[PPT]HYPEREMIA & CONGESTION IIhkmu.online/wp-content/uploads/2016/11/HYPEREMIA... · Web...
Transcript of [PPT]HYPEREMIA & CONGESTION IIhkmu.online/wp-content/uploads/2016/11/HYPEREMIA... · Web...
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HYPEREMIA & CONGESTION II
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HYPEREMIA AND CONGESTION:
There are 3 main basic requirements for normal circulatory function:-
Normal anatomic featuresNormal physiologic controls, andNormal biochemical composition of the blood.NB: These are essential to maintain normal
blood flow and perfusion of tissues
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Hyperemia and congestion cont--
• Derangements of blood flow or haemodynamic disturbances are considered under 2 broad headings:-
Disturbances in the volume of the circulating blood. These include:
Hyperemia and congestionHaemorrhage and shockCirculatory disturbances of obstructive nature: thrombosis, embolism, ischaemia and infarction
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DISTURBANCES IN THE VOLUME OF CIRCULATING BLOOD:
Hyperemia and congestion:Are the terms used for increased volume of
blood within dilated vessels of an organ or tissue.
Hyperemia (Active hyperemia):-Is the increased volume from arterial and
arteriolar dilatation Venous congestion (Passive hyperemia):Is the impaired venous drainage
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ACTIVE HYPEREMIA• The dilatation of arteries, arterioles and capilaries is effected
through; Sympathetic neurogenic mechanism or Via the release of vasoactive substances• The affected tissue or organ is pink or red in appearance
(erythema).• Examples of active hyperemia are:- Inflammation e.g. in pneumonia Muscular exercise High grade fever Blushing i.e. flushing in the skin of face in response to emotions.
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HYPEREMIA & CONGESTION• The dilatation of veins and capillaries due to
impaired venous drainage results in passive hyperemia or venous congestion, commonly referred to as congestion
• Congestion may be of 2 types:Acute congestion or Chronic congestion – this being more common and
is called Chronic Venous Congestion(CVC)• In CVC the affected tissue or organ is bluish in colour
due to accumulation of venous blood (Cynosis)
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Examples of disorders cont---• Passive congestion:-Mechanical obstruction due to thrombosis of veins of
lower legsVericositiesPressure by pregnant uterusTumours, etc • Postural oedema:-Transient oedema of feet and ankles due to increased
venous pressure seen in individuals who remain standing erect for a long time e.g.traffic constables
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CVC cont----
• Obstruction to the venous outflow may be local or systemic
• Accordingly, venous congestion may be of 2 types:
Local venous congestion:Results from obstruction to the venous
outflow from an organ or part of the body- e.g. portal venous obstruction in cirrhosis of
the liver, pregnancy, hernia, thrombosis
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CVC cont--
Systemic venous congestion:Is engorgement of systemic veins, e.g. - left-sided and right-sided heart failure - diseases of the lungs which interfere
pulmonary blood flow, such asPulmonary fibrosisEmphysema
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MORPHOLOGY OF CVC OF ORGANS
• Morphologic changes is seen most commonly in the lungs, liver, spleen and kidney
CVC LUNG:CVC of lung occurs in left heart failure, so that
there is consequent rise in pulmonary venous pressure.
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Morphology of lung cont--- Grossly:The lungs are heavyLungs are firm in consistencyThe sectioned surface of the lung is; - dark brown in colour, referred to as brown induration of
the lung due to the haemosiderin pigmentation and fibrosis
Histologically:The alveolar septa are widened due to; - interstitial oedema and - dilated and congested capillaries
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Morphology of lung histologically cont---
The septa are midly thickened due to; - slight increase in fibrous connective tissueMinute intra-alveolar haemorrhages due to - rupture of dilated and congested capillaries haemosiderin pigment due to; - breakdown of erythrocytesHeart failure cells – are alveolar macrophages
which has taken up haemosiderin pigment
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Lung-in heart failure (hemosiderin pigment, congestion)
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Lung: CVC perl’s prussian blue for iron (Fe+)
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Heart failure cells -lung
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Heart failure cells - lung
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MORHOLOGY cont---CVC LIVER:• Occurs in RHF or• Occlusion of inferior vena cava and hepatic vein Grossly:The liver is enlargedC/S – nutmeg appearance of liver due to:- - red and yellow mottled appearance corresponding
to ( congested centre of lobules and fatty peripheral zone respectively)
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NUTMEG LIVER
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NUTMEG LIVER
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NUTMEG LIVER
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CVC Liver cont--
Microscopically:More marked congestion in centrilobular
zone – due to severe hypoxiaCentral veins and sinusoids – distended and
filled with bloodCentrilobular hepatocytes-haemorrhagic
necrosis due to degenerative changes
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CVC Liver cont--
Long standing cases:- - fine centrilobular fibrosis - regeneration of hepatocytes – resulting in
cardiac sclerosis (cirrhosis) - fatty change of hepatocytes – in peripheral
zone of the lobule because this zone is less severely affected by chronic hypoxia
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CVC: LIVER-nutmeg around central vein from (RHF)
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LIVER: pronounced CVC(light yellow pigment”lipochrome” in necrotic hepatocytes) around central vein
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LIVER:longstanding CVC (cardiac sclerosis “cirrhosis”)
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CVC SPLEEN:
• Occurs in the following situations;Right-sided heart failure orPortal hypertension – due to cirrhosis of the
liverGrossly:-• Enlarged spleen• The organ is deeply congested and cynotic
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CVC SPLEEN CONT--Microscopically:• Red pulp:CongestionMarked sinusoidal dilatationAreas of recent and old haemorrhageOrganized areas of haemorrhage – called
Gamna gandy bodies or siderofibrotic nodules ( = are deposits of haemosiderin pigment and calcium salts) on fibrous connective tissue.
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CVC spleen-microcopically cont--
Late stages: - hyperplasia of microphages - hyperplasia of fibroblasts - hyperplasia of red pulp
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MORPHOLOGY OF THE KIDNEYGrossly:Slightly enlarged kidneysThe medulla is congestedMicroscopically:Degenerative changes of tubules: - cloudy swelling - fatty changeThe glomeruli: - mesangial proliferation