HYPER A EMIA & CONGESTION

1. HYPERAEMIA &CONGESTION

2. Hyperemia & congestion • Both refer to a local increase in volume of blood in a particular tissue/site • Hyperemia– active, due to increased inflow • Congestion – passive, impaired outflow,

4. Hyperemia vs Congestion Hyperemia • active process • augmented inflow • arteriolar dilation. (skeletal muscle during exercise; sites of inflammation) • tissues are redder due to engorgement with oxygenated blood • Congestion • passive process • restricted outflow • venous obstruction; (local or systemic [CCF]). • tissues are cyanotic (blue) due to the accumulation of deoxygenated blood

5. Chronic passive congestion or Chronic venous congestion

6. There is stasis of poorly oxygenated blood • Results in chronic hypoxia

7. MORPHOLOGY Cut surfaces of hyperemic or congested tissues are hemorrhagic and wet • Hypoxia causes parenchymal cell degeneration and death with microscopic scarring • Capillary rupture results in hemorrhage • Breakdown and phagocytosis of RBCs cause accumulation of hemosiderin-laden macrophages

8. CVC LUNG

9. LUNG • Acute pulmonary congestion (Pulmonary edema) • Left heart failure, congestive heart failure • Lungs on gross- heavy with frothy fluid • Characterized by alveolar capillaries engorged with blood • Associated alveolar septal edema & / or focal intra alveolar hemorrhage

10. CVC - Lung • Etiology • Left ventricular failure, mitral stenosis • Gross • Heavy and wet initially • Late stages - Brown Induration of the lung (pigment + fibrosis) Lungs become brown & firm

11. Brown induration BROWN

12. MICROSCOPY • Chronic pulmonary congestion : EARLY - Alveolar capillaries are engorged Intra-alveolar granular pink precipitate • Later • Septa are thickened & fibrotic • Alveolar spaces contain hemorrhages & numerous hemosiderin laden macrophages ( heart failure cells)

14. C.V.C.OF LUNG (HEART FAILURE CELLS )

15. C.V.C.OF LUNG (HEART FAILURE CELLS)Perl’s stain – for hemosiderin

16. CVC LIVER

18. Congestion - Liver • Etiology • Right sided heart failure • Hepatic vein thrombosis • Inferior vena cava thrombosis • Acute hepatic congestion • Central vein & sinusoids are distended with blood • Central hepatocyte degeneration • Periportal hepatocytes – fatty change

19. CVC - Liver • Gross – Nutmeg Liver (red alternate with yellow) -Liver is enlarged, Capsule is tense • Central regions – Red brown (centrilobular hemorrhagic necrosis) • Surrounding zones - Uncongested liver tissue with fatty change lighter & pale yellowish

21. Zone 3 ischemia / centrilobular necrosis

22. centrilobular necrosis

23. Fatty change (Periphery)

24. Microscopy Long standing cases – hepatic fibrosis called “Cardiac cirrhosis” or Cardiac sclerosis

25. CVC SPLEEN

26. CVC Spleen • CVC causing splenic enlargement is called Congestive Splenomegaly • Etiology • Right heart failure • Cirrhosis • Portal vein thrombosis • Splenic vein thrombosis

27. Gross • Grossly; enlarged ,dark brown. • Firm spleen • Capsule is thickened and fibrous • C/S – Meaty, gray-red to deep red • White pulp is indistinct

28. CONGESTIVE SPLENOMEGALY

29. Microscopy • Red pulp is congested, mass increased with dilated sinusoids. • Atrophied white pulp. • Collagen deposition in the walls • Slowing of the blood in the rigid sinusoids • Foci of recent and old hemorrhages • Organisation of old hemorrhages – Gamna Gandy bodies( fibro siderotic nodules)

30. Gamna (Gamma) Gandy bodies Foci of fibrosis containing iron & calcium salts on connective tissue and elastic fibers

32. Brown induration • Heart failure cells • Nutmeg liver • “Cardiac cirrhosis” • Gamna-Gandy bodies

33. HAEMORRHAGE (bleeding)

34. Haemorhage • Extravasation of blood • Trauma, bleeding disorders, CVC, rupture of aneurysm

35. Hemorrhage from an insignificant injury is seen a number of hemorrhagic diatheses • External / internal • Hemorrhage may be external or internal • may be small (a bruise) or large (retroperitoneal, intraperitoneal) & potentially fatal.

36. Hemorrhage is categorized by size: • Petechiae – 1-2mm skin/ mucus membrane/ serosal surface elevated intravascular pressure, thrombocytopenia • Purpuras- >3mm trauma, vasculitis or increased vascular fragility

37. Haematoma-contained within a tissue • Ecchymoses - > 1-2cm subcutaneous hematomas or bruises, usually associated with significant trauma (bruise) but may occur with minimal trauma with clotting factor deficiencies • Haematomavshamartoma

38. petechiae, purpura joint bleed. ecchymoses

39. Petechiae

40. Ecchymoses

41. Ecchymoses

43. characteristic colour changes in a bruise • The RBC in these lesions are degraded & phagocytized by macrophages; • the hemoglobin (red-blue colour) • is enzymatically converted into bilirubin (blue-green colour) • & eventually into hemosiderin (gold-brown colour)

44. Minute hemorrhages Hamatoma

46. Clinical SignificanceofHemorrhage • Volume • Rate • Site

47. Rapid loss of up to 20% of blood volume or slow losses of larger volumes may be well tolerated by an otherwise unstressed individual. • Large volume / rapid – hypovolemic shock (cardiovascular collapse)

48. Large accumulations are named for their location: Hemothorax, hemopericardium, hemoperitoneum, hemarthrosis

49. Chronic external loss – iron deficiency anemia • Bleeding within the body cavities – iron is retained • Jaundice

50. ISCHAEMIA & INFARCTION