Mechanisms of Disease:Mechanisms of Disease:
Disorders of CirculationDisorders of Circulation
Sharon M. Dial, DVM, PhD
Ari...
Disorders of CirculationDisorders of Circulation
Disturbances of blood flow
Hemostasis and Thrombosis
Obstacles of Blood F...
Fluid HomeostasisFluid Homeostasis
Depends on three major physical factors
– An intact and functional circulatory system
...
Disturbances of FluidDisturbances of Fluid
ExchangeExchange
Starling’s law
The amount of fluid filtered out into the
inte...
Disturbances of FluidDisturbances of Fluid
ExchangeExchange
Normal fluid exchange
– Starlings law:
 Intravascular hydros...
From: Mechanisms of Disease, ed D.O. Slauson, B.J. Cooper, 2nd
Ed.
Fluid CompartmentsFluid Compartments
Extracellular Fluid
Intracellular Fluid
Intravascular Fluid
Plasma
RBC mass
Albumin 4...
Arteriolar Venous
Intravascular Hydrostatic Pressure 30 mm Hg 17 mm Hg
Interstitial Hydrostatic Pressure 8 mm Hg 8 mm Hg
I...
Disturbances of FluidDisturbances of Fluid
ExchangeExchange
Lymphatics
– Vessel structure
 Thin wall
 Valves
– Maintain...
Disturbances of FluidDisturbances of Fluid
ExchangeExchange
 Edema – Accumulation of
Excess interstitial fluid
 Mechanis...
Disturbances of FluidDisturbances of Fluid
ExchangeExchange
– Edema
 Regional –
– venous or lymphatic obstruction,
– loca...
Disturbances of fluidDisturbances of fluid
exchangeexchange
Generalized edema – often associated with
transudation of flu...
From: Robbins Pathologic Basis of Disease, ed. Cotran, Kumar, Collins.
AscitesAscites
 Cardiac disease
– Low cellularity
– High protein
 Associated with
increased portal
pressure (portal
hype...
Disturbances of Blood FlowDisturbances of Blood Flow
Alterations in Circulation
– Hyperemia
 Active
– Physiologic (exerc...
Disturbances of Blood FlowDisturbances of Blood Flow
Examples
– Acute local active hyperemia
 Hyperemia of inflammation
...
Acute local active hyperemiaAcute local active hyperemia
http://www.vetmed.ufl.edu/path/pbteach/wlc/vem5161/circ/circ2.htm...
Acute local passive hyperemiaAcute local passive hyperemia
http://www.vetmed.ufl.edu/path/pbteach/wlc/vem5161/circ/circ2.h...
Chronic local passiveChronic local passive
hyperemiahyperemia
http://www.bayinsider.com
Deep venous thrombosis
Consequences of chronicConsequences of chronic
congestioncongestion
Lung – interstitial fibrosis and alveolar
hemorrhage
...
www-medlib.med.utah.edu/WebPath/LUNGHTML
Hemosiderin-laden macrophages
“heart failure cells”
cv
http://www.vh.org/Providers/Textbooks/LiverPatholog
http://www.vh.org/Providers/Textbooks/LiverPatholog
HemorrhageHemorrhage
Loss of blood elements externally, into
body cavities or into interstitium
– Hemorrhage by rhexis
 ...
HemorrhageHemorrhage
 Effects of hemorrhage
– Depend on site
 Subcutaneous vs subdural
– Rate
 Slow gastrointestinal bl...
Hemorrhage by diapedesisHemorrhage by diapedesis
http://medlib.med.utah.edu/WebPath
Acute Gastritis
Hemorrhage by rhexisHemorrhage by rhexis
Ruptured Pulmonary
Artery
HemorrhageHemorrhage
Causes
– Trauma
 Ruptured spleen or splenic hematoma
– Infectious disease
 Vasculitis
 Disseminat...
The Vocabulary ofThe Vocabulary of
HemorrhageHemorrhage
 Hemopericardium
 Hemothorax
 Hemoperitoneum
 Hemarthrosis
 H...
HemopericardiumHemopericardium
http://medlib.med.utah.edu
Hemorrhage into pericardium
with cardiac tamponade
Ruptured aort...
HemothoraxHemothorax
http://medlib.med.utah.edu
Warfarin Toxicity
HemoperitoneumHemoperitoneum
HemarthrosisHemarthrosis
http://www.mednet.gr/pim/ht2.htm
Acute hemarthrosis due
To hemophilia
EpistaxisEpistaxis
http://web.vet.cornell.edu/public/popmed/clinpath
HemorrhageHemorrhage
Resolution of hemorrhage
– Resorption – by phagocytosis
– organization
http://dermatology.cdlib.org
9-year-old NM Labrador9-year-old NM Labrador
RetrieverRetriever
Presented for lethargy and a distended
abdomen.
Physical...
9-year-old NM Labrador9-year-old NM Labrador
RetrieverRetriever
“Bear” Normal comparison
9-year-old NM Labrador9-year-old NM Labrador
RetrieverRetriever
“Bear” Normal comparison
9-year-old NM Labrador9-year-old NM Labrador
RetrieverRetriever
Fluid analysis
– Pericardial fluid – hemorrhagic effusion...
10-year-old Miniature Poodle10-year-old Miniature Poodle
 Presented for “weight
gain”
 Increased drinking and
urination
...
10-year-old Miniature Poodle10-year-old Miniature Poodle
Fluid Analysis:
– Clear/ colorless fluid
– Total Protein - < 1.0...
10-year-old Miniature Poodle10-year-old Miniature Poodle
Hematology and Clinical chemistry values
were all within normal ...
10-year-old Miniature Poodle10-year-old Miniature Poodle
PPT lecture 1 outline
PPT lecture 1 outline
PPT lecture 1 outline
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PPT lecture 1 outline

  1. 1. Mechanisms of Disease:Mechanisms of Disease: Disorders of CirculationDisorders of Circulation Sharon M. Dial, DVM, PhD Arizona Veterinary Diagnostic Laboratory
  2. 2. Disorders of CirculationDisorders of Circulation Disturbances of blood flow Hemostasis and Thrombosis Obstacles of Blood Flow Disturbances of Fluid Exchange Ischemia and Shock
  3. 3. Fluid HomeostasisFluid Homeostasis Depends on three major physical factors – An intact and functional circulatory system – An intact and functional lymphatic system – Normal concentration of serum proteins (specifically albumin)
  4. 4. Disturbances of FluidDisturbances of Fluid ExchangeExchange Starling’s law The amount of fluid filtered out into the interstitium at the arterial side of the microcirculation is “approximately” equal to that reabsorbed at the venous end.
  5. 5. Disturbances of FluidDisturbances of Fluid ExchangeExchange Normal fluid exchange – Starlings law:  Intravascular hydrostatic pressure (blood pressure)  Oncotic pressure of plasma proteins  Oncotic pressure of extravascular proteins  Interstitial hydrostatic pressure
  6. 6. From: Mechanisms of Disease, ed D.O. Slauson, B.J. Cooper, 2nd Ed.
  7. 7. Fluid CompartmentsFluid Compartments Extracellular Fluid Intracellular Fluid Intravascular Fluid Plasma RBC mass Albumin 4.5% Globulin 2.5% Fibrinogen 0.3%
  8. 8. Arteriolar Venous Intravascular Hydrostatic Pressure 30 mm Hg 17 mm Hg Interstitial Hydrostatic Pressure 8 mm Hg 8 mm Hg Intravascular Oncotic Pressure 25 mm Hg 25 mm Hg Interstitial Oncotic Pressure 10 mm Hg 10 mm Hg From: Robbins Pathologic Basis of Disease, ed. Cotran, Kumar, Collins. 7 mmHg out 6 mmHg in
  9. 9. Disturbances of FluidDisturbances of Fluid ExchangeExchange Lymphatics – Vessel structure  Thin wall  Valves – Maintain negative pressure
  10. 10. Disturbances of FluidDisturbances of Fluid ExchangeExchange  Edema – Accumulation of Excess interstitial fluid  Mechanisms of edema – Increased vascular permeability – Increased intravascular hydrostatic pressure – Decreased intravascular osmotic pressure – Decreased lymphatic drainage
  11. 11. Disturbances of FluidDisturbances of Fluid ExchangeExchange – Edema  Regional – – venous or lymphatic obstruction, – localized inflammation (increased vascular permeability) • Vasoactive mediators – histamine, bradykinin, leukotrienes • Mediators that alter endothelial cell structure – IL-1, TNF, gIF  Generalized – – Cardiogenic – Nephrogenic – Hepatic – Hypoproteinemic
  12. 12. Disturbances of fluidDisturbances of fluid exchangeexchange Generalized edema – often associated with transudation of fluid into body cavities. – Hydropericardium – Hydrothorax – Hydroperitoneum Generalized subcutaneous edema - Anasarca
  13. 13. From: Robbins Pathologic Basis of Disease, ed. Cotran, Kumar, Collins.
  14. 14. AscitesAscites  Cardiac disease – Low cellularity – High protein  Associated with increased portal pressure (portal hypertension)  Primary hypoproteinemia – Low cellularity – Low protein  Associated with decreased plasma oncotic pressure.
  15. 15. Disturbances of Blood FlowDisturbances of Blood Flow Alterations in Circulation – Hyperemia  Active – Physiologic (exercise, blushing, increased mental activity) – Pathologic (diabetes, inflammation)  Passive – hepatic congestion in right heart failure  Classification – Duration – acute versus chronic – Extent – localized versus generalized – Mechanism – active versus passive
  16. 16. Disturbances of Blood FlowDisturbances of Blood Flow Examples – Acute local active hyperemia  Hyperemia of inflammation – Acute local passive hyperemia  Hyperemia (congestion) of torsion – Chronic local passive hyperemia  Venous occlusion or valvular incompetence – Chronic generalized passive hyperemia  Systemic hyperemia (congestion) of cardiac disease
  17. 17. Acute local active hyperemiaAcute local active hyperemia http://www.vetmed.ufl.edu/path/pbteach/wlc/vem5161/circ/circ2.htm Oral Mucosa Bovine Malignant Catarrhal Fever
  18. 18. Acute local passive hyperemiaAcute local passive hyperemia http://www.vetmed.ufl.edu/path/pbteach/wlc/vem5161/circ/circ2.htm Lung Torsion Note dark red/black Lung lobe
  19. 19. Chronic local passiveChronic local passive hyperemiahyperemia http://www.bayinsider.com Deep venous thrombosis
  20. 20. Consequences of chronicConsequences of chronic congestioncongestion Lung – interstitial fibrosis and alveolar hemorrhage Liver – central lobular necrosis and fibrosis Spleen – hyperplasia and thrombosis – Can be associated with hematoma.
  21. 21. www-medlib.med.utah.edu/WebPath/LUNGHTML Hemosiderin-laden macrophages “heart failure cells”
  22. 22. cv http://www.vh.org/Providers/Textbooks/LiverPatholog
  23. 23. http://www.vh.org/Providers/Textbooks/LiverPatholog
  24. 24. HemorrhageHemorrhage Loss of blood elements externally, into body cavities or into interstitium – Hemorrhage by rhexis  Rupture of blood vessel with frank bleeding – Hemorrhage by diapedesis  Loss of red blood cells through intact vessels and across membranes – Hematoma – blood clot in interstitial tissues
  25. 25. HemorrhageHemorrhage  Effects of hemorrhage – Depend on site  Subcutaneous vs subdural – Rate  Slow gastrointestinal blood loss by diapedesis (chronic gastritis)  Rapid blood loss by ruptured vessel – Total blood volume lost  Hemorrhagic shock – loss of 20-40% of total blood volume
  26. 26. Hemorrhage by diapedesisHemorrhage by diapedesis http://medlib.med.utah.edu/WebPath Acute Gastritis
  27. 27. Hemorrhage by rhexisHemorrhage by rhexis Ruptured Pulmonary Artery
  28. 28. HemorrhageHemorrhage Causes – Trauma  Ruptured spleen or splenic hematoma – Infectious disease  Vasculitis  Disseminated intravascular coagulation – Coagulopathies – Platelet abnormalities
  29. 29. The Vocabulary ofThe Vocabulary of HemorrhageHemorrhage  Hemopericardium  Hemothorax  Hemoperitoneum  Hemarthrosis  Hemoptysis  Epistaxis  Petechia  Ecchymoses  Purpura
  30. 30. HemopericardiumHemopericardium http://medlib.med.utah.edu Hemorrhage into pericardium with cardiac tamponade Ruptured aortic aneurysm
  31. 31. HemothoraxHemothorax http://medlib.med.utah.edu Warfarin Toxicity
  32. 32. HemoperitoneumHemoperitoneum
  33. 33. HemarthrosisHemarthrosis http://www.mednet.gr/pim/ht2.htm Acute hemarthrosis due To hemophilia
  34. 34. EpistaxisEpistaxis http://web.vet.cornell.edu/public/popmed/clinpath
  35. 35. HemorrhageHemorrhage Resolution of hemorrhage – Resorption – by phagocytosis – organization http://dermatology.cdlib.org
  36. 36. 9-year-old NM Labrador9-year-old NM Labrador RetrieverRetriever Presented for lethargy and a distended abdomen. Physical exam – Increased heart rate (tachycardia) – Muffled heart sounds – Increased respiratory rate (tachypnea) – Distended abdomen (fluid filled)
  37. 37. 9-year-old NM Labrador9-year-old NM Labrador RetrieverRetriever “Bear” Normal comparison
  38. 38. 9-year-old NM Labrador9-year-old NM Labrador RetrieverRetriever “Bear” Normal comparison
  39. 39. 9-year-old NM Labrador9-year-old NM Labrador RetrieverRetriever Fluid analysis – Pericardial fluid – hemorrhagic effusion – Peritoneal fluid – Modified transudate  High protein (4.0 g/dl)  Low cells (< 500/ul)
  40. 40. 10-year-old Miniature Poodle10-year-old Miniature Poodle  Presented for “weight gain”  Increased drinking and urination (polydipsia/polyuria)
  41. 41. 10-year-old Miniature Poodle10-year-old Miniature Poodle Fluid Analysis: – Clear/ colorless fluid – Total Protein - < 1.0 g/dl – Cell count - < 100 /ul
  42. 42. 10-year-old Miniature Poodle10-year-old Miniature Poodle Hematology and Clinical chemistry values were all within normal limits except: – Hypoalbuminemia-1.5 g/dl (2.7-4.0) Urinalysis – Large amount of protein in urine (proteinuria).
  43. 43. 10-year-old Miniature Poodle10-year-old Miniature Poodle

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