This document discusses hemodynamic disorders including thrombosis, embolism, and hemorrhage. Thrombosis is the formation of a blood clot within a blood vessel. It can be caused by endothelial injury, changes in blood flow, changes in blood composition, or hypercoagulability. Embolism occurs when a mass travels through the bloodstream and blocks a vessel. Common types are thromboembolism, fat embolism, air embolism, and amniotic fluid embolism. Hemorrhage is the escape of blood from vessels. It can be external from sites like the skin or internal within body cavities. The effects of hemorrhage range from local homeostasis to systemic shock

1. Hemodynamic Disorders

2. Thrombosis
Definition:
Solidified mass from the constituents of the blood,
within blood vessels, during life.

3. Aetiology of thrombosis

4. 1- Endothelial injury
• Causes
Atherosclerosis Traumatic injury
Inflammations

5. 2- Alteration in the blood flow(stasis)
Def : deviation of platelets from the axial
blood stream and contact with the
endothelium.
Causes :
1- venous thrombosis due to heart failure
2- varicose venous
3- acute inflammation
4- hyper viscosity states

6. 3- changes in blood compositions
1- Increase of red blood cells in case of
polycythemia.
2- increase of white blood cells in case of
leukemia
3- loss of plasma in case of dehydration
4- increases of fibrinogen during pregnancy

7. 4- hypercoagulability of blood
Def: it is alteration in clotting mechanisms
predisposing to thrombosis: the causes
include:
1- inherited lack of natural anticoagulant:
antithrombain III, protein c or protein s.
2- acquired stasis e.g in cases of oral
contraceptives, nephritic syndrome, late
pregnancy, cancer burns…..

8. Types of thrombosis
1- according site:
A- arterial
B- venous
C- capillary
D- cardiac
2- according size
A- Mural
B- Occlusive

9. 3- According to thrombi color :
A- pale thrombi
B- red thrombi
C- mixed thrombi
4- According of presence or absence of bacteria:
A- sterile thrombi
B- infected ( septic Thrombi

10. Fate of thrombi
• THROMBOLYSIS
• RECANALISATION
• EMBOLISM
• FIBROSIS: ORGANISATION

11. Common sites of thrombosis

13. Embolism
• An embolus is an insoluble mass circulating in
the blood.

14. Types of Emboli
• By sites:
1- pulmonary (97% from DVT)
2- systemic ( 80% from heart)
• By material :
1- thromboembolism
2- fat embolism
3- Air
4- Amniotic fluid
5- tumor, foreign body, septic,……

15. Pulmonary thromboembolism
• Depending on size of embolism, it may occlude main
pulmonary artery, or impact across the bifurcation (
saddle embolus), or pass out into smaller, branching
arterioles.

16. Pulmonary embolism - effects
• Massive PE > 60% reduction in blood flow
rapidly fatal
• Major PE- medium sized vessels blocked .
Patients short of breath +/- cough and blood
stained sputum.
• Minor PE- small peripheral pulmonary
arterials blocked. Asymptomatic or minor
shortness of breath

17. Systemic thromboembolism
• Refers to emboli travelling within the arterial
circulation.
• Most (80%) arise from intracardial mural
thrombi .
• The major sites for arteriolar embolization are
the lower extremities (75%) and the brain
(10%).

18. Fat embolism
• Microscopic fat globules may be found in the
circulation after fracture of long bones ( which
have fatty marrow) or , rarely, in soft tissue
trauma and burn.
• Fat is released by marrow or adipose injury
and enters the circulation through rupture of
blood vessels.

20. Air embolism
• Gas bubbles within the circulation can obstruct
vascular flow acting as thrombotic masses.
Bubbles may coalesce to form frothy masses
sufficiently large to occlude major vessels.
• Air may enter the circulation during obstetric
procedures or as a consequence of chest wall
injury.
• An excess of 100 cc is required to have clinical
effect.

21. Amniotic fluid embolism
• uncommon complication of labor and the
immediate postpartum period, characterized by
sudden sever dyspenea, cyanosis, and
hypotensive shock, followed by seizures and
coma.
• Caused by infusion of amniotic fluid or fetal
tissue into the maternal circulation via a tear in
the placental membranes or rupture of uterine
veins.

22. • Tumor emboli due to spread of malignant tumor
• Parasitic and bacterial emboli: such as
bilharzias ova and clumps of bacteria.
• Foreign body emboli: these are rare e.g. crushed
tablets injected intravenously in drug addicted.

23. Hemorrhage
• Def: escape of blood outside the cardiovascular
system.
• Aetiology: apart from physiological loss of blood
(menses) causes of bleeding include:
1- local causes of bleeding:
• Traumatic injury of vessels : accidents, surgery.
• Erosion of vessels e.g in case of malignant tumors,
T.B and peptic ulcer.
• Rupture of aneurysm.
• Inflammation e.g bilharzial and dysentery.

24. 2- General causes of bleeding:
• Hypertension
• Blood diseases e.g hemophilia , leukemia
• Vitamin C and K deficiency.

25. Types of hemorrhage
• 1- external hemorrhage:
a) From skin
b) From respiratory tract:
 Epistaxis : bleeding from nose.
 Hemoptsisy: coughing blood.
c) From alimentary tract:
 Hematemesis : vomiting of blood due to bleeding in
duodenum, stomach or esophagus
 Melena: passage of dark digested blood in stool.
 Bleeding per rectum passage of red undigested blood
with stool.

26. • D) from urinary tract: hematuria.
• E) from female genitalia
 menorrhagia: excessive or prolong menses.
 metrorehagia: irregular uterine bleeding.

27. 2- Internal hemorrhage
a) Hemothorax hemorrhage in pleural sac.
b) Hemopercardium hemorrhage in pericardial
sac.
c) Hemoperitonium hemorrhage in peritoneal
sac
d) Hematocele hemorrhage inside tunica
vaginalis.
e) Hemarthrosis hemorrhage inside joint cavities
.

28. Effects of hemorrhage
1. Local effects: homeostasis ( natural arrest of
hemorrhage ):
• Mechanism of homeostasis:
a) Hypotension due to blood loss reduced rate of
bleeding.
b) Curling of endothelium minimized of bleeding
c) Vascular constriction by serotonin released from
platelets at sites of vascular leakage.
d) Clotting of blood around site of injury.
e) Gradual fibrous organization of the clot

29. Causes of failure of homeostasis
a. Large vascular injury
b. Coagulation defect and blood diseases

30. 2- Systemic effects
a. Chronic (repeated ) blood loss as in cases of
bilharziasis.
b. Rapid blood loss the amount depend on the
amount of hemorrhage.
 Very small amount no effect
 Moderate amount about 750-1000 ml of
blood
 Massive amount more than 1000ml lead to
shock.

31. 3- interstitial hemorrhage
1. According to type of bleeding vessels
 Red arterial
 Blue venous
2. According its extent, interstitial hemorrhage may
be:
 Petechial: small spots of hemorrhage
 Ecchymosis: a bigger patch or patches of
hemorrhage
 Hematoma : large blood swelling