HAEMODYNAMIC DISORDERS

2. HAEMODYNAMICDISORDERS 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 AcrossCapillary 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:

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 !