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Uploaded byJyothi Reshma S
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Hemodynamics - Hyperemia

This document discusses disorders of perfusion including hyperemia, congestion, and hemorrhage. It describes active hyperemia which results from increased demand and passive hyperemia or congestion from impaired venous outflow. Chronic venous congestion can lead to edema, hypoxia, fibrosis, capillary rupture and hemorrhage. Specific organs affected by chronic venous congestion like the liver, lung and spleen are described. The liver shows centrilobular congestion and necrosis while the lung contains hemosiderin-laden macrophages. Grossly organs are enlarged and microscopically show dilated sinusoids, fibrosis and iron-containing macrophages. Different types of hemorrhage like petechiae, purpura

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DISORDERS OF PERFUSION Dr. Jyothi Reshma S Tutor Dept of Pathology HYPEREMIA, CONGESTION, HEMORRHAGE HEMODYNAMICS - 2
ACTIVE HYPEREMIA  Active hyperemia : increased supply of blood from the arterial system  Physiologic response to increased functional demand  Eg: heart and skeletal muscle during exercise, inflammation  Neurogenic and hormonal influences  Reactive hyperemia - temporary interruption of blood
PASSIVE HYPEREMIA  Passive hyperemia or congestion : impaired exit of blood through venous pathways  Increased hydrostatic pressure - edema.  Lack of blood flow - chronic hypoxia - ischemic tissue injury and scarring.  Capillary rupture - small hemorrhages - catabolism of extravasated red cells - hemosiderin-laden macrophages - Chronic venous congestion (CVC)
Consequences of Impaired Venous Outflow Increased intravascular pressure Stasis HAEMORRHAGE NECROSIS CONGESTION OEDEMA HYPOXIA FIBROSIS Capillary rupture Acute Chronic
CVC LUNG  Enlarged, heavy  Fibrosis + iron = firm brown lung - brown induration
CVC LUNG Alveolar congestion Intra-alveolar hemorrhage Hemosiderin-laden macrophages in the lung - congestive heart failure – heart failure cells
LIVER - ORGANIZATION
CVC LIVER Distension - central vein and sinusoids Centrilobular area is at the distal end of the hepatic blood supply - ischemic necrosis Periportal hepatocytes - better oxygenated because of proximity to hepatic arterioles — fatty change.
CVC LIVER – NUTMEG LIVER Dark foci of centrilobular congestion surrounded by paler zones of unaffected peripheral portions of the lobules
CVC LIVER – M/S Centrilobular hemorrhage Hemosiderin- laden macrophages Hepatocyte dropout and necrosis
CVC SPLEEN  Gross : enlarged and tense  M/s: Diffuse splenic fibrosis - iron-containing, fibrotic and calcified foci of old hemorrhage Gamna-Gandy bodies  Excessive functional activity—hypersplenism - hematologic abnormalities - thrombocytopenia
CVC SPLEEN Gamna- Gandy bodies
SUMMARY GROSS MICROSCOPY  Enlarged  Reddish blue - cyanosed  C/s : oozing of blood  Firm : fibrosis  Capsule : thickened  Capillary (sinusoids) : dilated , congested – blood  Septa : thickened  Fibrotic bands  Hemosiderin laden macrophages : special names (lung, spleen) PATHOGENESIS
HEMORRHAGE Escape of blood from the vasculature into surrounding tissues, a hollow organ or body cavity, or to the outside ETIOLOGY, TYPES, CONSEQUENCES
HEMATOMA  Localized hemorrhage - within a tissue or organ
PETECHIAE  Pinpoint hemorrhages - <3mm - skin or conjunctiva  Rupture - capillary or arteriole  Coagulopathies or vasculitis
PURPURA  Diffuse superficial hemorrhages in the skin  Up to 1 cm in diameter
ECCHYMOSIS  Large superficial hemorrhage in the skin  > 1cm  Purple – green – yellow (progressive oxidation of bilirubin released from the hemoglobin of degraded erythrocytes)
Hemothorax, hemopericardium, hemarthrosis, hemoperitoneum
COMPREHENSION QUESTIONS  A 40-year-old woman dies after a long history of an illness characterized by dyspnea, orthopnea, hepatomegaly, distended neck veins, and peripheral edema. The cut surface of the liver as it appears at autopsy is shown in the first panel. The second panel shows the microscopic appearance of the liver. What is the most likely cause of these findings?
 A 36-year-old man dies during cardiac surgery. He had a history of long-standing rheumatic heart disease with mitral stenosis. At autopsy, the pathologist reports findings consistent with mitral stenosis and noted the presence of “heart failure cells.” This finding results from (A) activation of the coagulation cascade. (B) chronic passive congestion of the lungs. (C) hypoxic myocardial injury. (D) myocardial hyperemia.
EXAMPLE OF ECCHYMOSI S
T H A N K Y O U