Hemodynamic disorders, thrombosis and shock (practical pathology)

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Hemodynamic disorders, thrombosis and shock (practical pathology)

  1. 1. HEMODYNAMIC DISORDERS & THROMBOSIS
  2. 2. Edema
  3. 3. Edema
  4. 4. Normal alveoli
  5. 5. Pulmonary Edema
  6. 6. Fluid in Trachea/Bronchi
  7. 7. Abdominal Ascites
  8. 8. Edematous Brain
  9. 9. Normal Brain
  10. 10. Hyperemia and Congestion
  11. 11. Congestion and Hyperemia
  12. 12. CONGESTION AND HYPEREMIA
  13. 13. Congested Lungs
  14. 14. Acute Pulmonary Congestion
  15. 15. Heart Failure Cells” in Alveoli“ Chronic Pulmonary Congestion
  16. 16. Congested and Enlarged Spleen
  17. 17. Nutmeg Liver • A descriptive term for a liver with chronic passive congestion, a hepatopathy due to cardiac decompensation and failure. • If the congestion is severe, these changes may be accompanied by haemorrhagic necrosis
  18. 18. Nutmeg liver
  19. 19. Microscopically, the nutmeg pattern results from congestion around the central veins, as seen here. This is usually due to a "right sided" heart failure .
  20. 20. • Liver is divided histologically into lobules. • The center of the lobule is the central vein. • At the periphery of the lobule are portal triads.
  21. 21. • Functionally, the liver can be divided into three zones, based upon oxygen supply. • Zone 1 encircles the portal tracts where the oxygenated blood from hepatic arteries enters. • • Zone 3 is located around central veins, where oxygenation is poor. Zone 2 is located in between.
  22. 22. Hemorrhage
  23. 23. • Petechiae measure less than 3 mm. • Purpura measure 0.3–1 cm. • Ecchymoses greater than 1 cm.
  24. 24. • 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.
  25. 25. • 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.
  26. 26. Intracerebral Hemorrhage Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.
  27. 27. Intracerebral Hemorrhage
  28. 28. Pericardial Hemorrhage
  29. 29. Hemostasis and Thrombosis
  30. 30. THROMBOSIS -Virchow triad
  31. 31. Thrombus - Morphology Venous Arterial  Arise in arteries  Arise in deep veins and superficial veins (popleteal  Femoral Iliac),  Grow in retrograde fashion (towards the heart)  Antigrade  Forms at site of Endothelial injury (AS), turbulence (aneurysms)  At site of stasis (lower extremities)  Pale/ white  Red / dark  Lines of Zahn  No lines of Zahn
  32. 32. • 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.
  33. 33. Venous Thrombi: Clinical
  34. 34. Thrombotic Vegetations Mitral Valve Photo: Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.
  35. 35. Abdominal Aortic Aneurysm Thrombus
  36. 36. (Deep Vein Thrombosis (DVT
  37. 37. Plaque with Recent Thrombus
  38. 38. Thrombosis Outcomes Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.
  39. 39. Early Organizing Thrombus
  40. 40. Embolism
  41. 41. Embolization (Embolus( Thromboembolism of Pulmonary Artery Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003; . Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.
  42. 42. Infarction
  43. 43. Infarction (Infarct( (Lung (Left(; Spleen (Right Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003.
  44. 44. Pulmonary Infarction
  45. 45. Small Intestine Infarction
  46. 46. Kidney Infarction (Replaced by Fibrotic Scar (Left
  47. 47. Pale Infarct (Wedge( of Spleen
  48. 48. Thanks

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