Logy Course 8

.IRCLL'\TORY D]STURBANC]ES

I

H.reFdia & congesti.n

Edema Edema is an excessve accumulation oflluid in r ssues and body cavlies unirf lamhatory (rransudale): ec@sd

-

pc

o p,och os

1sN).

Lw pr&

n

vihes

s

(cHl

nfiammalory {exudatel

Uninflammatory edema -

va

o!.op7 rqq.e rrer nq&drr

Mrcrosooov 6 qht@l!u ar sre In e,t6.eru;r mak \ (MEC) componenrs

Loca isation of the edemal

-

edema is mor€ iiequent

Y

encou

TvDes oi edema based on ihe slte oi nu d accumulaiion {iiiiersulium aid body caviues): htaiqsular: subculanmus. ma zedordftuse qene.a zed anasarca 4h.hisa*!ere andgeiera adema wih rssue and.:vrary M!on

Id

Subcutaneous edema : "-sa cafd ac edema :c.urs n congestive heartiailure

wiih high pH -subc!taneous edema depending on gravlly n areas wth increased pH)

generalized rcnal edema

-

occurs in renal dysiunction wrui low p c o.

subculaneous d ff!se edema fiiially developed perlorbllary

Pulmonary edema udeiaiu,e(miia

sienosb

+atd

ste. w h

trcshr d2.3

Gr€o

tansldd6 donreii)

a,

umes

rdhy/loamt nuid (:n coded), p4e pin' in.dor{bv he F*en.e

bois6lon

3nd

sePlar,:ite6rta

[email protected]|'

Cerebral edema ar€s (bd i absces

eai

n'""""

V,:

;.4 E.

cenera zed edema (6n€Pharts,

pg€pi|ary.9a6and.oose

2. HYPERAEMIA AND CONGESTION Hyperaemia = increase ofthe bood volume in a tissue or organ terrltory byvascular dllatation (distended wiih blood) Types of hyperaemia: -ac ve(hype'aenra o 3c1ve corsesliol) = i.c'easeo oiblood volume in a lissue oroean by arte olar

-

dilaialion (es inflammatory rocus, etc.). passive (stasis or passive coigesiion) = incrssed oi blood volume in a tssue of organ by venoLs bed dilatation (e.9. systemic cause n RCF orlo€lcause ir venous obslruclion)

PaSSiVe congestion (stasis) the lncrcase in blood volume in a tissue or organ territory by dilatation of capillary network. Causes: (a) loca jzed stasis venous obsiruciion (b) generallzed or systemic stasis left or right cardiacfailure (URCF)

) t

Pulmonary passive congestion (Lung stasis ) Pulmonary stasis occurs in chronic LCF dLre to rekograde venous blood stagnation n the ung. The most freqL]ent causes of LCF are HTA, Cland SA.

Macroscopy

ood), and

luno4senaled

b

ar.oh c had

rf brosis) and

henosydeine) = appe6nce

Microscopy

{n rohemo'lhase) and aid

Hepatic passive congestion (hepatic stasis)

.

iver stasis occurs in chronic RCF due to retfograde stagnation of venous blood in the vein cave system. the most frequent cause of RCF is pulmonary fbrosis of dlffereni causes.

Macroscopy

cedro ob! d 5,ea Grasc)

rB

l.d!a,dstldonleoistshq,s a6s ,esur|9 a

headFcentpde Ep a.ed

. yell@

byit

arss = a hepat c med

ss lcad

a.d tr6 n

hypolcst€loss cLobuar.r*s

l\/li.r^c.nn\,/

3. HEMORRHAGE Beed nq sthe escape ofblood from heart and vesses d!riio lile+vaious cond tions Bleeding rnay occLr invanous circumstancesl .ap ary ruplures + oeu.ln caplLary congeslron a/rer a and vedouB ruplures + occur ofien in ader ai and venouq card e ruplure ptuduced in ohesl lraumaormmp caled reat Types ofbLeeding o. hemorrhage l (a) exlenal bleed ns - the escaped b md

-

(bj

nremar bleedinq - lh€

esaped blood

. intaevharybrd ns (*rcus€v1*) . mrereir d bei 19lfrsslet

Types of external haemorrhages

Types of internal haemorrhages ' .

Lntracaviiary haemoilhages: - haemorhoa cDn€dbn olblood nlh6 pleu€L€vllv

-

'o.1o.o,ooodr.Eoe''dd".a''lJ

hemop€itoneum colleciion of blood n th€ perilonea joint cavlv h emarlhrosis @llection of blood in the

@'q

Interslifal bleeding in €lation with the volume of the

-

Pel*hiae-poinrlke bl€eding ol€pillary ongin 1na-u,a'raflo aqe- dfiuse b'"d'1S {rho r d +or'o' o ihe aff*led ussuesi' e g bruse I o' oaq a eo DLood tri di*.nion ihe affected i ssue

nierctitial haemorrhages

s ohrv b'ood haPmorhdres

.:";,""..""."

: o

-

=

pfpuc lo,er I r

-

i.- "o qq"

J-e!Nmruiurql.anbefala! Eo ;rebia h*mdoma6.ureit mEroaieurysms n NrA

Cerebral Haemorrhage

The clinical picture .

. .

The clin calsgn ficance of haenrorrhage depends on vo ume and raie of bleeding Rapid bleeding, in larse amount morc than 20% of blood volume produce dealh by lripovolem c

Chronic haemorfiage, in smallamount, depend ng on b eeding location, may occur: (a) death i nleresl v ta orSans{brain sleh)i (b)ferp ve anemla li interesl dfrereni otlier organs (chron c Peoiic ulcer)

4. THROMBOSIS

.oD

Path ogenesls There are 3 main iactorsthal pred sposelo tne fornal on of a thromb!s NnchofirLad):

, le€l

on

ii lh. r..:r lor

lstas s 0r

. rl and se3dndary (3cqu red) r.enel ''d.tsoihFdcoaauabjlltLod$s

tutu

encel

(prnary d sotue's sodeisl

d

Microscopy .

Thelhrombrs scomposeo0r

Fodre ibli (pormsz'

.

on

re h sto osda seciod (HE

o e6 iophi. rb h.onLadnq

isposition to thrombosis

Thrombus macr0scopy

Thrombi classification

Thrombi evolution Resoluloi hrcmbus lysis by r fi no !r d svst€m P,ooao.ton tbombus mav nneale n eze bv add

-

rhe

ng

neo aveB

retad o; ofhe thombus io rhe

'dbjle€lwlhrcmbusisrag|aodby deradhed and

ca

cf.ddn

6ried

o

he lhrombus can be alonq oflhe brod stEan b mp.d n a

Embo sm / Ihrombemhrsm: part

ofthethrcmbus bv imprcgnalion sith €lc um

6i

dd,N'd

*li

dery (osrrudrye srcmblt

Connective organized thrombi

Ma a(e,y rumei s odlealed aid

5, EMBOLISM Ernbolism (E) a pathological process characierized 's by caring of emboli in the blood stream, at djstance from point of origin, and obliteration of smaller blood vessels through an embolusEmbolus (e) is a solid, liquid or gas material, circulating in the blood, away from his point of origin.

Types of enrboli

i$!eFrer€nboal ErnboLLsm

il!id

wilh amr

Thrombembolism -:,, , -* d- c*"ea.brp'--r.-"-

, o!res naedtus6.nqcvd4* , -";.

,-

,."""

olc

Fluid embolism Fat embo lsm

-

)lipidic

.onsequE^.es lal

embol

q obu es rrom

s-c dp _o-ary 2ruF Amnioiiciuld embolism t amniotici!id emboi 'o-o.da1 bn d o.i a..o-ared ^r posipanufr delvratons/p.duf rion; is a malof €lse of maiem:l o.q n rupru,eol uler ne veiisal

sauamouire

s.4n

es63a.

b drr

p'd m

Gas embolism s a rare

-

fom ofembolism

Armaventer n the b@d n case ol a vein nc s oni as a €sul a€ lotn nq a r pulmod.ry mbd (obsi@tidn) NLtrooen mav enle. n lhe dcu aion as bubbre, or qas (ihis .ondil on oauE oft€n ro peBonEmtl nq al q€al depihs -

orcdud on ofors bubbLes

'

o /d4 f q* lbroodnfq"n) xf Lhebloodc@dioi (!*se

'n ds€ase 6birud od=d@mp'essoi

-

mon"to '"a- bra'' eabo (adre ischem:) sedoMai ehemicneDross oL

Emoo sm uonseouences .

.

Obstruction of the aderies with suppfession of blood circulation in the larrit^n, r ticc,'a ^f ^r ^rdrn .)(ischemlc necrosis) l\,4ay

be a cause of death in cases of

-rnassve embolism of main pulmonary adery cerebral embolism

6, ISCHEIVIIA chrcn. s.lr€ma: pa'13land grad!a

,

-

reduclon of lhe arler a fow causes aderardamages ass@iaied wilhwitb lumenal stenosis 1e g uncompicated arh€rcma.ATs)

(pros€ssve rep acement or the drdph ed tssre by r bos t A.ule schem a sudden and toialsuppresson ol the eneia flDw narobtruction 1oq comdcaled arhercfra Ars by thbmbG 3) . donsequ€nc*: ischemlc necrcsis 0nfdd)in the te.dlory ol distr burion ofa rssueor organ

'.doryora1$ue9iolgan

rar::

t

.

comEleres samp

.

Micb.coplc.rry a@le

tmphy=ceradaPrve

rc. a.

no of

lio tuohrc dairL

INFARCTION

C assif

€l

on or lhe inracbons

lintarcls aE

c

a$ifed basd

the amouni

01

losr b e€din9)

es or

acde

schemia

Myocardial infarction

[,4yocardial infarction microscopy

[,4yocafdial nlarcton nr rroscopy

er imb freme nophr..n0pasm rhe

(presef/ed eos

Renal Infarct ,-.-

:--':.

. 1,:',.: <1-

^er.s

s

(dtaoperai.a

or lhe

Splenic Infarct

Cerebral I nfarct

tr-

Pulmonary Infarct

.

I

nre

stinal i nf&.lion

i

causcd by

ob{ructi\elesions.frheupFerneTenrenodirea duel. (a) llnonbenrboli occludine a distll anery brdch; (b) obslructile thJonbosh deleloped or an ATS plaque ar $e level ofproxnml anerl seemenr, resuhing & c\tensile latal inlacti venous iniifction by $nngularion (snh rhepresence oJ Lhe heniarbagl. orlosion (inlhe case ofsienoidian lohalut

-

Necrotic ul4rinal scgme.li.rea da'k in color- *jlhlhick {all dnd baemonhaeic inihmtior Tnerc is a ncl lihil6eNleen inteni.al ne.r.ri. s.gnc.land adjacent nomral irteslinum Ilar beasso.iared*ith suppurallon.Il conplicates $i1h pefomlion d.d penlonnis (!c!le abd..r.i]