Acute pulmonary congestion is Acute pulmonary congestion is characterized by alveolar capillaries characterized by alveolar capillaries engorged with blood and may be engorged with blood and may be associated edema.associated edema.

• Chronic pulmonary congestion, the Chronic pulmonary congestion, the alveolar septa are thickened and alveolar septa are thickened and fibrotic and the alveolar spaces may fibrotic and the alveolar spaces may contain numerous hemosiderin laden contain numerous hemosiderin laden macrophages.macrophages.

hemosiderin laden macrophageshemosiderin laden macrophages

Hepatic Congestion Hepatic Congestion MorphologyMorphology

Acute hepatic congestion: the central vein Acute hepatic congestion: the central vein and sinusoids are distended with blood.and sinusoids are distended with blood.

Chronic hepatic congestion: the central Chronic hepatic congestion: the central regions of the hepatic lobules are grossly regions of the hepatic lobules are grossly red brown and depressed due to loss of red brown and depressed due to loss of cells, and the peripheral regions of the cells, and the peripheral regions of the hepatic lobules are unaffected, the hepatic lobules are unaffected, the appearance is called appearance is called nutmeg liver.nutmeg liver.

Liver with chronic passive congestion and hemorrhagic necrosis.

Liver CongestionLiver Congestion

Fluid Balance

Water Balance

• Hydrostatic pressure

• Plasma colloid osmotic pressure

Balance between these Balance between these opposing factors is opposing factors is

responsible for water responsible for water balancebalance

EdemaEdema

• Edema: Increased fluid in interstitial tissue spaces

–Hydrothorax: Fluid in the pleural cavity–Hydropertonium (Ascites): Fluid in the

peritoneal cavity–Anasarca: Severe generalized edema

with profound subcutaneous tissue swelling

Causes of EdemaCauses of Edema

• Increased Hydrostatic pressureIncreased Hydrostatic pressure• Reduced Plasma Colloid PressureReduced Plasma Colloid Pressure• Lymphatic ObstructionLymphatic Obstruction• Sodium RetentionSodium Retention• InflammationInflammation

Causes of Edema Increased

Hydrostatic pressure

1 Impaired venous Returni. Congestive Heart failureii.Ascitesiii. Venous obstruction or

compression- Thrombosis- Extralumenal pressure- Lower limb inactivity with independency

2 Arteriolar Dilatationi. Heatii.Neurohormonal dysregulation

Causes of Edema

Reduced Plasma Colloid Pressure

1. Loss of Proteins. Loss of Proteinsi Glomerulopathy Glomerulopathy (nephrotic (nephrotic syndrome)syndrome)ii Gastroenteropathyi Gastroenteropathy

2. Decreased Protein . Decreased Protein synthesissynthesis

i MalnutritionMalnutritionii Liver cirrhosisi Liver cirrhosis

Causes of Edema

Lymphatic Obstruction

• InflammatoryInflammatory• NeoplasticNeoplastic• PostsurgicalPostsurgical• PostirradiationPostirradiation

Causes of Edema

Sodium Retention • Excessive intake (with renal Excessive intake (with renal failure)failure)

• Increased tubular Increased tubular reabsorptionreabsorption

• Renal IschemiaRenal Ischemia• Increased renin-angiotensin-Increased renin-angiotensin-aldosterone secretionaldosterone secretion

Causes of EdemaCauses of Edema

Inflammation • Acute inflammationAcute inflammation• Chronic inflammationChronic inflammation• AngiogenesisAngiogenesis

HemorrhageHemorrhage

• Extravsation of blood from vascular spacesExtravsation of blood from vascular spaces• Hemorrhage can be external or internal Hemorrhage can be external or internal

(enclosed within a tissue called (enclosed within a tissue called Hematoma )Hematoma )• Could beCould be insignificant or significant causing insignificant or significant causing

death.death.• Clinical significance of hemorrhage depends on:Clinical significance of hemorrhage depends on:– Volume and rate of blood loss Volume and rate of blood loss • rapid loss of up to 20% of the blood volume rapid loss of up to 20% of the blood volume

may have little impact in healthy adults.may have little impact in healthy adults.• great loss may cause hypovolemic shockgreat loss may cause hypovolemic shock

– The site of hemorrhage (hemorrhage in the The site of hemorrhage (hemorrhage in the brain stem may cause death)brain stem may cause death)

Types of Hemorrhages:Types of Hemorrhages:

• Petechiae: minute hemorrhages (1-2 mm) into Petechiae: minute hemorrhages (1-2 mm) into skin, mucous membranes or serosal surfaces. skin, mucous membranes or serosal surfaces. Associated with:Associated with:– Intravascular pressure, Intravascular pressure, Platelet counts, Platelet counts,

Defective platelet function, Defective platelet function, Clotting factors. Clotting factors.

Petechiae in Petechiae in colonic colonic mucosamucosa

Types of HemorrhagesTypes of Hemorrhages

• Purpuras: (3-5 mm) hemorrhages associated with Purpuras: (3-5 mm) hemorrhages associated with similar conditions which cause petechiae, and similar conditions which cause petechiae, and trauma, vasculitis, increased vascular fragility.trauma, vasculitis, increased vascular fragility.

• Ecchymoses: (1-2 cm) subcutaneous hematomas Ecchymoses: (1-2 cm) subcutaneous hematomas (bruises). Accompanied by RBCs which are degraded, (bruises). Accompanied by RBCs which are degraded, phagocytosed, and characteristic color changes due phagocytosed, and characteristic color changes due to enzymatic conversion of Hb (to enzymatic conversion of Hb (redred-blue) to bilirubin -blue) to bilirubin (blue-(blue-greengreen) and eventually hemosiderin(Golden-) and eventually hemosiderin(Golden-brownbrown).).

Areas of Areas of Ecchymoses, Ecchymoses, and areas of and areas of PurpurasPurpuras

Types of HemorrhagesTypes of Hemorrhages

• Large accumulations of blood in the body Large accumulations of blood in the body cavities; Hemothorax, Hemopericardium, cavities; Hemothorax, Hemopericardium, Hemarthrosis, Hemoperitoneum. Hemarthrosis, Hemoperitoneum.

Hemopericardium

Clinical terms denoting various forms Clinical terms denoting various forms of hemorrhageof hemorrhage

• Hemoptysis (spitting of bloodHemoptysis (spitting of blood ))• Hematemesis (vomiting of blood)Hematemesis (vomiting of blood)• Hematochezia (passage of bloody stools)Hematochezia (passage of bloody stools)• Melena (passage of dark colored stools)Melena (passage of dark colored stools)• Hematuria (blood in urine)Hematuria (blood in urine)• Metrorrhagia (acyclic bleeding from the Metrorrhagia (acyclic bleeding from the

uterus between periods)uterus between periods)