Hemodynamic Disorders 2019 Lerman handout

Page 1: Title and Author

• Title: Hemodynamic Disorders, Thromboembolism, and Shock

• Author: Mark A. Lerman, D.M.D.

• Affiliation: Associate Professor and Division Director of Oral Pathology, Tufts University School of Dental Medicine

• Date: May 10, 2019

Page 2: Overview of Circulatory Dysregulation

• Key concepts include:

  • Hyperemia and congestion

  • Edema

  • Hemorrhage

  • Hemostasis and thrombosis

  • Embolism

  • Infarction

  • Shock

Page 3: Normal Circulation

• Key Points:

  • Intact vessels maintain wall integrity.

  • Physiologic ranges for intravascular pressure and osmolarity are crucial.

  • No pressure in capillary beds during normal circulation.

Page 4: Normal vs. Abnormal Pressures

• Normal Hydrostatic Pressure:

  • Approx. 32 mm Hg at arterial end, 12 mm Hg at venous end.

• Transudate:

  • Forms due to increased hydrostatic or decreased osmotic pressure.

• Exudate:

  • Forms during inflammation due to increased vascular permeability.

Page 5: Differences between Transudate and Exudate

• Transudate:

  • Low protein content, results from hydrostatic pressure increase.

• Exudate:

  • Protein-rich, results from increased osmotic pressure.

Page 6: Overview of Circulatory Dysregulation

• Reiterates key concepts of circulatory issues listed previously.

Page 7: Hyperemia

• Definition: Increase in blood volume within tissue.

• Process: Active, results from arteriolar dilation and increased capillary flow.

• Appearance: Red coloration due to oxygenated blood engorgement.

Page 8: Congestion

• Definition: Passive process due to impaired outflow.

• Causes: Obstructed venous return (e.g., CHF).

• Symptoms: Blue-red coloration (cyanosis), potential hypoxia and cell death.

Page 9: Congestion in Lungs

• Acute Changes: Blood-engorged vessels, edema.

• Chronic Changes: Fibrotic septae, macrophages in alveoli.

Page 10: Chronic Passive Congestion

• Causes: Left heart failure, mitral stenosis.

• Histopathology: Congestion leading to "heart failure" cells (hemosiderin-laden macrophages).

Page 11: Effects of Congestion

• Liver and Lower Extremities: Right heart failure causes visible changes in liver.

• Appearance: Dilated congested central veins, nutmeg liver appearance.

Page 12: Reiteration of Circulatory Dysregulation

• List of circulatory issues restated.

Page 13: Edema

• Definition: Accumulation of interstitial fluid within tissues.

• Causes: Imbalance in hydrostatic and osmotic pressures.

Page 14: Edema Terminology

• Anasarca: Generalized edema.

• Hydrothorax: Fluid in pleural cavity.

• Hydropericardium: Fluid in pericardial cavity leading to cardiac tamponade.

• Hydroperitoneum (ascites): Fluid in peritoneal cavity.

Page 15: Various Types of Fluid Accumulation

• Diagrams indicating locations of edema (lungs, liver, stomach, etc.).

Page 16: Causes of Edema

• Factors include:

  • Vascular permeability

  • Increased hydrostatic pressure

  • Decreased osmotic pressure

  • Impaired lymphatic drainage

  • Sodium retention

Page 17: Pathophysiologic Causes of Edema

• Detailing causes of: increased hydrostatic pressure, hypoproteinemia, lymphatic obstruction, sodium retention, etc.

Page 18: Altered Vascular Permeability

• Vascular permeability changes related to allergic responses, acute inflammation, and burns.

Page 19: Hydrostatic Pressure and Edema

• Generalized vs. localized increases in pressure due to various underlying conditions (e.g., CHF, DVT).

Page 20: Pathways Leading to Edema

• Overview of factors contributing to edema, including heart failure and nephrotic syndrome.

Page 21: Decreased Osmotic Pressure

• Conditions leading to decreased albumin levels include nephrotic syndrome, cirrhosis, malnutrition.

Page 22: Reiteration of Edema Pathways

• Emphasizes the impact of various health conditions on edema formation.

Page 23: Lymphatic Obstruction

• Effects of localized obstruction on lymphatic drainage.

Page 24: Repeat of Lymphatic Obstruction Section

• Details on lymphedema from localization.

Page 25: Sodium Retention and Edema

• Impacts of sodium retention leading to increased hydrostatic pressure and reduced osmotic pressure.

Page 26: Patterns of Edema

• Subcutaneous Edema: Indicators of heart or kidney disease.

• Pulmonary Edema: Linked to left heart failure or lung infections.

• Brain Edema: Life-threatening.

Page 27: Summary of Circulatory Dysregulation

• Final restatement of key circulatory dysregulation concepts.

Page 28: Hemorrhage Definition

• Blood escapes from the vasculature due to vessel damage.

Page 29: Hemorrhage Patterns

• Distinctions between hematomas, petechiae, purpura, and ecchymoses; potential accumulation in various anatomical spaces.

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Page 31: Courtesy Credit

• Acknowledgement of Dr. Michael Kahn.

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Page 35: Hemorrhage Revisited

• Further elaboration on the context of hemorrhage.

Page 36: Massive Exsanguination

• Definition: Severe bleeding leading to death, often due to trauma or vessel rupture (e.g., aortic aneurysm).

Page 37: Clinical Significance of Hemorrhage

• Factors include volume of blood lost, rate of bleeding, and site of damage; implications of external bleeding.

Page 38: Recap of Circulatory Dysregulation

• Review of previously discussed circulatory disturbances.

Page 39: Hemostasis and Thrombosis Overview

• Concepts of hemostasis involving vascular wall, platelets, and coagulation cascade.

Page 40: Vascular Wall and Clotting

• Endothelial cells' role in inhibiting or promoting thrombosis.

Page 41: Mechanisms of Thrombosis

• Factors favoring or inhibiting thrombosis outlined; involvement of various proteins and mediators.

Page 42: Platelet Activation

• Description of platelet function post-endothelial injury, leading to clotting processes.

Page 43: Coagulation Cascade Overview

• Sequential activation leading to clot formation; significance of tissue factor.

Page 44: Paths of Coagulation

• Distinction between intrinsic and extrinsic pathways in coagulation.

Page 45: Structure of Thrombus

• Description of a thrombus as a solid mass comprising platelets, fibrin, and erythrocytes.

Page 46: Causes of Thrombosis

• Overview of primary abnormalities leading to thrombosis (Virchow’s triad).

Page 47: Hypercoagulable States

• Table listing genetic and acquired hypercoagulable states leading to thrombosis.

Page 48: Locations of Thrombi

• Description of different sites where thrombi may develop: arterial and venous.

Page 49: Outcomes of Thrombi

• Potential outcomes include dissolution or organization and their implications on blood flow.

Page 50: Phlebothrombosis Features

• Characteristics of venous thrombi and their pathological implications.

Page 51: Mural Thrombus Formation

• Thrombi that form in heart and aorta; appearance and relevance in terms of damaged muscle.

Page 52: Heart Valve Thrombi

• Description of vegetations due to infective endocarditis and related conditions.

Page 53: Summary of Valvular Thrombi

• Various forms of vegetations based on causative agents.

Page 54: Outcomes of Thrombi

• Potential outcomes re-emphasized including propagation, embolization, and dissolution.

Page 55: Propagation of Thrombus

• Conditions contributing to the excessive growth of thrombi.

Page 56: Embolization

• Definition and process of thrombus parts dislodging and causing blockages.

Page 57: Dissolution of Thrombus

• Factors affecting the degradation and shrinkage of thrombi.

Page 58: Organization and Recanalization

• Process whereby thrombi may be integrated into vessel walls and form new paths.

Page 59: Visual Representation of Recanalization

• Illustration of the process involved in thrombus organization.

Page 60: Recanalization of Thrombus

• Resulting conditions after thrombus dissolution and the formation of granulation tissue.

Page 61: Recap of Circulatory Dysregulation

• Brief overview of previously mentioned circulatory disorders.

Page 62: Definition of Embolus

• Description of emboli and their most common forms.

Page 63: Deep Vein Thrombosis

• An illustration highlighting thrombus locations in deep leg veins and their potential complications.

Page 64: Thromboembolus Outcomes

• Outcomes based on the origin and path of thromboemboli (e.g., pulmonary complications).

Page 65: Pulmonary Embolism

• Statistics, causes, and significance of pulmonary embolism in the USA.

Page 66: Arrest Locations of Pulmonary Embolism

• Primary locations where emboli may lodge within the pulmonary vascular system.

Page 67: Fat Embolism

• Description of causes and symptoms associated with fat embolism syndrome.

Page 68: Malignant Tumor Emboli

• Characteristics of tumor cells entering circulation.

Page 69: Air Emboli

• Causes and effects of air emboli on the body.

Page 70: Foreign Material Emboli

• Examples of unusual emboli related to medical practices and vascular conditions.

Page 71: Amniotic Fluid Emboli

• Overview of complications arising from amniotic fluid entering circulation.

Page 72: Other Types of Emboli

• Various uncommon emboli not covered by previous sections.

Page 73: Overview of Circulatory Dysregulation

• Summary of the circulatory regulation issues.

Page 74: Infarction Overview

• Definition of infarct and the implications of ischemic necrosis.

Page 75: Types of Infarcts

• Differentiation between types of infarcts based on color and infection presence.

Page 76: Red Infarcts

• Characteristics and conditions leading to hemorrhagic infarcts.

Page 77: White Infarcts

• Characteristics and occurrence areas of ischemic infarcts.

Page 78: Pathological Findings in Infarction

• Histopathologic outcomes and types of necrosis resulting from infarction.

Page 79: Renal Infarction

• Brief mention and implications of renal infarctions.

Page 80: Factors Influencing Infarction Development

• Overview of factors impacting the likelihood and extent of infarction.

Page 81: Summary of Circulatory Dysregulation

• Recap of key issues within circulatory dysfunctions.

Page 82: Definition and Overview of Shock

• Defining shock and its serious implications on health.

Page 83: Characteristics of Shock

• Symptoms and physiological changes characteristic of shock.

Page 84: Categories and Symptoms of Shock

• Different types of shock outlined along with symptoms.

Page 85: Types of Shock Explained

• Detailed breakdown of cardiogenic, hypovolemic, and septic shock.

Page 86: Causes of Hypovolemic Shock

• Conditions leading to fluid loss and related shock.

Page 87: Septic Shock Causes

• Overview of factors leading to septic shock and its prevalence.

Page 88: Table of Major Shock Types

• Summary table outlining different shock types with examples and mechanisms.

Page 89: Stages of Shock

• Description of shock progression stages.

Page 90: Manifestations of Shock

• Clinical manifestations associated with the various types of shock.

Page 91: Clinical Course of Shock

• Factors affecting outcomes and survival rates in different types of shock.

Page 92: Recap of Circulatory Dysregulation

• Final summary of circulatory discussion points.

Page 93: Acknowledgment

• Closing Note: Thank you.