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The health and well being of cells and tissue depends not only on intact circulation to deliver oxygen,
also on normal fluid homeostasis.
Abnormalities in either blood supply or fluid balance are result in morbidity/mortality.
The pathologies include edema, vascular congestion, hemorrhage, thrombosis, embolism, infarction
and shock.
A. Edema
Edema signifies increased fluid in the interstitial tissue space.
Edema caused by increased hydrostatic pressure or reduced plasma protein is typically a
protein-poor fluid called a transudate. Edema fluid of this type is seen in patients
suffering from heart failure, renal failure, hepatic failure, and certain forms of
malnutrition.
In contrast, inflammatory edema is a protein-rich exudate that is a result of increased
vascular permeability.
Causeof edema:
Thrombosis
i. Endothelial injury is dominant and can cause thrombosis. Thrombosis result
from exposed subendothelial ECM & tissue factor, adherence platelets &
depletion of prostaglandin I2 and PAIs
ii. Alteration in normal blood flow can cause thrombosis. Normal blood flow is
laminar, disrupt of this flow bring platelets into contact with the
endothelium
iii. Hypercoagulability contributes less frequently to thrombotic states but is
important in certain states
E. EMBOLI
Is a detached intravascular solid, liquid or gaseous that is carried by the blood to a
site distant from its point of origin.
Caused disturbance vessel passage partial/complete vascular occlusion
ischemic necrosis distal tissue/infarction.
Type of Embolism:
i. Pulmonary Thromboembolism
ii. Systemic Thromboembolism
iii. Fat Embolism
iv. Air Embolism
v. Amniotic Fluid Embolism
F. INFARCTION
an area ischemic necrosis caused by occlusion of either the arterial supply or the
nervous drainage in a particular tissue.
Classified on the basis of their color :
i. Red infarcts (hemorrhagic) : venous occlusions
ii. White infarcts (anemia) : arterial occlusion
Factors that influence development of an Infarct
i. The nature of the vascular supply.
ii. Rate of development of the occlusion.
iii. Vulnerability of a given tissue to hypoxia
iv. Oxygen content of the blood.
G. SHOCK
Shock or cardiovascular collapse, is the final common pathway for a number of
potentially lethal clinical events.
Constitutes systemic hypoperfusion owing to reduction either in cardiac out put or
in the effective circulating blood volume.
End result : hypotension, impaired tissue perfusion and cellular hypoxia/anoxia.
Neurogenic shock, e.g. in the setting of anesthetic accident or spinal cord injury.
Loss of vascular tone and peripheral pooling of blood.
Anaphylactic shock, initiated by a gene-ralized IgE-mediated hypersensitivity
response, is associated with systemic vasodilatation and increase vascular
permeability.
Stages of Shock
i. An initial nonprogressive phase during which reflex compensatory
mechanisms are activated and perfusion of vital organs is maintained.
ii. A progressive stage characterized by tissue hypoperfusion and onset of
worsening circulatory and metabolic imbalances including acidosis.
iii. An irreversible stage that sets in after the body has incurred cellular and
tissue injury so severe that even if the hemodynamic defects are corrected,
survival is not possible.