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1. edema; hemodynamic disorders

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1. edema; hemodynamic disorders

  1. 1. Hemodynamic Disorders Hemodynamic Disorders  Edema  Edema  Hyperemia and Congestion  Hyperemia and Congestion  Hemorrhage  Hemorrhage  Hemostasis and Thrombosis  Hemostasis and Thrombosis  Embolism  Embolism  Infarction  Infarction  Shock  Shock 1 Dr. Krishna Tadepalli, MD, www.mletips.com
  2. 2. Definitions Definitions  Homeostasis  maintaining blood as a liquid  Homeostasis  maintaining blood as a liquid  Thrombosis Clotting at inappropriate sites  Thrombosis Clotting at inappropriate sites  Hemostasis  Clotting at appropriate site (site of  Hemostasis  Clotting at appropriate site (site of injury) injury)  Embolism migration of clots  Embolism migration of clots  Infarction obstruction of blood flow to tissues  Infarction obstruction of blood flow to tissues and leads to cell death and leads to cell death  Hemorrhage inability to clot after vascular  Hemorrhage inability to clot after vascular injury injury  Shock extensive hemorrhage can result in  Shock extensive hemorrhage can result in hypotension and death hypotension and death 2 Dr. Krishna Tadepalli, MD, www.mletips.com
  3. 3. Edema = Increased fluid in the interstitial tissue spaces Edema = Increased fluid in the interstitial tissue spaces  Anasarca: Generalized edema + profound subcutaneous  Anasarca: Generalized edema + profound subcutaneous swelling swelling  Pathophysiology  Pathophysiology 1. Increased Hydrostatic Pressure 1. Increased Hydrostatic Pressure  Most common cause --Congestive heart failure,  Most common cause Congestive heart failure, others --DVT others DVT 2. Decreased oncotic or osmotic Pressure 2. Decreased oncotic or osmotic Pressure  Nephrotic syndrome, Cirrhosis  Nephrotic syndrome, Cirrhosis 3. Sodium retention 3. Sodium retention  Renal failure, Renin- Angiotensin --Aldosterone  Renal failure, Renin- Angiotensin Aldosterone 4. Inflammation 4. Inflammation  Acute or chronic,  Acute or chronic,  Type of edema  exudate in inflammatory and transudate  Type of edema  exudate in inflammatory and transudate 3 in non inflammatory conditions in non inflammatory conditions Dr. Krishna Tadepalli, MD, www.mletips.com
  4. 4. Edema - Pathogenesis 4 Dr. Krishna Tadepalli, MD, www.mletips.com
  5. 5. Edema Edema  Morphology = Mostly involve Subcutaneous tissues, Lung,  Morphology = Mostly involve Subcutaneous tissues, Lung, Brain Brain  Subcutaneous ––can be pitting (Cardiac or renal disorders) or  Subcutaneous can be pitting (Cardiac or renal disorders) or non ––pitting ((Thyroid disorders) non pitting Thyroid disorders)  Pitting edema can be in dependent parts (at ankles in  Pitting edema can be in dependent parts (at ankles in ambulatory and Back or sacrum in bedridden patientsambulatory and Back or sacrum in bedridden patientscardiac disorders) nondependent area ((periorbital in renal cardiac disorders) nondependent area periorbital in renal disorders) disorders)  Lung or Pulmonary edema ––Most common in Left Heart  Lung or Pulmonary edema Most common in Left Heart failure, lungs are wet and heavy, pink frothy fluid in alveoli failure, lungs are wet and heavy, pink frothy fluid in alveoli  Cerebral edema – localized ((Abscess, Neoplasms) //  Cerebral edema – localized Abscess, Neoplasms) Generalized Generalized ((Encephalitis), narrowed sulci and distended gyri, fatal if edema Encephalitis), narrowed sulci and distended gyri, fatal if edema develops rapidly (due to cerebellar or Tonsillar Herniation) develops rapidly (due to cerebellar or Tonsillar Herniation) Clinical significance Clinical significance In Almost disorders causing edema, excess sodium re-absorption In Almost disorders causing edema, excess sodium re-absorption via Renin Angiotensin-Aldosterone pathway) is key factor ( (via Renin Angiotensin-Aldosterone pathway) is key factor Treatment  salt intake, Diuretics (↑sodium Excretion), Aldosterone Treatment  salt intake, Diuretics (↑sodium Excretion), Aldosterone 5 antagonists antagonists Dr. Krishna Tadepalli, MD, www.mletips.com
  6. 6. Edema 6 Dr. Krishna Tadepalli, MD, www.mletips.com
  7. 7. Edema = Increased fluid in the interstitial tissue spaces Edema = Increased fluid in the interstitial tissue spaces  Anasarca: Generalized edema + profound subcutaneous  Anasarca: Generalized edema + profound subcutaneous swelling swelling  Pathophysiology  Pathophysiology 1. Increased Hydrostatic Pressure 1. Increased Hydrostatic Pressure  Most common cause --Congestive heart failure,  Most common cause Congestive heart failure, others --DVT others DVT 2. Decreased oncotic or osmotic Pressure 2. Decreased oncotic or osmotic Pressure  Nephrotic syndrome, Cirrhosis  Nephrotic syndrome, Cirrhosis 3. Sodium retention 3. Sodium retention  Renal failure, Renin- Angiotensin --Aldosterone  Renal failure, Renin- Angiotensin Aldosterone 4. Inflammation 4. Inflammation  Acute or chronic,  Acute or chronic,  Type of edema  exudate in inflammatory and transudate  Type of edema  exudate in inflammatory and transudate 7 in non inflammatory conditions in non inflammatory conditions Dr. Krishna Tadepalli, MD, www.mletips.com

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