Hemodynamic Disorders, Thrombosis and Shock

Circulatory System
It is the transport system that causes circulation of blood throughout body in a continuous circuit. Systemic Circulation Pulmonary Circulation Function of Circulatory System 1. Supplies oxygen and substances to tissues. 2. Return carbon dioxide to lungs and other metabolic end products to kidney. 3. Regulates body temperature. 4. Distributes hormones and other substances that regulates cell functions. 5. Maintain proper ionic concentration.

Edema
1. 2. 3. 4. 5.

This is an abnormal accumulation of fluid in interstitial tissue spaces or body cavities. Cause of edema: Increase hydrostatic pressure. Increased capillary permeability. Decreased oncotic pressure. Increased sodium retention. Blockage of lymphatics results in lymphedema.

Types of Edema 1. Anasarca: is generalized edema. 2. Hydrothorax: is accumulation of fluid in the pleural cavity. 3. Hydropericardium: is abnormal accumulation of fluid in the pericardial cavity. 4. Hydroperitoneum (Ascites): is abnormal accumulation of fluid in the peritoneal cavity. 5. Transudate: this is noninflammatory edema fluid results from altered intravascular hydrostatic or osmotic pressure. 6. Exudate: this edema fluid results from increased vascular permeability caused by inflammation.

Hyperemia and Congestion

Both terms indicate a local increased volume of blood in a particular tissue. Hyperemia: is an active process resulting from augmented tissue inflow due to arteriolar dilatation, for example, skeletal muscle during exercise or at sites of inflammation. The affected tissue is redder owing to the engorgement with oxygenated blood. Congestion: is a passive process resulting from impaired outflow from a tissue. It may occur systemically, as in cardiac failure, or may be local, resulting from an isolated venous obstruction. The tissue has a blue-red color, especially as worsening congestion leads to deoxygenated hemoglobin in the affected tissue.

Hemorrhage

Hemorrhage generally indicates extravasation of blood due to rupture of blood vessels. Hematoma: hemorrhage may be external or may be enclosed within a tissue: this accumulation reffered to as hematoma. Hemothorax, hemopericardium, hemoperitoneum, and hemarthrosis: hemorrhage may occur in the pleural cavity, pericardial cavity, or synovial space, respectively. Petechial hemorrhage, petechiae, or purpura: the small, punctate hemorrhages occur in the skin, mucous membranes, or serosal surfaces. Ecchymosis: diffuse hemorrhage is usually in skin and subcutaneous tissue.

NORMAL HEMOSTASIS

NORMAL HEMOSTASIS: MAINTAINS BLOOD IN A FLUID STATE AND PRODUCES A LOCAL HEMOSTATIC PLUG AT SITES OF VASCULAR INJURY.

Thrombosis

INAPPROPRIATE ACTIVATION OF THE HEMOSTATIC PROCESS IN UNINJURED VASCULATURE OR FORMATION OF THROMBUS IN THE SETTING OF RELATIVELY MINIMAL VASCULAR INJURY

FACTORS PREDISPOSING TO THROMBOSIS

HYPERCOAGUABILITY

ANY ALTERATION OF THE COAGULATION PATHWAY THAT PREDISPOSES TO THROMBOSIS

PRIMARY (GENETIC)

FACTOR V GENE MUTATION AND PROTHROMBIN GENE MUTATIONS MOST FREQUENT V becomes resistant to protein c inactivation Prothrombin levels elevated Bed rest immobilization, obesity, cancer, atrial fibrillation, myocardial infarction, tissue damage (surgery

SECONDARY (ACQUIRED)

FACTORS PREDISPOSING TO THROMBOSIS

ABNORMALITIES OF BLOOD FLOW TURBULENCE

Endothelial injury Local areas of stasis Disrupt laminar flow

Moves platelets from center of flow to the vessel wall Prevent dilution of activated clotting factors by flowing blood Slow down the inflow of clotting factor inhibitors Promotes endothelial cell activation

Fate of Thrombus

Propagation: thrombus may accumulate more platelets and fibrin (propagate), eventually obstructing some critical vessel. Embolization: thrombi may dislodge and be transported to other sites in the vasculature. Dissolution: Thrombi may be removed by fibrinolytic activity. Organization and Recanalization: thrombi may induce inflammation and fibrosis (organization) and may eventually become recanalized, that is, may re-establish vascular flow.

Embolism

An embolus is a detached intravascular solid, liquid, or gaseous mass that is carried by the blood to a site distant from its point of origin.

Infarction
o

An infarct is an area of ischemic necrosis caused by occlusion of either the arterial supply or the venous drainage in an particular area. Types of infarcts: Anemic infarcts: these infarcts are white or pale infarcts. They are usually caused by arterial occlusions in organs with single blood supply for example heart, spleen, and kidney. Hemorrhagic infarcts: these infacrcts are red infarcts, in which red cells ooze into the necrotic area. They characteristically in the lung and GIT as a result of arterial occlusion.

Shock

This condition represents circulatory collapse with resultant hypoperfusion and decreased oxygenation of tissues. Causes of shock Decreased cardiac output, as occurs in hemorrhage or severe left ventricular failure Widespread peripheral vasodilation, as occurs in sepsis or severe trauma, with hypotension often being a prominent feature

Types of Shock

Hypovolemic shock: is ciculatory collapse resulting from the acute reduction in circulating blood volume caused by: Severe hemorrhage or massive loss of fluid from skin, from extensive burns, or from severe trauma. Loss of fluid from the GIT, through severe vomiting or diarrhea. Cardiogenic shock: is circulatory collapse resulting from pump failure of the left ventricle, often caused by massive myocardial infarction.

Septic shock: is most characteristically associated with gram-negative infections, which cause gram-negative endotoxemia; also occurs with gram-positive and other infections.

Neurogenic shock: is most often associated with severe trauma and reactive peripheral vasodilation.

Stages of Shock

Non progressive (early) stage: compensatory mechanisms, including increased heart rate and increased peripheral resistance, maintain perfusion of vital organs. Progressive stage: this stage is characterized by tissue hypoperfusion and the onset of circulatory and metabolic imbalance, including metabolic acidosis from lactic acidemia. Irreversible stage: organ damage and metabolic disturbances are so severe that survival is not possible.