The document discusses haemodynamics and shock, detailing the importance of uninterrupted circulation for cell and organ health, and the pathophysiological classification of edema, hyperemia, and congestion. It explores the mechanisms of hemostasis, types of hemorrhage, causes of thrombosis, and defines shock along with its three categories: cardiogenic, hypovolemic, and septic shock. The document emphasizes the stages of shock and the underlying causes leading to different types of circulatory failures.

1. HAEMODYNAMICS
AND SHOCK
Presented by-Dr.Mana ram
coordinator-Dr.samay singh meena

2. INTRODUCTION
Health of Cells & Organs:
 Uninterrupted Circulation (O2 &
Nutrients, Wastes)
 Normal Fluid & Electrolyte
Balance

3. Normal Fluid Homeostasis
 Vessel Wall Integrity
 Intravascular Pressure
 Intravascular Osmolarity
(CONTIN…….)
INTRODUCTION (contin……)

4. Normal Fluid Homeostasis
 Maintenance of blood as
fluid
 Formation of clot in case of
injury
INTRODUCTION (contin……)

5. Abnormalities of
Haemodynamic System
 Primary (e.g. Pathology in
discrete blood vessels like
Hemorrhage, Thrombosis or
Infarction)
 Secondary (e.g. Pulmonary
Edema, Shock etc.)
INTRODUCTION (contin……)

6. EDEMA
Definition:
“Increased Fluid in the Interstitial
Tissue Spaces”
Also Includes:
Hydrothorax, Hydropericardium
Hydroperitonium or Ascites and
Anasarca.

7. Pathophysiological
Classification
 Inflammatory Edema
 Non-Inflammatory Edema
1. Increased Hydrostatic
Pressure
2. Reduced Plasma Osmotic
Pressure
3. Lymphatic Obstruction
4. Sodium Retention

8.  Increased Hydrostatic Pressure:
1. Impaired Venous Return: (e.g. CCF,
Constrictive Pericarditis, Liver
Cirrhosis, Venous Obstruction)
2. Arteriolar dilatation: (e.g. Exposure
to Heat, Neurohormonal
dysregulation)
Pathophysiological
Classification (Continued….)

9.  Reduced Plasma Osmotic Pressure
1. Protein-Loosing Glomerulopathies
(Nephrotic Syndrome)
2. Liver Cirrhosis (Ascites)
3. Malnutrition
4. Protein-Loosing
gastroenteropathies
Pathophysiological
Classification (Continued….)

10.  Lymphatic Obstruction
1. Inflammatory
2. Neoplastic
3. Postsurgical
4. Postirradiation
Pathophysiological
Classification (Continued….)

11. Factors Affecting Fluid Balance Across
Capillary Wall

12.  Sodium Retention
1. Excessive salt Intake with Renal
Insufficiency
2. Increased Tubular Reabsorption
of Na+
3. Renal Hypoperfusion
4. Incresed Renin-Angiotension-
Aldosterone Secretion
Pathophysiological
Classification (Continued….)

13. HYPERMIA AND
CONGESTION
Definitions:
“Both indicates a local increased
volume of blood in a particular
tissue. ”

14. HYPERMIA AND CONGESTION
Differences:
HYPEREMIA CONGESTION
1 An active process A passive process
2 Increased blood flow
(vasodilatation)
Impaired blood flow
3 During exercise & in
inflammation
Venous obstruction &
cardiac failure
4 Oxygenated blood (Redder) Deoxygenated blood
(Cyanosed)

15. Normal Vasculature Regarding Blood Volume

16. Hyperemia

17. Congestion

18. CHRONIC PULMONARY CONGESTION
Caused by congestive heart failure, the septa are thickened and fibrotic,
and the alveoli often contain numerous macrophages laden with
hemosiderin (heart failure cell) derived from phagocytosed red cell.

19. Congestion (CVC of Liver; gross)
Liver with chronic passive congetion and hemorrhagic
necrosis- central area are red and slightly depressed
compared with the surrounding tan viable
parenchyma,forming a ‘nutmeg liver’ pattern

20. Congestion (CVC of Liver)
Centrilobular necrosis with degenerating hepatocytes
and hemorrhage

21. HEMOSTASIS
Process involving platletes , clotting factor, and
endothelium that occurs at the site of vascular
injury and culminates in the formation of a
blood clot, which serves to prevent or limit the
extent of bleeding.General sequence of event
1.arteriolar vasoconstriction
2.Primary hemostasis formation of platelet
plug 3.secondary
hemostasis : deposition of fibrin 4.clot
stabilization and resorption

23. Hemorrhage
Definition:
“Extravasation of blood due to vessel
rupture”
Types: (depending on the site, extent
and location)
External
Internal
Hematoma: ‘Blood within the tissue’
(small; like a Bruise, or sufficiently
large as to be fatal)

24. Petechial hemorrhages of colonic mucosa as a
consequence of thrombocytopenia

25. Fatal intracerebral hemorrhage

26. THROMBOSIS
 The primary abnormalities that lead to
thrombosis are (1) endothelial injury
(2) stasis or turbulent blood flow,
(3) hypercoagulability of the blood

27. SHOCK
Defination
Shock is a state of circulatory failure that
impaire tissue perfusion and lead to cellular
hypoxia
Three categories
1.Cardiogenic shock
2.Hypovolemic shock
3.Septic shock

28. STAGES OF SHOCK
 1.An initial nonprogressive stage
During which reflex
compensatory mechanism are activated and
vital organ perfusion is maintained .
2.Progressive stage
characterized by tissue hypoperfusion and
onset of worsening circulatory and metabolic
derangement, including acidosis
3.Irreversible stage in which cellular and
tissue injury is so sever that even if the
hemodynamic defects are corrected, survival

29. Cardiogenic shock
 Result from low cardiac output due to
myocardial pump failure.This can be due to
myocardial damage,ventricular
arrythmias,cardiac tamponade,pulmonary
embolism

30. Hypovolumic shock
 Results from low cardiac output due to low
blood volume ,such as can occur with
massive hemorrage or fluid loss from severe
burn

31. Septic shock
 Septic is defined as a subset of sepsis in
which particularly profound circulatory ,
cellular, and metabolic abnormalities are
associated with a greater risk of mortality
than with sepsis alone.

33. Thank You !