(精选)Circulatory disorders Shock教学课件.pptVIP

Circulatory disorders Shock Jan Laco, M.D., Ph.D. Summary 1. Edema 2. Hyperemia and Congestion 3. Hemorrhage 4. Thrombosis 5. Embolism 6. Infarction 1. Edema = ? fluid in interstitium cavities – hydrothorax, hydropericardium, ascites anasarca = severe generalized edema 3 major factors: hydrostatic pressure plasma colloid osmotic pressure lymphatic obstruction inflammation 1. Edema 1. ? hydrostatic pressure impaired venous return congestive heart failure constrictive pericarditis liver cirrhosis – ascites venous obstruction or compression thrombosis external pressure 1. Edema 2. ? plasma colloid osmotic pressure loss or reduced albumin synthesis nephrotic syndrome protein-losing gastroenteropathy liver cirrhosis malnutrition 1. Edema 3. lymphatic obstruction ? lymphedema inflammatory – filariasis ? elephantiasis neoplastic – breast carcinoma postsurgical (LN resection) + postirradiation 1. Edema subcutaneous tissue (pitting edema) + cavities generalized x local prominent right heart failure – lower limbs left heart failure - pulmonary edema nephrotic syndrome – periorbital edema (eyelids) brain edema – localized x generalized gyri flattening + sulci narrowing ? herniation 2. Hyperemia and Congestion = ? blood volume in particular tissue 2a. hyperemia – active (arteriolar dilation) red striated muscle exercise 2b. congestion – passive (impaired venous return) systemic x local blue-red color (cyanosis) accumulation of deoxygenated Hb chronic ? chronic hypoxia ? regressive changes + small hemorrhages ? siderophages 3. Hemorrhage 1. Petechiae (1-2 mm) - skin + mucosa ? intravascular pressure, ? platelets 2. Purpuras (3-5 mm) trauma, vasculitis, vascular fragility 3. Ecchymosis (1-2 cm) = hematomas (bruises) – RBC phagocytosis by macrophages - Hb (red-blue) ? bilirubin (blue-green) ? hemosiderin (golden-brown) 4. Cavities hemothorax, hemopericardium, hemoperitoneum hemarthros 3. Hemorrhage arterial + venous + capillary H. per rhexin – injury - brain H. per