1. Hemodynamic Disorders

2. Fluid Homeostasis
Homeostasis is maintained by the opposing effects of:
Vascular Hydrostatic Pressure
and
Plasma Colloid Osmotic Pressure

3. Edema
ASCITES

4. PERIORBITAL (RENAL)
Pitting Edema

5. Pulmonary Edema The Lungs are typically 2-3 times normal weight
Cross sectioning causes an outpouring of frothy,
sometimes blood-tinged fluid
It may interfere
with pulmonary function

6. Pulmonary Edema
the alveolar capillaries are engorged, and an intra-alveolar granular pink precipitate is seen

7. Brain Edema
The surface of the brain with cerebral edema demonstrates widened gyri with a flattened surface. The sulci are narrowed
The surface of the brain with cerebral edema demonstrates widened gyri with a flattened surface. The sulci are narrowed

8. Brain Edema
Clinical Correlation The big problem is: There is no place for the fluid to go!
Herniation into the foramen magnum will kill
Acute cerebral swelling can also often produce herniation of the cerebelllar tonsils into the foramen magnum. Note the cone shape of the tonsils around the medulla in this cerebellum.

9. Effects of Lipopolysaccharide Septic Shock
LPS = lipopolysaccharide
TNF = tumor necrosis factor
IL = interleukin
NO = nitric oxide
PAF = platelet-activating factor

10. ARDS/diffuse alveolar damage in shock
Some of the alveoli are collapsed; others are distended. Many contain dense proteinaceous debris, desquamated cells, and hyaline membranes

11. MYOCARDIAL NECROSIS in Shock
Myocardial Necrosis. Note the lower field contains intact myocardium, while the upper field exhibits coagulation necrosis of myocardium. In shock the hypoperfusion is greatest in the subendeocardium, which is perfused mainly in diastole.
lower field contains intact myocardium, while the upper field exhibits coagulation necrosis of myocardium. the hypoperfusion is greatest in the subendeocardium, which is perfused mainly in diastole.

12. ATN
ATN, note relative sparing of the glomeruli.
ATN in shock , extensive tubular isghaemia , note relative sparing of the glomeruli.