Pathomorphology of systemic and local violation of blood circulation презентация

OF SYSTEMIC AND LOCAL VIOLATION OF BLOOD CIRCULATION





DISORDERS OF HEMOSTASIS



Lecture on pathological anatomy for the
3-rd year students

or congestion
anemia or ischemia
violations of vessel’s wall permeability:
bleeding (hemorrhage)
edema (plazmorraghie)
violation of blood circulation:
stasis
sladge-phenomenon
thrombosis
embolism

blood outflow (valvular disease)
Vascular changes:
constrictions caused by vascular spasm
dilatations of vessels
obstructions of vessels
abnormal arterial-venous communications
rupture of vessel’s wall
increased vascular permeability

Blood disturbances, such as changes in the volume, composition, viscosity, or coagulation ability of blood.
Multi-systemic organ failure (shock or sepsis).

acute
chronic
According to the prevalence of process:
а) general (systemic) - disorders of heart function
local (region) - disorder of vascular function in
one area, that leads to structural changers
According to the type of violation of blood
circulation:
а) hyperemia (congestion) – arterial or vein
ischemia (anemia) – general or local
stasis – stopping of blood circulation in micro-
vessels

acute arrhythmia and myocardial insufficiency






De-compensation of heart function

pump function.
Violation of capacity of vascular system at: а) violation of neuro-endocrin function
loss of tone under influence of vascular-paralytic
metabolites
surplus of arterial-vein shunting in skin, lungs, kidney
violation of antigravity functions of body muscles.
Violation of Volume of Blood Circulation (VBC = plasma
+ proteins of plasma + blood cells). Reasons of violation:
а) bleeding
transudation
stagnation or expiration of lymph
vascular de-hydrotation (extra cells).
Violations of microcirculation of blood in tissue.

of extra-powerful stimuli and characterized by disturbances in CNS function, metabolism and microcirculatory system, resulting in destructive changes of the organs and tissues

cholera
Cardiogenic at:
vascular and myocardium insufficiency
obstruction of outflow (pulmonary embolism)
Septic – caused by bacterial toxins

Anaphylactic – immediate reaction of hypersensitivity
Neurogenic – drugs intoxications
Shock, at hormonal insufficiency (thyrotoxic,
myxedema)

circulation:
а) blood come out from organs-depots
arteriole-venous shunting began in skin,
lungs, kidneys
increased concentration of adrenalin and
noradrenalin (tachycardia, spasm of arteriole)

Progressive de-compensative stage – it is violations of microcirculation in tissue that leads to acute poly-organ insufficiency

Stage of hemodynamic de-compensation (irreversible) – firm vasodilatation, loss of sensitiveness to medicines

blood - blood is localized in micro-vessels and does not convolve, redistribution of blood in the vascular circulation (empty heart cavity and large vessels).
Microscopically:
Generalized spasm of the vessels
Microthrombosis
Increased vascular permeability in
microcirculatory system

Hemorrhages, degenerations and necrosis that are connected with hypoxia and effect of toxins

mass is increased in 2-3 times, a foamy liquid flows down from the surface of the cut with the admixture of dark blood – serouse- hemorrhagic edema - Large moist lungs

Kidneys – degeneration and necrosis in proximal canals is observed. During 2-3 days necrosis of cortex substances develops (symmetrical type) – Acute cortical necrosis of kidney (Shock kidney)

Liver – centro-lobular necrosis (hypoxic necrosis’s of central departments of lobules). Color of marble crumb.

GIT – acute gastric and intestine ulcers because of violation of micro-circulation in the wall of intestine.

through endothelial injury and/or release of thromboplastic substances into circulation. Reasons of development:

infections

trauma

neoplasia

obstetric complications

Morphology:
Small fibrin thrombi are formed in small arteries of brain, heart, lungs, kidneys, and other organs and produce ischemic tissue damage

Disseminated intravascular coagulation(DIC)

of intestine, peritonitis

thrombosis
Syndrome of
portal hypertension
Budd-Chiari syndrome
Syndrome of sub- clavicular vein (SCV)

- active hyperemia. In hyperemia, increased inflow results in erythema.
by impaired exit of blood through venous vessels - passive hyperemia or congestion. In congestion, diminished outflow leads to a capillary swollen resulting in cyanosis.

left or right ventricular failure.



Chronic passive congestion - is generalized increasing in venous pressure at:

Chronic heart failure (left- and right- sided), results in slower blood flow and a consequent increase in blood volume in many organs, including liver, spleen, and kidneys.

Congestive heart failure secondary to coronary artery disease and hypertension, and right-sided failure due to pulmonary disease.

of outflow of vein blood from the organ or part of the body
Types:

Swollening and indurations of extremities at the thrombosis of veins of lower extremities.

Syndrome of portal hypertension – violation of blood outflow from the portal vein system:

а) increasing and stagnation of blood in the portal vessels
compensate of porto-caval anastomosis

isolated ascites without hydrotorax and hydropericardium (ascites-peritonitis)
Budd-Chiari syndrome – violation of blood outflow
through the hepatic vein
Syndrome of sub-clavicular vein (SCV) – at the
thrombosis of SCV (after catheterization)

or tissue because of arising up of arterial blood inflow. Can be:

Physiologic - at increased functional demand of heart and skeletal muscle during exercise.

Pathological





Types, according to distribution:

general - is observed at the increased volume of circulatory blood or number of red cells. In such cases are marked red coloring of skin and mucous membranes and high arterial pressure

local – at inflammation or at different reasons.

vessel or cavity of heart to the surrounding outpace (outward bleeding) or into the tissue or cavity of body (inlaying bleeding).

of blood with excrement (melaena)
bleeding from uterus
(metrorrhagia)

of vessel wall






Outcomes:

dissolution of blood

formation of cyst in place of hemorrhage

encapsulation or germination of hematoma by the connective tissue

joining of infection and suppuration

or chambers of heart during life. Formation of a clotted mass of blood in the non-interrupted cardiovascular system. Basis of thrombosis is the physiological process of rolling up.

Thrombosis refers to the formation of a thrombus – it is aggregate of coagulated blood containing platelets, fibrin, and cellular elements.

blood flow and/or coagulability;
Abnormal blood flow (stasis or turbulence)

The elements of the triad may act independently or may
combine to cause thrombus formation.

closely to the wall of blood vessel, and postmortem clot lies freely.

A thrombus has dim, sometimes even rough surface (lines of Zahn), and at postmortem clot surface is smooth.

A thrombus has fragile consistency, while
consistency of postmortem clot is jam-like.

appears and consists of red cells mainly

white – yellow-white color, slowly appears in arteries, leucocytes prevail in composition


mixed

hyaline – in the vessels of different tissue, plasma proteins prevail in composition above the cells of blood.

vessel is closed by mass of blood clot

near-wall

spherical blood clots - in the chambers of heart and in aneurism

dilatational

thromb-endocarditis – at the damage of
endocardium

axial – with the longitudinal axis (head,
body, tail)

deposition of calcium salts in the
blood clot (in vein)
3. dissolution - aseptic autolysis
4. medicinal fibrinolisis
5. re-canalization of blood clot
6. propagandation
7. infected of blood clot with set about its particles
on organs with forming of abscesses
8. embolization

necrosis of tissue (infarct).
1.Thrombosis of a coronary or cerebral artery results:
myocardial infarct (heart attack)
cerebral infarct (stroke),
2. End-arteries that are affected by atherosclerosis and often suffer
thrombosis:
mesenteric arteries (intestinal infarction),
renal arteries (kidney infarcts),
arteries of the leg (gangrene).

by any material that can lodge in a blood vessel and obstruct its lumen.

The most common embolus is a thromboembolus that is, a thrombus formed in one location that detaches from a vessel wall at its point of origin and travels to a distant site.