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.IRCLL'\TORY D]STURBANC]ES
I H.reFdia & congesti.n
Edema
Edema is an excessve accumulation oflluid in
r ssues and body cavlies
unirf lamhatory (rransudale):
ec@sd p c o p,och os 1sN). Lw pr& n vihes s (cHl
- nfiammalory {exudatel
Uninflammatory edema
va o!.op7 rqq.e rrer nq&drr- Mrcrosooov 6 qht@l!u ar sre In
e,t6.eru;r mak \ (MEC) componenrs
Loca isation of the edemal
- edema is mor€ iiequent Y encou
TvDes oi edema based on ihe slte oi nu d accumulaiion
{iiiiersulium aid body caviues):htaiqsular: subculanmus. ma zedordftuse
qene.a zed anasarca 4h.hisa*!ere andgeiera Idadema wih rssue and.:vrary M!on
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Subcutaneous edema
: "-sa cafd ac edema
:c.urs n congestive heartiailure wiih high pH
-subc!taneous edema depending on gravlly
n areas wth increased pH)
generalized rcnal edema
- occurs in renal dysiunction wrui low p c o.
subculaneous d ff!se edema fiiiallydeveloped perlorbllary
Pulmonary edemaudeiaiu,e(miia sienosb +atd
ste. w h trcshr d2.3 umes
Gr€o a, tansldd6 donreii)
rdhy/loamt nuid (:n coded),p4e pin' in.dor{bv he F*en.e
bois6lon 3nd sePlar,:ite6rta
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Cerebral edema n'""""
ar€s (bd i absces eai
cenera zed edema (6n€Pharts,
pg€pi|ary.9a6and.oose
2. HYPERAEMIA AND CONGESTION
Hyperaemia = increase ofthe bood volume in a
tissue or organ terrltory byvascular dllatation
(distended wiih blood)Types of hyperaemia:
-ac ve(hype'aenra o 3c1ve corsesliol) = i.c'easeooiblood volume in a lissue oroean by arte olardilaialion (es inflammatory rocus, etc.).
- passive (stasis or passive coigesiion) = incrssed oiblood volume in a tssue of organ by venoLs beddilatation (e.9. systemic cause n RCF orlo€lcauseir venous obslruclion)
E.
V,:;.4
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PaSSiVe
the lncrcase in blood volume in a tissue or
organ territory by dilatation of capillary
network.
Causes:(a) loca jzed stasis
) venous obsiruciion(b) generallzed or systemic stasis
t left or right cardiacfailure (URCF)
congestion (stasis)
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Pulmonary passive congestion(Lung stasis )
Pulmonary stasisdLre to rekograde
n the ung.
occurs in chronic LCFvenous blood stagnation
The most freqL]ent causes of LCF are
HTA, Cland SA.
Macroscopy
luno4senaled b ood), and
ar.oh c had rf brosis) and
henosydeine) = appe6nce
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Microscopy
{n rohemo'lhase) and aid
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l\/li.r^c.nn\,/
3. HEMORRHAGE
Beed nq sthe escape ofblood from heart and vesses
d!riio lile+vaious cond tionsBleeding rnay occLr invanous circumstancesl
.ap ary ruplures + oeu.ln caplLary congeslron
a/rer a and vedouB ruplures + occur ofien in ader ai and venouq
card e ruplure ptuduced in ohesl lraumaormmp caled reat
Types ofbLeeding o. hemorrhage l
(a) exlenal bleed ns - the escaped b md
- (bj nremar bleedinq - lh€ esaped blood
. intaevharybrd ns (*rcus€v1*)
. mrereir d bei 19lfrsslet
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Types of external haemorrhages
Types of internal haemorrhages
' Lntracaviiary haemoilhages:
- haemorhoa cDn€dbn olblood nlh6 pleu€L€vllv
'o.1o.o,ooodr.Eoe''dd".a''lJ
- hemop€itoneumcolleciion of blood n th€ perilonea @'q
- h emarlhrosis @llection of blood in the joint cavlv
. Interslifal bleeding in €lation with the volume of the
Pel*hiae-poinrlke bl€eding ol€pillary ongin
- 1na-u,a'raflo'aqe- dfiuse b'"d'1S {rho r d +or'o' o
ihe aff*led ussuesi e g bruse
I o' oaq a eo DLood tridi*.nion ihe affected i ssue
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nierctitial haemorrhages
s ohrv b'ood haPmorhdres = pfpuc lo,er I r -.:";,""..""."
: o i.- "o qq"
J-e!Nmruiurql.anbefala!- Eo ;rebia h*mdoma6.ureit
mEroaieurysms n NrA
Cerebral Haemorrhage
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The clinical picture
. The clin calsgn ficance of haenrorrhage
depends on vo ume and raie of bleeding. Rapid bleeding, in larse amount morc than 20%
of blood volume produce dealh by lripovolem c
. Chronic haemorfiage, in smallamount,
depend ng on b eeding location, may occur:
(a) death i nleresl v ta orSans{brain sleh)i
(b)ferp ve anemla li interesl dfrereni otlier organs
(chron c Peoiic ulcer)
4. THROMBOSIS
.oD
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Path
There are 3 main iactorsthal pred sposelo tne
fornal on of a thromb!s NnchofirLad):
, le€l on ii lh. r..:r lor lstas s 0r tutu encel
. (prnary d sotue's
r.enel rl and se3dndary (3cqu red) d sodeisl''d.tsoihFdcoaauabjlltLod$s
ogenesls
Microscopy. Thelhrombrs scomposeo0r
Fodre ibli (pormsz' on
. re h sto osda seciod (HE
o e6 iophi. rb h.onLadnq
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to thrombosis
Thrombus -
macr0scopy
isposition
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Thrombi classification
Thrombi evolution
Resoluloi hrcmbus lysis by r fi no !r d svst€m
P,ooao.ton tbombus mav nneale n eze bv add ng neo aveB
- rhe retad o; ofhe thombus io rhe
'dbjle€lwlhrcmbusisrag|aodby
Embo sm / Ihrombemhrsm: part o he lhrombus can bederadhed and 6ried alonq oflhe brod stEan b mp.d n a
ca cf.ddn ofthethrcmbus bv imprcgnalion sith €lc um *li
6i dd,N'd dery (osrrudrye srcmblt
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Connective organized thrombi
Ma a(e,y rumei s odlealed aid
5, EMBOLISM
Ernbolism (E)'s
a pathological process
characierized by caring of emboli in the
blood stream, at djstance from point oforigin, and obliteration of smaller blood
vessels through an embolus-
Embolus (e) is a solid, liquid or gas
material, circulating in the blood, away
from his point of origin.
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Types of enrboli
i$!eFrer€nboal
ErnboLLsm wilh amr olcil!id
Thrombembolism
-:,, , -* d- c*"ea.brp'--r.-"-
, o!res naedtus6.nqcvd4*
, -";. ,- ,."""
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Fluid embolism
Fat embo lsm )lipidic embol
- .onsequE^.es lal q obu es rroms-c dp _o-ary 2ruF
Amnioiiciuld embolism t amniotici!id emboi'o-o.da1 bn d o.i a..o-ared ^rosipanufr delvratons/p.duf rion; is a malof €lse of maiem:l
o.q n rupru,eol uler ne veiisal b drr
sauamouire s.4n es63a. p'd m
Gas embolism
s a rare fom ofembolism
- Armaventer n the b@d n case ol a vein nc s oni as a €sula€ lotn nq a r pulmod.ry mbd (obsi@tidn)
NLtrooen mav enle. n lhe dcu aion as bubbre, or qas (ihis.ondil on oauE oft€n ro peBonEmtl nq al q€al depihs -
' o /d4 f q* lbroodnfq"n) xforcdud on ofors bubbLes
'nLhebloodc@dioi (!*se
6birud od=d@mp'essoi ds€ase
- oL mon"to '"a- bra'' eabosedoMai ehemicneDross (adre ischem:)
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Emoo sm uonseouences
. Obstruction of the aderies withsuppfession of blood circulation in thelarrit^n,
^fr ticc,'a
^r ^rdrn.)(ischemlc necrosis)
. l\,4ay be a cause of death in cases of
-rnassve embolism of main pulmonary adery
cerebral embolism
6, ISCHEIVIIA
chrcn. s.lr€ma: pa'13land grad!a reduclon of lhe arler a fow, causes aderardamages ass@iaied wilhwitb lumenal
stenosis 1e g uncompicated arh€rcma.ATs)
(pros€ssve rep acement or the drdph ed tssre by r bos t- A.ule schem a sudden and toialsuppresson ol the eneia flDw
narobtruction 1oqcomdcaled arhercfra Ars by thbmbG 3)
. donsequ€nc*: ischemlc necrcsis 0nfdd)in the te.dlory oldistr burion ofa rssueor organ
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'.doryora1$ue9iolgan t
rar:: tmphy=ceradaPrve
rc. a. no of lio tuohrc dairL
. comEleres samp es or acde
. Micb.coplc.rry a@le schemia
INFARCTION
C assif €l on or lhe inracbonslintarcls aE c a$ifed basd
the amouni 01 losr b e€din9)
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Myocardial infarction
[,4yocardial infarction microscopy
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[,4yocafdial nlarcton nr rroscopy
(presef/ed er imb fremeeos nophr..n0pasm rhe
Renal Infarct
,-.- :--':.
.1,:',.:
<1-
^er.ss (dtaoperai.a or lhe
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Splenic Infarct
Cerebral I nfarct
tr-
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Pulmonary Infarct
. I nre stinal i nf&.lion i causcd by
ob{ructi\elesions.frheupFerneTenrenodirea duel.(a) llnonbenrboli occludine a distll anery brdch;(b) obslructile thJonbosh deleloped or an ATS plaque ar $e level ofproxnml anerlseemenr, resuhing & c\tensile latal inlacti
venous iniifction by $nngularion (snh rhepresence oJ Lhe heniarbagl.orlosion (inlhe case ofsienoidian lohalut
Necrotic ul4rinal scgme.li.rea da'k in color- *jlhlhick {all dnd
baemonhaeic inihmtiorTnerc is a ncl lihil6eNleen inteni.al ne.r.ri. s.gnc.land adjacent
nomral irteslinum
- Ilar beasso.iared*ith suppurallon.Il conplicates $i1h pefomlion d.dpenlonnis (!c!le abd..r.i]