Fluid and hemodynamic disorders involve fluid shifts between intracellular, interstitial, and intravascular spaces. The balance of hydrostatic and oncotic pressures determines fluid distribution and can cause edema if disrupted. Clot formation is regulated by platelets, vessels, and clotting proteins, while thrombosis occurs when a pathological clot forms in blood vessels due to endothelial damage, stasis, or clotting abnormalities. Heart failure, kidney disease, infarction, and embolism can disrupt pressures and clotting homeostasis, potentially leading to shock if compensation fails.

2. Fluid and Hemodynamic
Disorders

3. Where’s my water?
• Intracellular
• Ions
• Ion specific gates in cell membrane
• Cellular proteins
• Extracellular
• Interstitial (between the cells) Lymph
• Intravascular
• Blood
• Lymphatic fluid

4. Movement of water in the vascular system
• Hydrostatic, the pumping pressure
• Heart
• Skeletal muscle action
• Oncotic or osmotic, holds fluid in.
• Proteins such as albumin
• Cellular elements such as RBCs

5. Intracellular & Extracellular Water

7. Things can go wrong
• Heart failure
• Kidney failure
• Myocardial infarction
• Pulmonary emobolus
• Tissue congestion
• Edema

8. Edema
• Too much extracellular fluid.
– Swelling
• tumor
– Localized or
– Generalized
– Dependent
• action of gravity

9. Tansudate or Exudate?
• Exudate
– Inflammatory water
– Part of the inflammatory reaction
• Rubor, dolor, calor, tumor
– Purposeful and intentional
– Localized

10. Tansudate or Exudate?
• Transudate
– Leakage, not part of healing
– Increased hydrostatic pressure
• Heart failure
• Lymphatic obstruction
– Decreased oncotic pressure
• Decreased albumin

11. Congestive Heart Failure

12. Congestive Heart Failure

13. Passive Congestion

14. Chronic Passive Congestion,
Nutmeg Liver

15. Chronic Passive Congestion

16. Pulmonary Edema

17. Pulmonary Edema

18. Pulmonary Edema

19. Pitting Edema

20. Lymphedema

21. Papilledema

22. Water in Hollow Spaces
• Hydrothorax
• Hydropericardium
• Hydroperitoneum
– Ascites

24. Healthy Blood Clotting
• Platelets
• Vessels
• Clotting Proteins

25. Healthy Clotting

26. Clotting Factors

27. Factor Activation

29. Hematoma

30. Petechiae

31. Thrombosis
• A pathological clot
• A clot forming in the fixed vascular
system.

32. Thrombosis
1. Endothelial damage
2. Stasis and clotting factor activation
3. Clotting factor abnormalities
– Too many clotting proteins
• Pregnancy
• Cancers
– Too little inhibition
– Abnormal factors
• Leiden Factor (abnormal V)

33. Thrombosis

34. Thrombosis
• Arterial Side Thrombi
– Platelet activation
– Endothelial cell injury
• Venous Side Thrombi
– Stasis
– Clotting factor activation
– Endothelial cell injury

35. Coronary Artery Thombosis
• Angiogram

36. Acute Myocardial Infarction

37. Mural Thrombus

38. Aneurysm with Thrombus

39. Deep Leg Vein Thrombosis

40. Airplane Travel
• Gunner turret

41. Outcomes of a DVT

42. Embolus
• Space occupying mass moving in
the fixed vascular system
• Blood clot
• Bone Fragments
• Amniotic Fluid
• Air

43. Pulmonary Embolus

44. Pulmonary Embolus

46. Infarction
• Anemic
– End artery supply
– No blood
– White
• Hemorrhagic
– Venous occlusion
– Loose tissues
– Dual blood supply
– Red

47. Anemic Infarct

48. Anemic Infarct

49. Cerebral Infarction

50. Hemorrhagic Infarct

51. Shock
• Poor perfusion
• Tissue hypoxia
• Tissue acidosis
• Many causes
– Poor pumping by heart
– Low blood volume
– Loss of fluid
– Overwhelming
infections

52. Types of Shock
• Cardiogenic
– Decreased output
• Hypovolemic
– Blood loss
– Fluid loss
• Anaphylaxis
– IgE and histamine
• Septic
– Gram negative rods
– Toxins

53. What Happens Next?
• Compensated
– Fluid shifts
• Decompensated
– Progression possible
• Irreversible
– No recovery

54. The Shock Spiral

55. Summary
• Fluid shifts
• Oncotic & Hydrostatic Pressures
• Excessive tissue water
• Exudate vs. Transudate
• Clot formation
• Vessels, platelets & proteins
• Thrombosis
• Pathological clot
• Arterial = endothelial damage & platelet activation.
• Venous = stasis and factor activation

56. Summary
• Infarction
• Ischemic = end artery organ
• Hemorrhagic = venous or dual blood supply
• Tissue vulnerability
– Brain
– Kidney
– muscle