HEMODYNAMIC DISORDERS, THROMBOSIS AND SHOCK

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HEMODYNAMIC DISORDERS, THROMBOSIS AND SHOCK
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• Edema

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Fluid Balance Across Capillary WallsFactors
Involved
Interstitial Fluid
Photo Kumar, Cotran, Robbins. Robbins Basic
pathology, 7th ed., Saunders, Philadelphia, 2003.
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Edema - Pathogenesis
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Edema
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Edema Lymphatic Obstruction
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Pulmonary Edema
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Fluid in Trachea/Bronchi
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Abdominal Ascites
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Normal Brain
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Edematous Brain
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• Hyperemia and Congestion

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Congestion and Hyperemia
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CONGESTION AND HYPEREMIA
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Congested Lungs
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Acute Pulmonary Congestion
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Heart Failure Cells in Alveoli Chronic
Pulmonary Congestion
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Congested and Enlarged Spleen
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Nutmeg liver
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Microscopically, the nutmeg pattern results from
congestion around the central veins, as seen
here. This is usually due to a "right sided"
heart failure.
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Congested Liver (Passive) Nutmeg LiverRight
Heart Failure
Photo Stevens A, Lowe J. Slide atlas of
pathology. Mosby, London, 1995. Kumar, Cotran,
Robbins. Robbins Basic pathology, 7th ed.,
Saunders, Philadelphia, 2003.
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• Hemorrhage

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• Here are petechial hemorrhages seen on the
  epicardium of the heart. Petechiae (pinpoint
  hemorrhages) represent bleeding from small
  vessels and are classically found when a
  coagulopathy is due to a low platelet count. They
  can also appear following sudden hypoxia.

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• The blotchy areas of hemorrhage in the skin are
  called ecchymoses (singular ecchymosis), or also
  as areas of purpura. Ecchymoses are larger than
  petechiae. They can appear with coagulation
  disorders.

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Intracerebral Hemorrhage
Photo Kumar, Cotran, Robbins. Robbins Basic
pathology, 7th ed., Saunders, Philadelphia, 2003.
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Intracerebral Hemorrhage
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Pericardial Hemorrhage
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• Hemostasis and Thrombosis

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THROMBOSIS -Virchow triad
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Thrombus - Morphology

• Arterial
• Arise in arteries
• Grow in retrograde fashion (towards the heart-
  away from the direction of flow)
• Forms at site of Endothelial injury (AS),
  turbulence (aneurysms)
• Pale/ white
• Lines of Zahn
• Firmly adherent to vessel wall
• From emboli ? Cause infarctions (lower
  extremities 75, Brain, Kidney, spleen)

• Venous
• Arise in deep veins and superficial veins
  (popleteal ? Femoral ?Iliac),
• Antigrade (towards the heart- direction of flow)
• At site of stasis (lower extremities)
• Red / dark
• No lines of Zahn
• Loosely attached (easily embolize)
• Emboli cause Pulmonary embolism ( silent in 50
  of pts.)

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• These are "lines of Zahn" which are the
  alternating pale pink bands of platelets with
  fibrin and red bands of RBC's forming a true
  thrombus.

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Venous Thrombi Clinical
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Thrombotic VegetationsMitral Valve
Photo Stevens A, Lowe J. Slide atlas of
pathology. Mosby, London, 1995.
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Mural ThrombusOver Myocardial Infarction
Photo Stevens A, Lowe J. Slide atlas of
pathology. Mosby, London, 1995.
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Mural Thrombus
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Abdominal Aortic Aneurysm Thrombus
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Deep Vein Thrombosis (DVT)
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Plaque with Recent Thrombus
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ThrombosisOutcomes
Photo Kumar, Cotran, Robbins. Robbins Basic
pathology, 7th ed., Saunders, Philadelphia, 2003.
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Early Organizing Thrombus
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• Embolism

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Embolization (Embolus)Thromboembolism of
Pulmonary Artery
Photo Kumar, Cotran, Robbins. Robbins Basic
pathology, 7th ed., Saunders, Philadelphia, 2003
. Stevens A, Lowe J. Slide atlas of pathology.
Mosby, London, 1995.
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Right Ventricle Embolus from Leg Vein
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Pulmonary Embolus
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Bone Marrow EmbolusIn Pulmonary Vessel
Photo Kumar, Cotran, Robbins. Robbins Basic
pathology, 7th ed., Saunders, Philadelphia, 2003.
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• Infarction

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Infarction (Infarct)Lung (Left) Spleen (Right)
Photo Kumar, Cotran, Robbins. Robbins Basic
pathology, 7th ed., Saunders, Philadelphia, 2003.
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Pulmonary Infarction
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Small Intestine Infarction
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Kidney InfarctionReplaced by Fibrotic Scar (Left)
Photo Kumar, Cotran, Robbins. Robbins Basic
pathology, 7th ed., Saunders, Philadelphia, 2003.
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Pale Infarct (Wedge) of Spleen
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Coagulative Necrosis Pulmonary Infarct