1、Hemodynamic Disorders,Ye Liu （劉 曄） Department of Pathology,An Anatomical Study of the Motion of the Heart and of the Blood in Animals, 1628,Containing Heart, artery, Vein General circulation Pulmonary circulation Functions Deliver oxygen and nutrients Carry away metabolic wastes,A Healthy circulator

2、y system Normal blood volumn Homeostasis,Normal homeostasis vessel wall integrity intravascular pressure osmolarity normal hemostasis,Edema Hyperemia red, raised tempreture, increased volume ; enhanced function;,Congestion: passive process; general of local; reddish blue color (cyanosis), low temper

3、ature, increased volume, edema; decreased function,Types Physiological: shy, exercise, taking meal Pathological: inflammatory, post-decompressed Significance Benefits plenty supply of O2, functional enhancement, nutrition substance Hazards headache , hemorrhage, stroke,HYPEREMIA,Causes: Systemic: ge

4、neral or pulmonary cardiac dysfunction (right or left) Local: local venous compression or obstruction external Compression - tumor, bandage occlusion of lumen - thrombosis, embolism thickening of venous wall paralysis of neurogenic modulation - burn, frostbite,CONGESTION,CONGESTION,Chronic congestio

5、n Raised venous pressure Anoxia Metabolite accumulation Enlarged interendothelial gap Base membrane degeneration Parenchymal Interstitial fibrosis Atrophy Reticular fiber collapsed Increase permeability Degeneration Collagen increased Necrosis Fibroblast proliferation Microscopic scarring Edema Hemo

6、rrhage,Congestive sclerosis,Morphology Grossly hemorrhagic and wet Microscopically rich of red blood cells in small vessels,CONGESTION,CONGESTION,Lung acute pulmonary congestion Gross: Plump swollen lung with shining pleura, edematous fluid flowing out while cutting the lung LM: Alveolar capillaries

7、 highly dilated and engorged with blood rosary- like appearance Alveolar cavity filled with eosinophilic edema fluid Manifestation Pink colored foamy sputum,CONGESTION,Lung chronic pulmonary congestion Gross: Hard, with brown spots scattered Brown Induration LM: Septa thickened and fibrosis heart fa

8、ilure cells hemosiderin-laden macrophages Manifestation rusty sputum, dyspnea, etc.,CONGESTION,Liver acute hepatic congestion LM: Dilation of central vein and sinusoids with blood Atrophy, degeneration and necrosis of central hepatocytes,CONGESTION,Liver chronic hepatic congestion Nutmeg Liver Gross

9、: red-brown zones accentuated against the yellow surrounding zones LM: centrilobular necrosis and congestion, and perilobular fatty change; fibrosis Long-standing, severe hepatic congestion: hepatic fibrosis (cardiac cirrhosis),Hemorrhage （出血）,Causes Rupture of blood vessels Trauma Peptic ulcer, ane

10、urism, atherosclerosis Diapedesis Enlarged interendothelial gap (basement membrane injury). The intergrity of the vessels remains intact Injury to vascular wall: severe infection, anoxia, toxins Change in number and quality of platelets uremia, leukemia, idiopathic Disturbance of coagulation mechani

11、sm congenital disease, DIC , deficiency of Vit. K,hemorrhage,petechiae purpuras ecchymoses hematoma hemothorax hemopericardium hemoperitoneum hemoarthrosis,The clinical significance depends on the volume, the rate of loss and the site. Hemorrhagic shock Stroke,Normal hemostasis Maintain blood in a f

12、luid, clot-free state Localized hemostatic plug Thrombosis （血栓形成） Blood clot (thrombus，血栓) formation in cardiovascular system of a living body,Hemostasis MI, aortic aneurysms, ulcerated AS plaques, vegetations Target sites: lower extremities, brain, intestines, kidney, spleen Consequences: infarctio

13、n,Systemic Thromboembolism,Embolism,Thromboembolism 99% Non-thrombotic embolism Fat embolism Gas embolism Amniotic fluid embolism,Can you answer these questions: Where do they come from? Where do they lodge? What are the features of their impairment?,Fat Embolism 脂肪栓塞,released from the bone marrow a

14、nd soft tissue due to severe injury long bone fracture soft tissue trauma or burns squeeze of the fatty changed liver Mainly occurs in the lung and the brain Mostly asymptomatic, only 10% of severe skeletal injuries have some clinical manifestation,Fat Embolism,Results depend on the diameter and the

15、 quantity of the fat droplets 20m, pulmonary embolism 20 m, cerebral embolism other organ embolism Special staining (Sudan III ) Osmium staining,Fatty Embolus in the Vascular Lumen,Pathogenesis obstruction anemia and thrombocytopenia diffuse petechial rash ( in 20-50% cases),Fat Embolism,GAS Embolis

16、m氣體栓塞,Source: air or N2 bubbles Exogenic: transfusion, operation or trauma in the neck or chest, artificial pneumothorax, pneumoperitoneum Endogenic: decompression sickness or caisson disease,Results: Small amount of gas may be absorbed Occupies the heart ventricle, interrupted the blood flow cause

17、death Gas embolism in multiple organs (esp. brain pulmonary embolism; reflex vasoconstriction; allergic shock ; DIC,Alcian Blue PAS staining,Amniotic Fluid Embolism,INFARCTION （梗死形成）,The formation of a localizad area of ischemic necrosis within a tissue or organ due to impaired arterial supply or th

18、e venous drainage The necrosis area is called “infarct”. An extremely important cause of clinical illness: myocardiac infarction cerebral infarction,Causes Occlusion of arterial supply or venous drainage Thrombosis, embolism, athermanous plaques, external compression Functional spasm of arteriole Ty

19、pes White infarcts (anemic infarcts) Red infarcts (hemorrhagic infarcts) Septic infarcts,INFARCTION,INFARCTION,White infarction Arterial occlusion Solid, compact organs Few collateral circulation (spleen, kidney, heart, brain, etc.),Morphology Gross Dull pale, dry, wedge-shaped necrotic lesion A hem

20、orrhagic zone surrounding,INFARCTION,LM Ischemic coagulative necrosis Hemorrhagic zone : inflammatory and granulation tissue.,Most undergo organization and scarring in the end.,INFARCTION,Spleen Infarction,INFARCTION,Cardiac Infarction,INFARCTION,Brain Infarction ( liquefied necrosis),INFARCTION,Red

21、 infarction Arterial occlusion Venous occlusion Loose tissue Dual circulations: lung , small intestine previously congested re-established blood flow to a site of previous arterial occlusion and necrosis,INFARCTION,Hemorrhagic infarction of the lung Gross Roughly wedged shaped Dark red, solid area B

22、ase beneath the pleura Fibrin exudation LM Coagulative necrosis Large amounts of RBC filled in alveolar space Obscure structure,INFARCTION,Hemorrhagic infarction of the intestine,INFARCTION,Septic Infarction Bacteria containing emboli May form abscess and pus,INFARCTION,Fate of Infarct Enzymatic lysis, liquefaction and absorption Organization with scar formation Encapsulation and Calcification,INFARCTION,Factors that influence development of an infarct Nature of the vascular supply Rate of developmen