This document discusses hemodynamic disorders that can cause edema and effusions. It covers inflammatory and non-inflammatory edema, with inflammatory edema caused by increased vascular permeability and non-inflammatory edema seen in nutritional disorders. Common causes of edema include increased hydrostatic pressure from conditions like congestive heart failure, reduced plasma oncotic pressure from issues like albumin loss, and sodium/water retention. The morphology of edema, effusions, hyperemia, congestion, and their effects on organs like the lungs and liver are also described.

1. Hemodynamic Disorders
Dr.Abhinav Golla
MBBS .MD Pathology
Assistant Proffessor.
Lab Director
Aadhya Medicure Pathlabs .

2. EDEMA
• Disorders that upset
• Cardiovasular
• Renal
• Hepatic .
• Are often Marked by accumulation of fluid in Tissues ( EDEMA)
• In body cavities are called as (EFFUSSIONS)

5. EDEMA & EFFUSIONS
• May be:
•INFLAMMATORY
•NON INFLAMMATORY

6. INFLAMMATORY EDEMA
• Caused by Inflammatory Mediators.
• These fluids are PROTEIN RICH (EXUDATES).
• Accumulates due to INCREASE IN VASULAR
PERMEABILITY.
• Usually Inflammatory Associated edema is localized to one or few
tissues.

7. NON INFLAMMATORY EDEMA
• Common in many diseases
• Seen in severe Nutritional disorders
• PROTEIN POOR FLUIDS (TRANSUDATES)

8. CAUSES
• Increased HYDROSTATIC PRESSURE. Caused by disorders that IMPAIR
VENOUS RETURN.
Ex. Congestive Cardiac Failure
• Reduced PLASMA ONCOTIC PESSURE. Because
• ALBUMIN accounts half of the total PLASMA PROTEIN.( Increased
loss or Inadequate synthesis of albumin from circulation )
Ex. Nephrotic Syndrome.

9. Causes
• SODIUM & WATER RETENTION.
• Increased Hydrostatic pressure ( Intravascular fluid volume expansion)
• Diminished vascular colloid osmotic pressure( Due to dilution)
• LYMPHATIC OBSTRUCTION
• Trauma , Infection , Parasitic , Invasive Tumours ( IMPAIR THE
CLEARENCE OF LYMPHATIC FLUID ) resulting LYMPHEDEMA.

11. MORPHOLOGY
• GROSSLY
• Subcutaneous Edema (Dependent edema) : In region
with high hydrostatic Pressure.(leg & Sacrum). Causes
PITTING EDEMA.
• Periorbital edema :
• Pulmonary edema : (Frothy & Blood tinged).
• Brain Edema

13. EFFUSIONS
•HYDROTHORAX
•HYDROPERITONIUM
•HYDROPERICARDIUM

14. HYPEREMIA & CONGESTION.
•INCREASED BLOOD
VOLUME WITHIN
THE TISSUES , BUT
HAVING DIFFERENT
UNDERLYING
MECHAMISM &
CONSEQUENCES.

15. HYPEREMIA
•Active process.
•( site of
inflammation or in
skeletal muscle
during exercise.)
increase blood flow.

16. CONGESTION
•PASSIVE PROCESS. Results
from REDUCED OUTFLOW OF
BLOOD FROM TISSUES.
•COMMOMLY LEADS TO EDEMA.

17. • IN CHRONIC CASES capillary
rupture can also produce
small hemorrhagic foci ,
subsequent catabolism of
extravasated red
cells forms (HEMOSIDERIN
LADEN MACROPHAGES)

18. MORPHOLOGY
•GROSSLY
• Congested tissue take on a dusky reddish blue colour (Cyanosis) due
to red cell stasis and presence of deoxygenated hemoglobin .
•MICROSCOPICALLY
• ACUTE PULMONARY CONGESTION .
• Exhibits engorged alveolar capillaries
• Alveolar septal edema.
• Focal intraalveolar hemorrhage .

19. • In CHRONIC PULMONARY
CONGESTION .
•Caused by congestive heart failure
•Septa are thickned & fibrotic.
•Alveoli contains numerous
hemosiderin -
laden macrophages.( Heart Failure
Cells).

21. HEPATIC CONGESTION
•ACUTE HEPATIC CONGESTION.
• CENTRAL VEIN & SINUSOIDS ARE DISTENDED.
• Distal end of the hepatic blood supply (centrilobular area)
hepatocytes in this area undergo ischemic necrosis.
• Periportal hepatocytes may develop fatty change due
to oxygenation from hepatic arterioles.

23. CHRONIC HEPATIC CONGESTION
• GROSS
• Centrilobular are red brown and slightly depressed. Because of cell
death . More prominent against the surrounding zones of
uncongested tan liver .
•NUTMEG LIVER

24. NUTMEG LIVER
• Microscopically
• Centrilobular hemorrhage .
• Hemosiderin laden macrophages
• Variable degree of hepatocytes
dropout & necrosis.