1、Hemodynamic Disorders,王漱陽 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 circulatory system

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

3、ncreased 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,Morphology 小動脈和毛細(xì)血管擴張，充滿紅細(xì)胞

4、色澤鮮紅，體積可輕度增大，溫度高,HYPEREMIA,Causes: Systemic: general 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, fr

5、ostbite,CONGESTION,CONGESTION,Chronic congestion 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 Fibroblas

6、t proliferation Microscopic scarring Edema Hemorrhage,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

7、while cutting the lung LM: Alveolar capillaries highly dilated and engorged with blood rosary- like appearance Alveolar cavity filled with eosinophilic edema fluid Manifestation Pink colored foamy sputum,Lung,CONGESTION,CONGESTION,Lung Chronic Pulmonary Congestion Gross: Hard, with brown spots scatt

8、ered Brown Induration 褐色硬化 LM: Septa thickened and fibrosis heart failure cells 心衰細(xì)胞 hemosiderin-laden macrophages Manifestation rusty sputum, dyspnea, etc.,CONGESTION,Liver,右心衰竭 下腔靜脈、肝靜脈回流受阻,CONGESTION,Liver Acute Hepatic Congestion LM: Dilation of central vein and sinusoids with blood Atrophy, deg

9、eneration and necrosis of central hepatocytes,CONGESTION,Liver Chronic Hepatic Congestion Nutmeg Liver “檳榔肝” Gross: red-brown zones accentuated against the yellow surrounding zones LM: centrilobular necrosis and congestion, and perilobular fatty change; fibrosis Long-standing, severe hepatic congest

10、ion: congestive hepatic fibrosis (cardiac cirrhosis) superficial small granular “豬皮”,Nutmeg Liver 檳榔肝,病因 肝硬化 慢性心力衰竭,CONGESTION,Spleen,脾淤血-病變,Gross：體積增大、包膜增厚(玻璃樣變) 切面暗紅色、白髓減少、小梁增多 LM：脾竇擴張淤血、白髓受壓萎縮、竇壁纖維增生 tobacco nodules or Gandy-Gamma nodules 含鐵小結(jié)/煙草小結(jié),脾竇內(nèi)巨噬細(xì)胞含鐵血黃素。含鐵血黃素與鐵鹽、鈣鹽組成。肉眼針尖大小、中央呈黃色，周圍為褐色。,H

11、emorrhage （出血）,Causes Rupture of blood vessels Trauma Peptic ulcer, aneurism, atherosclerosis Diapedesis Enlarged interendothelial gap (basement membrane injury). The integrity of the vessels remains intact Injury to vascular wall: severe infection, anoxia, toxins Change in number and quality of pla

12、telets uremia, leukemia, idiopathic Disturbance of coagulation mechanism 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

13、site. Hemorrhagic shock Stroke,Normal hemostasis Maintain blood in a fluid, clot-free state Localized hemostatic plug Thrombosis （血栓形成） Blood clot (thrombus，血栓) formation in cardiovascular system of a living body 在活體心血管系統(tǒng)內(nèi)血液發(fā)生凝集和凝固而形成固體的過程,Hemostasis MI, aortic aneurysms, ulcerated AS plaques, veget

14、ations Target sites: lower extremities, brain, intestines, kidney, spleen Consequences: infarction,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 lo

15、dge? What are the features of their impairment?,Fat Embolism 脂肪栓塞,Released from the bone marrow and 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 skele

16、tal injuries have some clinical manifestation,Fat Embolism,Results depend on the diameter and the quantity of the fat droplets 20m, pulmonary embolism 20 m, cerebral embolism other organ embolism,Special staining Osmium staining (Sudan III ),Fatty Embolus in the Vascular Lumen,Pathogenesis obstructi

17、on anemia and thrombocytopenia diffuse petechial rash ( in 20-50% cases),Fat Embolism,GAS Embolism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,kesn,Result

18、s: Small amount of gas may be absorbed Occupies the heart ventricle, interrupted the blood flow cause 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 o

19、f a localized area of ischemic necrosis within a tissue or organ due to impaired arterial supply or the venous drainage. 由于部分動脈或靜脈阻塞引起局部組織或器官供血不足或停止而發(fā)生的壞死,稱為梗死(infarct)。 The necrosis area is called infarct. 其過程稱梗死形成(infarction). An extremely important cause of clinical illness: myocardiac infarction

20、 cerebral infarction,Causes Occlusion of arterial supply or venous drainage Thrombosis, embolism, athermanous plaques, external compression Functional spasm of arteriole Types White infarcts (anemic infarcts) Red infarcts (hemorrhagic infarcts) Septic infarcts,INFARCTION,臟器血供特點、組織的結(jié)構(gòu)疏密程度、血管阻塞程度、是否有淤

21、血、有無感染,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 hemorrhagic zone surrounding,陳舊梗死灶機化、瘢痕、凹陷,INFARCTION,LM Ischemic coagulative necrosis Hemorrhag

22、ic zone : inflammatory and granulation tissue.,Most undergo organization and scarring in the end.,Kidney Infarction,INFARCTION,Spleen Infarction,INFARCTION,Cardiac Infarction,INFARCTION,Brain Infarction ( liquefied necrosis),INFARCTION,Red infarction Arterial occlusion Venous occlusion Loose tissue

23、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 Base beneath the pleura Fibrin exudation LM Coagulative necros

24、is 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 development of occlusion Vulnerabilit