2. HAEMODYNAMIC DISORDERS
What is haemodynamics?
Dr. Afsar Saeed Shaikh
M.B.B.S, M.Phil.
Assistant Professor of Chemical Pathology
Pathology Department, KEMU, Lahore.

3. INTRODUCTION Health of Cells & Organs:
Uninterrupted Circulation (O2 & Nutrients, Wastes)
Normal Fluid & Electrolyte
Balance

4. INTRODUCTION (contin……)
Normal Fluid Homeostasis
Vessel Wall Integrity
Intravascular Pressure
Intravascular Osmolarity
(CONTIN…….)

5. INTRODUCTION (contin……)
Normal Fluid Homeostasis
Maintenance of blood as fluid
Formation of clot in case of injury

6. INTRODUCTION (contin……)
Abnormalities of Haemodynamic System
Primary (e.g. Pathology in discrete blood vessels like Hemorrhage, Thrombosis or Infarction)
Secondary (e.g. Pulmonary Edema, Shock etc.)

7. EDEMA Definition: “Increased Fluid in the Interstitial Tissue Spaces”
Also Includes:
Hydrothorax, Hydropericardium Hydroperitonium or Ascites and Anasarca.

8. Pathophysiological Classification
Inflammatory Edema
Non-Inflammatory Edema
Increased Hydrostatic Pressure
Reduced Plasma Osmotic Pressure
Lymphatic Obstruction
Sodium Retention

9. Pathophysiological Classification (Continued….)
Increased Hydrostatic Pressure:
Impaired Venous Return: (e.g. CCF, Constrictive Pericarditis, Liver Cirrhosis, Venous Obstruction)
Arteriolar dilatation: (e.g. Exposure to Heat, Neurohormonal dysregulation)

10. Pathophysiological Classification (Continued….)
Reduced Plasma Osmotic Pressure
Protein-Loosing Glomerulopathies (Nephrotic Syndrome)
Liver Cirrhosis (Ascites)
Malnutrition
Protein-Loosing gastroenteropathies

11. Pathophysiological Classification (Continued….)
Lymphatic Obstruction
Inflammatory
Neoplastic
Postsurgical
Postirradiation

12. Factors Affecting Fluid Balance Across Capillary Wall

13. Pathophysiological Classification (Continued….)
Sodium Retention
Excessive salt Intake with Renal Insufficiency
Increased Tubular Reabsorption of Na+
Renal Hypoperfusion
Incresed Renin-Angiotension-Aldosterone Secretion

14. HYPERMIA AND CONGESTION
Definitions:
“Both indicates a local increased volume of blood in a particular tissue. ”

15. HYPERMIA AND CONGESTION
Differences:
HYPEREMIA
CONGESTION 1
An active process
A passive process 2
Increased blood flow (vasodilatation)
Impaired blood flow 3
During exercise & in inflammation
Venous obstruction & cardiac failure 4
Oxygenated blood (Redder)
Deoxygenated blood (Cyanosed)

16. Normal Vasculature Regarding Blood Volume

17. Hyperemia

18. Congestion

19. Congestion (CPC of Liver; gross)

20. Congestion (CPC of Liver)

21. Hemorrhage Definition: “Extravasation of blood due to vessel rupture”
Types: (depending on the site, extent and location)
External
Internal
Hematoma: ‘Blood within the tissue’
(small; like a Bruise, or sufficiently large as to be fatal)

22. Hemorrhage Petechiae: Minute 1-2 mm
Into skin, mucous membrane, or serosal surfaces
Causes: Locally increased intravascular pressure, low platelet count, defect in platelet function, and deficiency of clotting factors.

23. Petechial hemorrhages of colonic mucosa as a consequence of thrombocytopenia

24. Hemorrhage Purpura: Slightly larger ≥ 3mm
All causes of Petechiae, plus
Secondary to trauma, vascular inflammation, and increased vascular fragility

25. Hemorrhage Ecchymoses: (Subcutaneous hematoma; Bruises)
Larger > 1-2 cm
Characteristically seen after trauma
Exacerbation of any of the aforementioned conditions

26. Hemorrhage Ecchymoses: (Colours changes in hematoma)
Hemoglobin (Red-blue)
Bilirubin (Blue-green)
Hemosiderin (Gold-brown)

27. Fatal intracerebral hemorrhage

28. Thank You !