Hemodynamic

disorders
Dr. Mehzabin Ahmed
 Edema
 Accumulation of excess fluid (protein poor
transudate, with specific gravity
below1.012) in the tissues
 Normally very little fluid leaks from the
vessels to form interstitial fluid
 This is cleared up by the lymphatics
 Edema results when the leakage from the
vessels is excessive
 Causes of edema
Inflammatory Non inflammatory
edema edema
 Alteration of the   hydrostatic

vascular pressure
permeability- in  plasma oncotic

acute inflammation pressure

& in  Lymphatic

allergic reactions obstruction

 Salt & water
retention
 Edema
Pressure gradients controlling the fluid movement:
• Hydrostatic
pressure: or the
capillary blood
pressure
(35mmhg)
• Osmotic
pressure:
maintained by
the plasma
proteins
(25mmhg)
• Some fluid enters
the lymphatic
 Non inflammatory
edema
  hydrostatic pressure- increase in the
capillary blood pressure
 Causes include:
 Local increase in the pressure:results
from impaired venous outflow.
 E.g.,deep vein thrombosis of the
lower extremities leads to edema of
the affected leg
 Generalized increase in venous
pressure,with resulting systemic
venous pressure occurs more
commonly with congestive heart
 Non inflammatory edema
 plasma oncotic pressure Reduction in
plasma albumin concentration results in
edema
 Causes are:
 Nephrotic syndrome

 Liver failure

 Protein malnutrition

 Protein losing gastroenteropathy

Non inflammatory edema
 Lymphatic obstruction prevent the normal
drainage of fluids into the thoracic duct
 Causes are;
 Inflammatory
 Neoplastic
 Postsurgical
 postirradiation

 Salt and therefore the water retention are

contributory factors for the development of
edema. It occurs with any acute reduction of
renal function, e.g.,poststreptococcal
 Terms
• Edema:increased fluid in the interstitial tissue
spaces.

• Effusion:excess of fluid in the serous or coelomic

cavities
– Hydrothorax;excess fluid in the pleural cavity
– Hydropericardium;excess fluid in the pericardial cavity
– Hydroperitoneum(ascites):excess fluid in the peritoneum

• Anasarca:severe & generalized edema with

subcutaneous tissue swelling
 Examples of edema
Type of Condition Tissue 
edema causing where the hydrostati
the fluid c pressure
edema collects is in
Pulmonary Left Alveoli of Pulmonar
edema sided the lung y vascular
heart bed
failure
Subcutane Right Subcutane Systemic
ous edema sided ous venous
heart system
failure
 Elephantiasis (filariasis)
Pulmonary edema

Pink edema fluid

in the alveoli

Subcutaneous pitting pedal edema

Hyperemia
 It is the
increase in the
blood supply
(inflow) to the
tissues due to
arteriolar
dilation as
during an
exercise.
 Congestion
 It is the increased pooling of the blood in the capillary
bed as a result of a decreased venous return as in
cardiac failure.
 In long-standing congestion, called chronic passive
congestion, the stasis of poorly oxygenated blood also
causes chronic hypoxia, which can result in
parenchymal cell degeneration or death, sometimes
with microscopic scarring.
 Capillary rupture at these sites of chronic congestion
may also cause small foci of hemorrhage; breakdown
 Examples of chronic venous ( passive) congestion are seen
in
 Liver in cases of chronic right heart failure -there are
alternate regions of congestion and fatty change giving
the liver alternate dark and light bands - nutmeg liver
 Lungs in cases of chronic left heart failure- longstanding
congestion causes the alveolar walls to become fibrosed
(makes the lung firm /indurated). Damaged capillaries
result in the extravasation of RBCs, which are
phagocytosed by the alveolar macrophages and the
hemoglobin is converted to hemosiderin (makes the
lungs brown in color) - brown induration of the lung.
Nutmeg liver- alternate light (area of fatty change) and dark
regions (areas of congestion)
 Hemorrhage
 It is the extravasation of blood from
ruptured blood vessels.
 The rupture can occur in large
arteries due to trauma,
atherosclerosis, inflammation or
neoplastic infiltration.
 Capillary bleeding can occur in
chronic congestion.
 Types of hemorrhage
 Hematoma- the collection of extravasated blood in
the tissues after rupture of the blood vessels.
 Petechiae- they are pinpoint hemorrhages (1-2mm
diameter) in the skin, mucous membranes or
serosal surfaces
 Purpura-these are larger hemorrhages (>3mm dia)
occurring in vascultis, trauma.
 Ecchymosis- larger hemorrhages (>1-2 cm dia)
occurring in the subcutaneous tissues. They are
commonly called bruises.
 Hemothorax- the collection of blood in the pleural
cavity
 Hemoperitoneum- the collection of blood in the
 Petechiae

Purpura Subarachnoid hemorrhage

Cerebral hemorrhage
 At the end of this unit, the student should be able
to:
 Define the following terms
 Hemorrhage
 Hematoma
 Hemothorax
 Hemoperitoneum
 Hemarthrosis
 Petechiae
 Purpura
 Hematemesis
 Epistaxis
 Hemoptysis
 Melena
 Menorrhagia
 Define the following terms
 Thrombosis
 Embolism
 DIC
 Shock
 infarction
 Explain the pathogenesis of thrombus
formation
 List the outcomes of a thrombus
 List some disorders commonly associated
with thrombus formation
 List the types of embolism and give
examples of each type
 List the types of infarcts and give
examples of each type
