HAEMODYNAMIC DISORDERS What is haemodynamics? Dr. Afsar Saeed Shaikh M.B.B.S, M.Phil. Assistant Professor of Chemical Pathology Pathology Department, KEMU, Lahore.

INTRODUCTION Health of Cells & Organs: Uninterrupted Circulation (O2 & Nutrients, Wastes) Normal Fluid & Electrolyte Balance

INTRODUCTION (contin……) Normal Fluid Homeostasis Vessel Wall Integrity Intravascular Pressure Intravascular Osmolarity (CONTIN…….)

INTRODUCTION (contin……) Normal Fluid Homeostasis Maintenance of blood as fluid Formation of clot in case of injury

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.)

EDEMA Definition: “Increased Fluid in the Interstitial Tissue Spaces” Also Includes: Hydrothorax, Hydropericardium Hydroperitonium or Ascites and Anasarca.

Pathophysiological Classification Inflammatory Edema Non-Inflammatory Edema Increased Hydrostatic Pressure Reduced Plasma Osmotic Pressure Lymphatic Obstruction Sodium Retention

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)

Pathophysiological Classification (Continued….) Reduced Plasma Osmotic Pressure Protein-Loosing Glomerulopathies (Nephrotic Syndrome) Liver Cirrhosis (Ascites) Malnutrition Protein-Loosing gastroenteropathies

Pathophysiological Classification (Continued….) Lymphatic Obstruction Inflammatory Neoplastic Postsurgical Postirradiation

Factors Affecting Fluid Balance Across Capillary Wall

Pathophysiological Classification (Continued….) Sodium Retention Excessive salt Intake with Renal Insufficiency Increased Tubular Reabsorption of Na+ Renal Hypoperfusion Incresed Renin-Angiotension-Aldosterone Secretion

HYPERMIA AND CONGESTION Definitions: “Both indicates a local increased volume of blood in a particular tissue. ”

HYPERMIA AND CONGESTION Differences: HYPEREMIA CONGESTION 1 An active process A passive process 2 Increased blood flow (vasodilatation) Impaired blood flow 3 During exercise & in inflammation Venous obstruction & cardiac failure 4 Oxygenated blood (Redder) Deoxygenated blood (Cyanosed)

Normal Vasculature Regarding Blood Volume

Hyperemia

Congestion

Congestion (CPC of Liver; gross)

Congestion (CPC of Liver)

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)

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.

Petechial hemorrhages of colonic mucosa as a consequence of thrombocytopenia

Hemorrhage Purpura: Slightly larger ≥ 3mm All causes of Petechiae, plus Secondary to trauma, vascular inflammation, and increased vascular fragility

Hemorrhage Ecchymoses: (Subcutaneous hematoma; Bruises) Larger > 1-2 cm Characteristically seen after trauma Exacerbation of any of the aforementioned conditions

Hemorrhage Ecchymoses: (Colours changes in hematoma) Hemoglobin (Red-blue) Bilirubin (Blue-green) Hemosiderin (Gold-brown)

Fatal intracerebral hemorrhage

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