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PA3 Haemodynamic alteration血液動力學改變 (Edema (reason (Increased Hydrostatic…
PA3 Haemodynamic alteration血液動力學改變
Hyperemia充血
blood volume increase
Type
active hyperemia
Oxygenated blood
example
inflammation
exercise
morphological alteration
• Increased organ size
• Increased temperature
• Reduced consistency降低一致性
• Erythema (redness)
passive hyperemia(congestion堵塞)
definition
reduced oxygen
associated to edema
example
Generalized (heart failure)
Localized (venous obstruction)
morphological alteration
• Reduced organ size
• Reduced temperature
• Cyanosis (dark red/purple)
• Reduced consistency(increased in chronic)
Edema
definition
reduction of the intravascular volume
interstitial liquid (transudate ,exudate) or in cavities (pericard, pleural space胸膜腔 , peritonei腹膜)
Types
kind
inflammatory edema炎性水腫 -> Exudate (>1020)
hydrostatic edema靜水腫 --> Trasudate (<1012)
location
local
ascites腹水
hydrothorax胸水
hydropericardium心包水.
Generalized:anasarca全身水腫
reason
Increased Hydrostatic Pressure↑ 靜水壓力
• Right heart failure --> edema in lower limbs and organs
• Liver cirrhosis肝硬化--> ascites腹水
• Femoral veins ́ thrombosis 股靜脈血栓形成--> edema in lower limbs
• Left heart failure (acute myocardial infarction急性心肌梗塞)--> pulmonary edema
Reduced Oncotic Pressure↓ 膠體滲透壓: Hypoproteinemia 低蛋白血症
malnutrition營養不良
nephrotic syndrome腎病性
enteropathies with protein losses蛋白質丟失的腸病
cirrhosis (↓ synthesis albumin白蛋白 + portal hypertension門靜脈高壓症)
Lymphatic obstruction
Inflammatory processes (filariasis 絲蟲病--> elephantiasis象皮病)
Iatrogenic edema associated with surgery與手術相關的醫源性水腫 (breast ca.)
Neoplasms腫瘤 --> obstructive lymph node metastases阻塞性淋巴結轉移
Endothelial damage: Inflammatory exudates (burns, drugs)
Sodium/Water Retention鈉/水保留
Excessive salt intake with renal insufficiency
Increased tubular reabsorption of sodium
Renal hypoperfusion腎臟低灌注 --> increased renin- angiotensin- aldosterone secretion腎素 - 血管緊張素 - 醛固酮分泌增加
morphological
microscopy
Increase interstitial space
Identification of a pink liquid (eosinophilic嗜酸性)
Separation of the cells細胞分離
macroscopy
↑ temperature
↓ consistence
Pale Redness淡紅色
When cut liquid oozes切割時液體滲出
↑ organ size
Hemorrhage出血
definition :Extravasation of blood by rupture of the vascular wal
Type(according to )
important
anatomical location
outward
in a tissue
size
Petechiae瘀點: 1-2 mm (skin, mucosae, serosa漿膜) [thrombocytopenia血小板減少症]
Purpura紫癜: 3mm-1cm [vasculitis血管炎]
Ecchymosis瘀斑/ subcutaneous hematomas皮下血腫: > 1-2 cm[traumatisms創傷病]
Collections in organic cavities (hemothorax血胸hemarthros血管)
Thrombosis血栓形成
Type
precipitation thrombus 降水血栓(WHITE)
rapid circulation快速流通
platelets and fibrin 血小板和纖維蛋白
coagulation(stasis) thrombus凝血血栓 (RED)
Slow circulation ,deep located veins
Low consistency低濃度 --> emboli
Tend to be occlusive傾向於閉塞
Red blood cells and fibrin
mixed thrombus (1+2)
Arterial circulation, medium size
Alternates red and white thrombus layers交替紅色和白色血栓層
Zahn lines血栓的特徵 (heart and aorta)
Fibrin thrombus hyaline thrombus 纖維蛋白或透明血栓
microthrombi微血栓 in the capillary bed --> hyaline appearance( fibrin 纖維蛋白)
valvular thrombus 瓣膜血栓(“VEGETATIONS”)
concept
postmortem coagle屍檢後的老鷹 :mass of blood coagulated after death within the organism in declining有機體死亡後血液凝固的質量下降
thrombus血栓: mass of blood clotted pathologically in the bloodstream
hematoma血腫 :mass of blood coagulated outside the bloodstream but within a tissue
Thrombosis--> Virchow's triad:描述了被認為有助於血栓形成的三大類因素
Embolism栓塞
Defintion
displacement by the blood of solid , liquid or gaseous mass
dragged by blood stream ends up locking in a different place
Types
liquid
fat
amniotic fluid羊水
gaseous
air
obstetric intervention 產科干預
air input from out side
100-150 cc.
nitrogen
divers disease
sudden decompression sickness 突然減壓病
form Nitrogen bubble in bloodstream
worker of pneumatic chambers氣動室工人
chronic subtype of Nitrogen bubbles formation
solid
thromboembolism 血栓栓塞
pulmonary embolism (TVP--> TEP)
saddle emboli
small emboli--> asymptomatic無症狀
tissue fragment 血栓栓塞: bone marrow
foreign body
bullets
birds shot
neoplastic cells: tumor emboli
atheroma plaques動脈粥樣硬化斑塊 : cholesterol emboli
bacteria or parasites + PMN: septic emboli化膿性栓子
Ischemia 缺血
inadequate blood supply to tissue--> hypoxia缺氧,anoxia缺氧症
deficit in the elimination of the waste products消除廢物產生的不足 --> cellular necrosis
Infraction梗塞
necrosis(+++,coagulative ) of an organ or tissue due to blood supply occlusion
Types
Reds infracts (haemorragic出血 )
well- defined明確的 , firm consistency and red -purple color
Types
venous occlusion
ovarian torsion卵巢扭轉
當卵巢扭曲其與其他結構的附著時 ，使得血流減少
testicular torsion睾丸扭轉
reperfusion process 再灌注過程
tissues with double circulation
lungs
bowel
brain
lax tissue: lung
previously congestive充血 tissues
white infracts (anemic貧血的)
well-delimited分隔良好 , yellowish -white with congested edges邊緣堵塞 and consistency ↓
arterial occlusion in solid organs of terminal circulation
spleen
kidney
heart