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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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