Hemodynamic Disorders Dr. Mohammed Alorjani, MD EBP Department of Pathology JUST/ KAUH

Edema Edema: accumulation of fluid in the interstitial tissue space. Hydrothorax: Fluid in the pleural cavity Ascites: Fluid in the peritoneal cavity Anasarca: Severe generalized edema

Water Balance Plasma colloid osmotic pressure inflow of fluid to vascular spaces Increased hydrostatic pressure edema Balance between these opposing factors is responsible for water balance

Causes of Edema Increased Hydrostatic pressure Reduced Plasma Colloid Pressure Lymphatic Obstruction Sodium Retention Inflammation

Causes of Edema Impaired venous Return Arteriolar Dilatation Increased Hydrostatic pressure Reduced Plasma Colloid Pressure Lymphatic Obstruction Sodium Retention Inflammation Impaired venous Return i. Congestive Heart failure ii. Venous obstruction or compression - Thrombosis - Extraluminal pressure - Lower limb inactivity with independency Arteriolar Dilatation i. Heat ii. Neurohormonal deregulation

Causes of Edema Glomerulopathy (nephrotic syndrome) Increased Hydrostatic pressure Reduced Plasma Colloid Pressure Lymphatic Obstruction Sodium Retention Inflammation . Loss of Proteins Glomerulopathy (nephrotic syndrome) i Gastroenteropathy . Decreased Protein synthesis Malnutrition i Liver cirrhosis

Causes of Edema Inflammatory Neoplastic Postsurgical Post-radiation Increased Hydrostatic pressure Reduced Plasma Colloid Pressure Lymphatic Obstruction Sodium Retention Inflammation Inflammatory Neoplastic Postsurgical Post-radiation

Causes of Edema Excessive intake (with renal failure) Increased Hydrostatic pressure Reduced Plasma Colloid Pressure Lymphatic Obstruction Sodium Retention Inflammation Excessive intake (with renal failure) Increased tubular reabsorption Renal Ischemia Increased renin-angiotensin-aldosterone secretion

Causes of Edema Acute inflammation Chronic inflammation Angiogenesis Increased Hydrostatic pressure Reduced Plasma Colloid Pressure Lymphatic Obstruction Sodium Retention Inflammation Acute inflammation Chronic inflammation Angiogenesis

Cerebral Edema Extremely dangerous because brain is surrounded by rigid bones Enlarged brain with loss or flattening of gyri and narrowed sulci Increased intracranial pressure compromises the blood supply Severe edema may lead to herniation and death

Pulmonary Edema Fluid first accumulates in alveolar walls, then leaks to alveolar spaces. Dyspnea and cough (mild edema) Frothy pink sputum and cyanosis (severe edema)

Characteristics of Normal Circulation Closed system Separation of systemic and pulmonary systems Unobstructed blood flow Competent cardiac valves Adequate myocardiac function Normal rhythm and rate

Excessive blood in an organ or tissue Hyperemia: Excessive blood in an organ or tissue Hyperemia: Increased blood supply, can be physiologic or pathologic Congestion: Impediment of venous blood return

Hyperemia and Congestion Increased blood volume in certain tissue Hyperemia is an active process characterized by: Increased blood flow due to arteriolar dilatation Tissue is red due to engorgement by oxygenated blood (e.g. inflammation, exercising muscle) Congestion is a passive process characterized by impaired blood flow from the tissue Tissue is red blue due to accumulation of deoxygenated blood

Hemorrhage Extravasation of blood from vascular spaces Hemorrhage can be external or internal Hematoma is accumulation of blood in soft tissue Hemorrhage due to large vessel rupture is caused by injury trauma atherosclerosis inflammation neoplastic infiltrate