Hemodynamic disorders, thrombosis and shock (practical pathology)
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HEMODYNAMIC DISORDERS&
THROMBOSIS
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Edema
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Edema
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Normal alveoli
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Pulmonary Edema
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Fluid in Trachea/Bronchi
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Abdominal Ascites
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Edematous Brain
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Normal Brain
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Hyperemia and Congestion
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Congestion and Hyperemia
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CONGESTION AND HYPEREMIA
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Congested Lungs
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Acute Pulmonary Congestion
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“Heart Failure Cells” in Alveoli Chronic Pulmonary Congestion
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Congested and Enlarged Spleen
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Nutmeg Liver
• A descriptive term for a liver with chronic passive congestion, a hepatopathy due to cardiac decompensation and failure.
• If the congestion is severe, these changes may be accompanied by haemorrhagic necrosis
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Nutmeg liver
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Microscopically, the nutmeg pattern results from congestion around the central veins, as seen here.
This is usually due to a "right sided" heart failure.
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• Liver is divided histologically into lobules.
• The center of the lobule is the central vein.
• At the periphery of the lobule are portal triads.
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• Functionally, the liver can be divided into three zones, based upon oxygen supply.
• Zone 1 encircles the portal tracts where the oxygenated blood from hepatic arteries enters.
• • Zone 3 is located around central veins, where
oxygenation is poor. Zone 2 is located in between.
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Hemorrhage
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• Petechiae measure less than 3 mm.
• Purpura measure 0.3–1 cm.
• Ecchymoses greater than 1 cm.
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• Here are petechial hemorrhages seen on the epicardium of the heart.
• Petechiae (pinpoint hemorrhages) represent bleeding from small vessels and are classically found when a coagulopathy is due to a low platelet count.
• They can also appear following sudden hypoxia.
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• The blotchy areas of hemorrhage in the skin are called ecchymoses (singular ecchymosis), or also as areas of purpura.
• Ecchymoses are larger than petechiae. • They can appear with coagulation disorders.
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Intracerebral Hemorrhage
Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.
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Intracerebral Hemorrhage
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Pericardial Hemorrhage
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Hemostasis and Thrombosis
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THROMBOSIS -Virchow triad
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Thrombus - MorphologyArterial
Arise in arteries
Grow in retrograde fashion (towards the heart)
Forms at site of Endothelial injury (AS), turbulence (aneurysms)
Pale/ white
Lines of Zahn
Venous
Arise in deep veins and superficial veins (popleteal Femoral Iliac),
Antigrade
At site of stasis (lower extremities)
Red / dark
No lines of Zahn
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• These are "lines of Zahn" which are the alternating pale pink bands of platelets with fibrin and red bands of RBC's forming a true thrombus.
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Venous Thrombi: Clinical
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Thrombotic VegetationsMitral Valve
Photo: Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.
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Abdominal Aortic Aneurysm Thrombus
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Deep Vein Thrombosis (DVT)
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Plaque with Recent Thrombus
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ThrombosisOutcomes
Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.
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Early Organizing Thrombus
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Embolism
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Embolization (Embolus)Thromboembolism of Pulmonary Artery
Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003; . Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.
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Infarction
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Infarction (Infarct)Lung (Left); Spleen (Right)
Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.
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Pulmonary Infarction
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Small Intestine Infarction
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Kidney InfarctionReplaced by Fibrotic Scar (Left)
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Pale Infarct (Wedge) of Spleen
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Thanks