1. Hemodynamic Disorders
Hemodynamic Disorders
Edema
Edema
Hyperemia and Congestion
Hyperemia and Congestion
Hemorrhage
Hemorrhage
Hemostasis and Thrombosis
Hemostasis and Thrombosis
Embolism
Embolism
Infarction
Infarction
Shock
Shock
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Dr. Krishna Tadepalli, MD, www.mletips.com
2. Definitions
Definitions
Homeostasis maintaining blood as a liquid
Homeostasis maintaining blood as a liquid
Thrombosis Clotting at inappropriate sites
Thrombosis Clotting at inappropriate sites
Hemostasis Clotting at appropriate site (site of
Hemostasis Clotting at appropriate site (site of
injury)
injury)
Embolism migration of clots
Embolism migration of clots
Infarction obstruction of blood flow to tissues
Infarction obstruction of blood flow to tissues
and leads to cell death
and leads to cell death
Hemorrhage inability to clot after vascular
Hemorrhage inability to clot after vascular
injury
injury
Shock extensive hemorrhage can result in
Shock extensive hemorrhage can result in
hypotension and death
hypotension and death
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Dr. Krishna Tadepalli, MD, www.mletips.com
3. Edema = Increased fluid in the interstitial tissue spaces
Edema = Increased fluid in the interstitial tissue spaces
Anasarca: Generalized edema + profound subcutaneous
Anasarca: Generalized edema + profound subcutaneous
swelling
swelling
Pathophysiology
Pathophysiology
1. Increased Hydrostatic Pressure
1. Increased Hydrostatic Pressure
Most common cause --Congestive heart failure,
Most common cause Congestive heart failure,
others --DVT
others DVT
2. Decreased oncotic or osmotic Pressure
2. Decreased oncotic or osmotic Pressure
Nephrotic syndrome, Cirrhosis
Nephrotic syndrome, Cirrhosis
3. Sodium retention
3. Sodium retention
Renal failure, Renin- Angiotensin --Aldosterone
Renal failure, Renin- Angiotensin Aldosterone
4. Inflammation
4. Inflammation
Acute or chronic,
Acute or chronic,
Type of edema exudate in inflammatory and transudate
Type of edema exudate in inflammatory and transudate
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in non inflammatory conditions
in non inflammatory conditions
Dr. Krishna Tadepalli, MD, www.mletips.com
5. Edema
Edema
Morphology = Mostly involve Subcutaneous tissues, Lung,
Morphology = Mostly involve Subcutaneous tissues, Lung,
Brain
Brain
Subcutaneous ––can be pitting (Cardiac or renal disorders) or
Subcutaneous can be pitting (Cardiac or renal disorders) or
non ––pitting ((Thyroid disorders)
non pitting Thyroid disorders)
Pitting edema can be in dependent parts (at ankles in
Pitting edema can be in dependent parts (at ankles in
ambulatory and Back or sacrum in bedridden patientsambulatory and Back or sacrum in bedridden patientscardiac disorders) nondependent area ((periorbital in renal
cardiac disorders) nondependent area periorbital in renal
disorders)
disorders)
Lung or Pulmonary edema ––Most common in Left Heart
Lung or Pulmonary edema Most common in Left Heart
failure, lungs are wet and heavy, pink frothy fluid in alveoli
failure, lungs are wet and heavy, pink frothy fluid in alveoli
Cerebral edema – localized ((Abscess, Neoplasms) //
Cerebral edema – localized Abscess, Neoplasms)
Generalized
Generalized
((Encephalitis), narrowed sulci and distended gyri, fatal if edema
Encephalitis), narrowed sulci and distended gyri, fatal if edema
develops rapidly (due to cerebellar or Tonsillar Herniation)
develops rapidly (due to cerebellar or Tonsillar Herniation)
Clinical significance
Clinical significance
In Almost disorders causing edema, excess sodium re-absorption
In Almost disorders causing edema, excess sodium re-absorption
via Renin Angiotensin-Aldosterone pathway) is key factor
( (via Renin Angiotensin-Aldosterone pathway) is key factor
Treatment salt intake, Diuretics (↑sodium Excretion), Aldosterone
Treatment salt intake, Diuretics (↑sodium Excretion), Aldosterone
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antagonists
antagonists
Dr. Krishna Tadepalli, MD, www.mletips.com