DISORDERS OF BLOOD FLOW

Circulatory system
 HYPEREMIA
Definition: increased blood flow to an organ due to
active dilatation of its arterioles & capillaries.

Types: might be

1. Physiological e.g. skin & muscles after exercise.

2. Pathological .e.g. acute inflammation.

 VENOUS CONGESTION
Definition: Stagnation of blood in an organ
due to obstruction of the venous outflow,
passive dilatation of veins, venules &
capillaries.
➢ Congestion almost always pathologic.
 VENOUS CONGESTION
Types: according to its distribution:

1. Localized

2. Generalized

Further sub-classified according to onset and

duration:

Acute and Chronic congestion

GENERALIZED VENOUS CONGESTION

Acute Chronic
Causes
Acute stagnation of Gradual stagnation of venous
venous blood in all blood in all organs: e.g. Rt.
organs: e.g. Acute Sided heart failure
heart failure
• It is a terminal
condition
GENERALIZED VENOUS CONGESTION

Acute Chronic
Effects

Congestion & Edema of all organs

General effects
 CHRONIC GENERALIZED VENOUS CONGESTION
Clinical effects:

1- Dilated congested veins (venae cava + tributaries)

 Isolated Rt. ventricle failure congestion of all

organs except the lung.

 Isolated Lt. ventricle failure only pulmonary

congestion
 CHRONIC GENERALIZED VENOUS CONGESTION
Clinical effects: (cont.)

2- Cyanosis: bluish coloration due to

increase amount of reduced hemoglobin
in blood.

 Due to defective blood oxygenation &

stasis of blood in capillaries

3- Cardiac edema
CHRONIC GENERALIZED VENOUS CONGESTION

1. CVC LUNG (BROWN INDURATION) :

Causes:
✓ Mital stenosis,
✓ Lt. side heart failure
Grossly:
 lung is enlarged, heavy, firm, brown
Microscopically:
➢ Thick septa
➢ Congested capillaries
➢ heart failure cells, RBCs, hemosidrin granules,
transudate
CHRONIC GENERALIZED VENOUS CONGESTION
2. NUTMEG (CVC) LIVER:
Causes:

➢ Rt. side heart failure,

➢ IVC obstruction

Grossly:
➢Enlarged, Heavy
➢ Firm,
➢Smooth surface
➢Tense stretched capsule, strips seasily
➢Nut meg appearance on cut section
 CHRONIC GENERALIZED VENOUS CONGESTION
2. NUTMEG (CVC) LIVER:
Microscopically:

 Central veins & sinusoids: congested

 Central hepatocytes: atrophy / necrosis

 Mid zonal hepatocytes: steatosis

 Peripheral hepatocytes: cloudy swelling.

LOCAL VENOUS CONGESTION
Acute Chronic
Causes
Sudden venous obstruction Gradual incomplete venous
by: obstruction: e.g.
➢Ligature of a vein Vein compression by:
➢Strangulated hernia ➢Tumors
➢Volvulus ➢Pregnant uterus
➢Twisted ovarian cyst ➢Enlarged LN
➢Venous thrombosis ➢Fibrosis
LOCAL VENOUS CONGESTION

Acute Chronic
Effects
➢Edema ➢Edema
➢Venous rupture ➢Opening of collateral
➢Hemorrhage venous anastomosis
➢Necrosis
EDEMA
 EDEMA
Definition: Pathological accumulation of excess
fluids in the interstitial tissue spaces and serous
sacs.

 Anasarca: Massive and generalized edema with

sever SC swelling
 EDEMA
Pathogenesis:
1. ↑ capillary hydrostatic pressure (congestion, inflammation)

2. ↑ Capillary permeability (inflammation)

3. ↓ Plasma osmotic pressure (hypoproteinemia)

4. ↑Tissue osmotic pressure (inflammation & necrosis)

5. ↑ Sodium and water retention (renal insufficiency,

aldosterone secretion)

6. ↓ Lymph flow: Lymphatic obstruction by fibrosis (filariasis,

fibrosis, neoplasia)
 EDEMA
Types of edema fluid:
Item Transudate Exudate
Main cause Venous congestion Inflammation
Appearance Clear, straw colored Turbid
Protein content Low (< 1 gm/dl) High (˃ 2.5 gm/dl)
Glucose content Normal Low
Fibrinogen content Low High
Specific gravity < 1.015 ˃ 1.018
Clotting on standing Absent Present
Inflammatory cells Absent Present
 EDEMA
Types of edema:
1- Pitting or non pitting
2- Localized or generalized
Pitting edema
Non-pitting edema
 EDEMA
Pitting versus non pitting edema:

Item Pitting edema Non pitting edema

Causes Localized: Venous Localized: lymphatic
congestion obstruction,
Generalized: cardiac, Inflammation
renal, hepatic, Generalized: myxodema
nutritional
Consistency Soft Hard
Upon pressure Fluid is displaced Fluid is not displaced
 EDEMA

Generalized edema Localized edema

 Cardiac  Inflammatory edema
 Renal  Obstruction of veins
 Nutritional  Lymphatic obstruction
 Hepatic

 Endocrinal

 Allergic
GENERALIZED EDEMA
1- Cardiac edema: In Rt. Side heart failure
•Pitting edema,
•first at the ankle, then
generalized

•Pitting edema,
2- Renal edema: •first periorbital, then
generalized

3- Nutritional edema: •Pitting edema,

•first abdominal, then
Due to hypoproteinemia generalized
GENERALIZED EDEMA
4- Hepatic edema: In liver cirrhosis
•Pitting edema,
•first at abdominal, then
generalized

5- Endocrinal edema: •↑ Adrenal hormones

• ↑ Estrogen

6- Allergic edema: •Pitting edema,

•first around eye lid &
Due to ↑ capillary in the face
permeability
LOCALIZED EDEMA:
1- Inflammatory edema: Non pitting edema
(exudate) due to increased vascular permeability

2- Venous obstruction edema: Pitting edema

(transudate) due to increased hydrostatic pressure e.g.

➢ Venous thrombosis

➢ External pressure

➢ Varicose veins
LOCALIZED EDEMA:
3- Lymphedema:
Definition: Hard, non pitting edema secondary to
reduced lymphatic drainage

Causes:
1. filarial lymphangitis
2. mechanical compression (tumor)
3. radiation of lymph nodes
4. neoplastic invasion of LN
5. Surgical removal of LN
 ‫‪Thank you‬‬

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