1. Hemodynamic Disorders

2. Hyperemia and Congestion Increased blood volume in a certain tissueIncreased blood volume in a certain tissue Hyperemia is an active process characterized by:Hyperemia is an active process characterized by: –Increased blood flow due to arteriolar dilatation Congestion is a passive process characterized by:Congestion is a passive process characterized by: –impaired blood flow from the tissue

3. Hyperemia Tissue is red due to engorgement by oxygenated blood

4. Congestion Tissue is blue due to engorgement by deoxygenated blood

5. Pulmonary Congestion Morphology Acute pulmonary congestion is characterized by alveolar capillaries engorged with blood and may be associated edema.Acute pulmonary congestion is characterized by alveolar capillaries engorged with blood and may be associated edema. Chronic pulmonary congestion, the alveolar septa are thickened and fibrotic and the alveolar spaces may contain numerous hemosiderin laden macrophages.Chronic pulmonary congestion, the alveolar septa are thickened and fibrotic and the alveolar spaces may contain numerous hemosiderin laden macrophages.

6. hemosiderin laden macrophages

7. Hepatic Congestion Morphology  Acute hepatic congestion: the central vein and sinusoids are distended with blood.  Chronic hepatic congestion: the central regions of the hepatic lobules are grossly red brown and depressed due to loss of cells, and the peripheral regions of the hepatic lobules are unaffected, the appearance is called nutmeg liver.

8. Liver with chronic passive congestion and hemorrhagic necrosis.

9. Liver Congestion

10. Fluid Balance

11. Water Balance Hydrostatic pressure Plasma colloid osmotic pressure Balance between these opposing factors is responsible for water balance

12. Edema Edema: Increased fluid in interstitial tissue spaces – Hydrothorax: Fluid in the pleural cavity – Hydropertonium (Ascites): Fluid in the peritoneal cavity – Anasarca: Severe generalized edema with profound subcutaneous tissue swelling

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

14. Causes of Edema T Increased Hydrostatic pressure 1Impaired venous Return i.Congestive Heart failure ii.Ascites iii.Venous obstruction or compression - Thrombosis - Extralumenal pressure - Lower limb inactivity with independency 2Arteriolar Dilatation i.Heat ii.Neurohormonal dysregulation

15. Causes of Edema T Reduced Plasma Colloid Pressure 1. Loss of Proteins i Glomerulopathy (nephrotic syndrome) ii Gastroenteropathy 2. Decreased Protein synthesis i Malnutrition ii Liver cirrhosis

16. Causes of Edema T Lymphatic Obstruction Inflammatory Inflammatory Neoplastic Neoplastic Postsurgical Postsurgical Postirradiation Postirradiation

17. Causes of Edema TSodium Retention Excessive intake (with renal failure) Excessive intake (with renal failure) Increased tubular reabsorption Increased tubular reabsorption Renal Ischemia Renal Ischemia Increased renin-angiotensin- aldosterone secretion Increased renin-angiotensin- aldosterone secretion

18. Causes of Edema T Inflammation Acute inflammation Acute inflammation Chronic inflammation Chronic inflammation Angiogenesis Angiogenesis

19. Hemorrhage Extravsation of blood from vascular spaces Extravsation of blood from vascular spaces Hemorrhage can be external or internal (enclosed within a tissue called Hematoma ) Hemorrhage can be external or internal (enclosed within a tissue called Hematoma ) Could be insignificant or significant causing death. Could be insignificant or significant causing death. Clinical significance of hemorrhage depends on: Clinical significance of hemorrhage depends on: – Volume and rate of blood loss rapid loss of up to 20% of the blood volume may have little impact in healthy adults. rapid loss of up to 20% of the blood volume may have little impact in healthy adults. great loss may cause hypovolemic shock great loss may cause hypovolemic shock – The site of hemorrhage (hemorrhage in the brain stem may cause death)

20. Types of Hemorrhages: Petechiae: minute hemorrhages (1-2 mm) into skin, mucous membranes or serosal surfaces. Associated with: Petechiae: minute hemorrhages (1-2 mm) into skin, mucous membranes or serosal surfaces. Associated with: –  Intravascular pressure,  Platelet counts, Defective platelet function,  Clotting factors. Petechiae in colonic mucosa

21. Types of Hemorrhages Purpuras: (3-5 mm) hemorrhages associated with similar conditions which cause petechiae, and trauma, vasculitis, increased vascular fragility. Purpuras: (3-5 mm) hemorrhages associated with similar conditions which cause petechiae, and trauma, vasculitis, increased vascular fragility. Ecchymoses: (1-2 cm) subcutaneous hematomas (bruises). Accompanied by RBCs which are degraded, phagocytosed, and characteristic color changes due to enzymatic conversion of Hb (red-blue) to bilirubin (blue-green) and eventually hemosiderin(Golden-brown). Ecchymoses: (1-2 cm) subcutaneous hematomas (bruises). Accompanied by RBCs which are degraded, phagocytosed, and characteristic color changes due to enzymatic conversion of Hb (red-blue) to bilirubin (blue-green) and eventually hemosiderin(Golden-brown). Areas of Ecchymoses, and areas of Purpuras

22. Types of Hemorrhages Large accumulations of blood in the body cavities; Hemothorax, Hemopericardium, Hemarthrosis, Hemoperitoneum. Large accumulations of blood in the body cavities; Hemothorax, Hemopericardium, Hemarthrosis, Hemoperitoneum. Hemopericardium

23. Clinical terms denoting various forms of hemorrhage Hemoptysis (spitting of blood) Hemoptysis (spitting of blood ) Hematemesis (vomiting of blood) Hematemesis (vomiting of blood) Hematochezia (passage of bloody stools) Hematochezia (passage of bloody stools) Melena (passage of dark colored stools) Melena (passage of dark colored stools) Hematuria (blood in urine) Hematuria (blood in urine) Metrorrhagia (acyclic bleeding from the uterus between periods) Metrorrhagia (acyclic bleeding from the uterus between periods)