HEMODYNAMIC DISORDERS

DR.ASMA SHAIKH
By the end of lecture, students of BSMT should be able to:

• Define edema, effusion, exudate, transudate, hyperemia and congestion

• List the important hemorrhagic disorders
• Define petechiae, purpura, hematoma, ecchymosis, hemarthrosis,
thrombocytopenia
• Define thrombus and thrombosis
• List the factors that predispose to thrombosis
• Difference between antemortem and postmortem clot
• Briefly discuss deep venous thrombosis
• Vascular hydrostatic pressure push water and salts out of the capillaries into
interstitial space

• Plasma colloid osmotic pressure pull water and salts back into the vessels

• Elevated hydrostatic pressure or diminished colloid osmotic pressure disrupts this

balance

• Small net movement of fluid into the interstitium and drain by lymphatic vessels
and thoracic duct into blood stream and keep tissue dry
Edema: Edema is the result of the movement of fluid from the vasculature into the
interstitial spaces.

Effusion: Accumulation of fluid in body cavities

• Inflammatory or non-inflammatory edema

• Inflammatory protein rich exudates accumulate due to increase in vascular

permeability caused by inflammatory mediators.

• Usually localized but in systemic inflammatory states as in sepsis, it produces

widespread endothelial injury and generalized edema
• Non-inflammatory edema and effusions are protein-poor fluid called transudates

• Heart failure, renal disease and severe nutritional disorders

Transudate: Fluid may be protein-poor

Exudate: Protein-rich
 CAUSES OF EDEMA

• Congestive heart failure

• Venous obstruction

• Malnutrition

• Liver cirrhosis

• Acute or chronic inflammation

Hyperemia: It is an active process in which arteriolar dilation leads to
increased blood flow. Affected tissues turn red (erythema)
Example: At the site of inflammation or in skeletal muscle during
exercise

Congestion: It is a passive process resulting from reduced outflow of

blood from a tissue.
Example: It can be systemic as in cardiac failure or localized as in
isolated venous obstruction
Hemostasis: A process by which blood clots form at the site of injury

Primary hemostasis: Formation of platelet plug

Secondary hemostasis: Deposition of fibrin

Hemorrhagic Disorders: Disorders associated with abnormal bleeding due to

primary or secondary defects in vessel wall, platelets or coagulation factors

All of them must function properly to ensure hemostasis

HEMORRHAGIC DISORDERS
HEMORRHAGIC DISORDERS
DEFECTS OF PRIMARY HEMOSTASIS

• Platelet defect or Von Willebrand Disease: Small bleed in skin

or mucosal membranes.

• Petechiae: Minute one to two mm hemorrhages

• Purpura: Larger than petechiae. >3mm

• Mucosal bleeding may present with epistaxis, G.I bleed,

menorrhagia or intracerebral hemmorhage
PUNCTATE PETECHIAL HEMORRHAGES OF THE
COLONIC MUCOSA DUE TO THROMBOCYTOPENIA
FATAL INTRACEREBRAL BLEED
DEFECTS OF SECONDARY HEMOSTASIS

• Coagulation factors defects

• Present with bleed into soft tissues (muscle) or joints called hemarthrosis

• Hemarthrosis after minor trauma is characteristic of hemophilia due to deficiency

of clotting factor VIII and IX
DEFECTS IN SMALL VESSELS

• Presents with palpable purpura and ecchymosis

• Ecchymoses: (bruises) hemorrhages of 1 to 2 cm in size

• Hematoma: Volume of extravasated blood that is sufficient to create a palpable

mass of blood

• Purpura and ecchymoses are characteristic of systemic disorders that disrupt small
blood vessels example vasculitis or that lead to blood vessel fragility example
scurvy
 THROMBOSIS

• Thrombosis occurs when blood clots block veins or arteries.

• Symptoms include pain and swelling in one leg, chest pain, or numbness on one
side of the body.

• Complications of thrombosis can be life-threatening, such as a stroke or heart

attack.

• Abnormality that leads to thrombosis:

a) Endothelial injury b) Stasis or turbulent blood flow c) Hypercoagulability of
blood
VIRCHOW TRIAD
ENDOTHELIAL INJURY
NORMAL BLOOD FLOW
ABNORMAL BLOOD FLOW
Thrombi
• Thrombi can have grossly (and microscopically) apparent laminations
called lines of Zahn:
- Pale platelet and fibrin layers alternating with darker red cell–rich
layers.
- Only found in thrombi that form in flowing blood
- Can distinguish antemortem thrombosis from the bland
nonlaminated clots that form in the postmortem state.
• Thrombi occurring in heart chambers or in the aortic lumen are
designated as mural thrombi.
MURAL THROMBI
THROMBI(LINE OF ZAHN)
MORPHOLOGY OF THROMBI
ANTEMORTEM VERSUS POSTMORTEM CLOTS
 Venous Thrombosis
(Phlebothrombosis)
• Mostly in superficial or deep veins of the legs
• Superficial vein thrombosis occur in the saphenous
system (varicosities).
- Manifestations: local congestion, swelling
(edema), pain, tenderness, infections of
overlying skin and development of varicose
ulcers. Rarely embolize
• Deep vein thrombosis(In the larger veins at or
above the knee joint) is more serious; it may lead to
pulmonary emboli, causes edema, pain and
tenderness
THANK YOU