Hemodynamic disorders pathology

1. HEMODYNAMIC DISORDERS
AHMAD ULLAH
LECTURER ANESTHESIA

2. HEMODYNAMIC DISORDERS
• When blood passes through capillary, there is little net movement of substances into the
tissues
• This movement is disturbed by pathologic conditions – edema
• The integrity of blood vessels is compromised by trauma
• Hemostasis prevents bleeding, if inadequate – hemorrhage
• Inappropriate clotting (thrombosis) or migration of clots (embolism) can obstruct
blood vessels, causing ischemic cell death (infarction)

3. 1.IncreaseTissue FluidVolumes
1. Hyperemia
2. Congestion
3. Edema
2.DecreaseTissue Blood Flow
1. Hemorrhage
2. Thrombosis
3. Embolism

4. HYPEREMIA
• An active process of increased in inflow of blood volume in a tissue due to arteriolar dilation
• Increased blood flow ------- Due to arteriolar dilatation
• Tissues appear red (erythematous) and warm due to oxygenated blood.
• e.g. Sites of inflammation or exercising muscles
• Associated with capillary dilatation
• Increased inflow leads to erythema
• Active hyperemia is generally a beneficial physiological response (e.g to meet metabolic demand or
in inflammatory )

6. CONGESTION
• It is the medical conditions that arise due to an abnormal accumulation of fluid, typically
blood or other bodily fluids, in tissues or organs.
• This condition often results from an imbalance in the circulatory system and can lead to
a range of health issues.

8. TYPES OF CONGESTION
1)Venous Congestion:This occurs when blood flow out of a particular area is impaired, leading to
an accumulation of blood. It can be due to:
• Heart Failure:The heart's reduced ability to pump blood effectively leads to a backlog in the
veins, particularly in the lungs (pulmonary congestion) or systemic circulation (systemic venous
congestion).
• DeepVeinThrombosis (DVT): Blood clots in deep veins, often in the legs, can obstruct blood
flow and cause congestion.
• ChronicVenous Insufficiency:A condition where veins have trouble sending blood from the
legs back to the heart, leading to swelling and discomfort.

9. 2) Pulmonary Congestion: Specifically related to the lungs, this occurs when fluid
accumulates in the lung tissues and alveoli. Common causes include:
• Left-Sided Heart Failure:When the left side of the heart fails to pump effectively, fluid
backs up into the lungs.
• Pulmonary Edema:A condition where excess fluid collects in the lung tissues, often
due to heart failure or acute respiratory distress.

10. 3) Hepatic Congestion:This is when blood backs up in the liver due to:
• Right-Sided Heart Failure: Impaired pumping from the right side of the heart can lead
to fluid buildup in the liver.
• Cirrhosis: Liver scarring can obstruct blood flow through the liver, causing congestion.

11. 4) Portal Hypertension: Increased blood pressure in the portal venous system can lead
to congestion in the spleen and other abdominal organs. It is often associated with liver
disease, especially cirrhosis.

12. PATHOPHYSIOLOGY:
• Impaired Blood Flow: Congestion often results from problems in blood flow, either
due to obstructive conditions like thrombosis or due to heart failure where the heart's
pumping capacity is diminished.
• Increased Hydrostatic Pressure:When blood flow is obstructed, pressure increases
in the veins, pushing fluid out into surrounding tissues.
• Fluid Accumulation:The fluid that accumulates in tissues can lead to edema, which is
swelling due to excess fluid.

13. SYMPTOMS:
Symptoms of congestion pathology vary depending on the affected area but can include:
• Swelling: Often in the legs or abdomen.
• Shortness of Breath: Especially if the lungs are affected.
• Pain or Discomfort: In the areas where fluid accumulates.
• Fatigue: Due to reduced efficiency of the heart or other organs.

14. EDEMA
• Water makes 60% of body weight
• 2/3 intracellular
• 1/3 extracellular
• Most in interstitium and very small amount in plasma
• Edema refers to accumulation of extra fluid within tissues interstitium
• Usually in lower limb, but also involve the entire body
• Old age and pregnant women are more likely to get edema

15. EFFUSION
• Fluid accumulations in body cavities is known as effusions
• Pleural cavity – hydrothorax
• Pericardial cavity – hydro pericardium
• Peritoneal cavity – ascites
• Severe swelling of subcutaneous tissues – Anasarca

16. PATHOGENESIS
• Fluid movement b/w vascular and interstitium is control by two opposing pressures:
1. Vascular hydrostatic pressure – fluid, tends to outflow
2. Colloid osmotic pressure – plasma proteins, tends to inflow
• Hydrostatic pressure at arteriolar end is slightly high
• Osmotic pressure at venular end is slightly elevated
• These pressure allow only a small net outflow of fluid into the
interstitial space, drained by lymphatic vessels

17. PATHOGENESIS
• Imbalance in these pressures cause increased movement of fluid (transudate) into the
interstitium – edema
• High hydrostatic pressure
• Low osmotic pressure

18. ETIOLOGIES
1. Increased Hydrostatic Pressure
2. Reduced Plasma Osmotic Pressure
3. Lymphatic Obstruction
4. Sodium Retention
5. Inflammation

19. MECHANISM
Increased Hydrostatic Pressure
• Caused by disorders that impair venous return
• Local increases in IV pressure
• DVT in the lower extremity – local edema distal to affected leg
• CHF – Generalize increases in venous pressure – systemic edema

20. Factors increasing hydrostatic pressure:
1. Reduced cardiac output
2. Low output results in renal hypoperfusion – stimulate RAAS,
Inducing sodium and water retention

21. MECHANISM
Reduced Plasma Osmotic Pressure
• Caused by reduction of plasma albumin concentrations
• Albumin make ½ of total plasma protein
• Albumin lost – Nephrotic syndrome – leak glomerulus, loss of albumin in urine –
generalized edema
• Synthesizes in inadequate amounts – liver cirrhosis and protein malnutrition

22. MECHANISM
Lymphatic Obstruction
• Compromises resorption of fluid from interstitial spaces into the blood
• Edema due to lymphatic obstruction is called lymphedema
• Results from a localized obstruction due to inflammation, neoplasia, surgery

23. MECHANISM
Sodium Retention
• Excessive retention of salt (with water) increase hydrostatic pressure (expansion of IV
volume) and reducing plasma osmotic pressure
• Diseases that compromise renal function
1. Glomerulonephritis and acute renal failure (low GFR)
2. Hyperaldosteronism – heart failure stimulating RAAS

24. MECHANISM
Inflammation
• Increased vascular permeability
• Exudation occur which increased osmotic pressure in interstitium
• Protein in interstitium exert osmotic pressure and attract more and more fluid

25. SIGNS
• Swelling
• Skin that hold a dimple or pit after being hold or pressed
• Shiny skin
• Enlarge abdomen
• Sudden weight gain
• Severe leg pain, feel heavy and difficult to walk
• Ulcer may developed on the skin – impair blood flow

26. THANKS