2 hyperemia-congestion
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2 hyperemia-congestion
- 1. HemodynamicsHemodynamics Hyperemia and CongestionHyperemia and Congestion Dr.CSBR.Prasad, M.D.
- 2. Hyperemia and CongestionHyperemia and Congestion Both are vascular events
- 4. Hyperemia and CongestionHyperemia and Congestion • Both indicate a local increased volume of blood in a particular tissue. • There is increased vascular volume • Hyperemia is an active process - arteriolar dilation – arterial side • Congestion is a passive process - impaired outflow – venous side - may be systemic / local
- 5. HyperemiaHyperemia CongestionCongestion Blood volume Increased Increased Vascular volume Increased Increased Mechanism Active – chemicals Passive – stagnation Vascular compartment Arterial side Venous side Site Usually local Local / systemic
- 7. Hydrostatic pressure is increased in both the conditions, hence Hyperemia and congestion are always associated with edema Hyperemia and CongestionHyperemia and Congestion
- 9. • Inflammations – conjunctivitis • Hypercalcemia • Hyperparathyroidism • Ataxia – telangiectasia (if the vessels are tortuous) Conjunctival hyperemia - causesConjunctival hyperemia - causes
- 10. Sturge-Weber SyndromeSturge-Weber Syndrome Blanching (circle)Blanching (circle)
- 11. CongestionCongestion • Distension of blood vessels • May be an active or passive process • Reversible condition
- 13. Left-sided cardiac failure Causes: • 1. Systemic hypertension (most common cause). • 2. Ischemic heart disease. • 3. Mitral or aortic valve disease. • 4. Primary myocardial disease.
- 14. Left-sided cardiac failure Clinical presentation 1. Due to obstruction to pulmonary vascular out-flow there is pulmonary congestion and edema. 2. Reduction of renal perfusion causes: (i) Salt and water retention (ii) Ischemic acute tubular necrosis (iii) Impairment of waste excretion causing azotemia. 3. Reduced perfusion of central nervous system causes hypoxic encephalopathy (irritability to coma).
- 15. Right-sided cardiac failure Causes: 1. Most common cause is the left ventricular failure, causing pulmonary congestion and raised pulmonary arterial pressure. 2. Intrinsic disease of lungs and pulmonary vasculature causing obstruction to right ventricular out-flow (cor pulmonale). 3. Pulmonary or tricuspid valve disease. 4. Congenital heart disease in which there is left-to-right shunt. Example: (i) Patent foramen ovale ; (ii) Patent ductus arterisus and (iii) Interventricular septal defect. Other causes: i) Extracardiac circulatory failure. Example: Haemorrhage ; vasovagal syncope etc. ii) Impaired atrial filling by external compression. Example: Constrictive pericarditis.
- 16. Right-sided cardiac failure Clinical presentation 1. Congestion and edema of portal and dependent peripheral sites (Eg: feet, ankle, sacrum) and effusions in pleura and peritoneum (ascites). 2. Hepatomagaly - Centrilobular congestion and atrophy of central hepatocytes (nutmeg liver) 3. Congestive splenomegaly with sinusoidal dilation, focal hemorrhage followed by hemosiderosis and fibrosis. 4. Renal congestion causes acute hypoxic tubular necrosis.
- 19. CVC liver -- GrossCVC liver -- Gross In chronic passive congestion of the liver (nutmeg liver) the central regions of the hepatic lobules are grossly red-brown and slightly depressed (owing to a loss of cells) and are accentuated against the surrounding zones of uncongested tan liver (nutmeg liver)
- 20. CVC – LiverCVC – Liver ‘Starry sky’ appearance in US
- 21. Nut meg liver
- 22. Nut megNut meg
- 23. • Centrilobular necrosis with loss of hepatocytes dropout and • Hemorrhage, including hemosiderin-laden macrophages • Hepatic fibrosis [In severe, long-standing hepatic congestion there may even be grossly evident hepatic fibrosis (cardiac cirrhosis)] CVC liver -- microscopyCVC liver -- microscopy
- 24. In acute hepatic congestion: • Central vein and sinusoids are distended with blood • Central hepatocyte degeneration • The periportal hepatocytes - may only develop fatty change. CVC liver -- MicroscopyCVC liver -- Microscopy
- 28. CVC - Liver
- 29. Centrilobular necrosis - causesCentrilobular necrosis - causes NOTE: Because the central portion of the hepatic lobule is the last to receive blood, centrilobular necrosis can also occur whenever there is reduced hepatic blood flow (including shock from any cause); there need not be previous hepatic congestion.
- 30. CVC LungCVC Lung
- 33. Pulmonary edema
- 34. • The cut surfaces of hyperemic • tissues are hemorrhagic and wet CVC Lung - GrossCVC Lung - Gross
- 35. Acute pulmonary congestion: • alveolar capillaries engorged with blood • alveolar septal edema and/or • focal intraalveolar hemorrhage CVC Lung -CVC Lung - Microscopic
- 36. Chronic pulmonary congestion: • the septa are thickened and fibrotic • the alveolar spaces may contain numerous hemosiderin-laden macrophages (heart failure cells). CVC Lung -CVC Lung - Microscopic
- 37. Pulmonary edema with a few extravasated RBCs
- 39. CVC – Lung [ Perl’s stain ]
- 40. E N DE N D gotogoto HemorrhageHemorrhage
Editor's Notes
- The terms hyperemia and congestion both indicate a local increased volume of blood in a particular tissue. Hyperemia is an active process resulting from augmented tissue inflow because of arteriolar dilation, as in skeletal muscle during exercise or at sites of inflammation. The affected tissue is redder because of the engorgement of vessels with oxygenated blood. Congestion is a passive process resulting from impaired outflow from a tissue. It may occur systemically, as in cardiac failure, or it may be local, resulting from an isolated venous obstruction. The tissue has a blue-red color (cyanosis), particularly as worsening congestion leads to accumulation of deoxygenated hemoglobin in the affected tissues ( Fig. 4-3 ).
- The terms hyperemia and congestion both indicate a local increased volume of blood in a particular tissue. Hyperemia is an active process resulting from augmented tissue inflow because of arteriolar dilation, as in skeletal muscle during exercise or at sites of inflammation. The affected tissue is redder because of the engorgement of vessels with oxygenated blood. Congestion is a passive process resulting from impaired outflow from a tissue. It may occur systemically, as in cardiac failure, or it may be local, resulting from an isolated venous obstruction. The tissue has a blue-red color (cyanosis), particularly as worsening congestion leads to accumulation of deoxygenated hemoglobin in the affected tissues ( Fig. 4-3 ).
- Figure 4-3 Hyperemia versus congestion. In both cases there is an increased volume and pressure of blood in a given tissue with associated capillary dilation and a potential for fluid extravasation. In hyperemia, increased inflow leads to engorgement with oxygenated blood, resulting in erythema. In congestion, diminished outflow leads to a capillary bed swollen with deoxygenated venous blood and resulting in cyanosis.
- Conjunctival hyperemia
- Blanching hyperemia Gum hyperplasia, with abnormal vessels evident on the hard palate.
- In severe, long-standing hepatic congestion (most commonly associated with heart failure), there may even be grossly evident hepatic fibrosis (cardiac cirrhosis).
- The periportal hepatocytes, better oxygenated because of their proximity to hepatic arterioles, experience less severe hypoxia and may only develop fatty change.
- Figure 4-4 Liver with chronic passive congestion and hemorrhagic necrosis. A, Central areas are red and slightly depressed compared with the surrounding tan viable parenchyma, forming the so-called "nutmeg liver" pattern. B, Centrilobular necrosis with degenerating hepatocytes, hemorrhage, and sparse acute inflammation. (Courtesy of Dr. James Crawford, Department of Pathology, University of Florida, Gainesville, FL.)
- Note the round, clear, lipid vacuoles in the surviving hepatocytes
- Pulmonary congestion with dilated capillaries and leakage of blood into alveolar spaces leads to an increase in hemosiderin-laden macrophages, as seen here. Brown granules of hemosiderin from break down of RBC's appear in the macrophage cytoplasm. These macrophages are sometimes called "heart failure cells" because of their association with pulmonary congestion with congestive heart failure.