.

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 pc 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 Id

adema wih rssue and.:vrary M!on
 Subcutaneous edema
: "-sa cafd ac edema
wiih high pH
:c.urs n congestive heartiailure
-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 fiiially
developed perlorbllary

Pulmonary edema
udeiaiu,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

L@iddi.h4p4hedwo|'
 n'""""
Cerebral edema
V,:
ar€s (bd i absces eai ;.4 E.
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'easeo
oiblood volume in a lissue oroean by arte olar
dilaialion (es inflammatory rocus, etc.).
- passive (stasis or passive coigesiion) = incrssed oi
blood volume in a tssue of organ by venoLs bed
dilatation (e.9. systemic cause n RCF orlo€lcause
ir venous obslruclion)
 PaSSiVe congestion (stasis)

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)
 Pulmonary passive congestion
(Lung stasis )

Pulmonary stasis occurs in chronic LCF

dLre to rekograde venous blood stagnation
n the ung.
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
Microscopy

{n rohemo'lhase) and aid

 Hepatic passive congestion
(hepatic stasis)

. iver stasis occurs in chronic RCF due to

retfograde stagnation of venous blood in
the vein cave system.
the most frequent cause of RCF is
pulmonary fbrosis of dlffereni causes.

Macroscopy

cedro ob! d 5,ea Grasc) rB

l.d!a,dstldonleoistshq,s
headFcentpdea6s ,esur|9 a

Ep a.ed byit ss lcad a.d tr6 n

. yell@ arss = hypolcst€loss

a hepat c med cLobuar.r*s
l\/li.r^c.nn\,/

3. HEMORRHAGE

Beed nq sthe escape ofblood from heart and vesses

d!riio lile+vaious cond tions
Bleeding 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
 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€itoneum colleciion of blood n th€ perilonea @'q
joint cavlv
- h emarlhrosis @llection of blood in the

. 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 tri
di*.nion ihe affected i ssue
 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
 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
 Path ogenesls
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

Microscopy
. Thelhrombrs scomposeo0r

Fodre ibli (pormsz' on

. re h sto osda seciod (HE

o e6 iophi. rb h.onLadnq
isposition to thrombosis

Thrombus -
macr0scopy
 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 ohe lhrombus can be
deradhed 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

 Connective organized thrombi

Ma a(e,y rumei s odlealed aid

5, EMBOLISM
Ernbolism (E) a pathological process
characierized 'sby caring of emboli in the
blood stream, at djstance from point of
origin, 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.
 Types of enrboli

i$!eFrer€nboal

ErnboLLsm wilh amr olc

il!id

Thrombembolism

-:,, , -* d- c*"ea.brp'--r.-"-

, o!res naedtus6.nqcvd4*
, -";. ,- ,."""
 Fluid embolism
Fat embo lsm )lipidic embol

- .onsequE^.es lal q obu es rrom

s-c dp _o-ary 2ruF
Amnioiiciuld embolism t amniotici!id emboi
'o-o.da1 bn d o.i a..o-ared ^r
posipanufr 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 €sul

a€ 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) xf

orcdud on ofors bubbLes Lhebloodc@dioi (!*se
6birud od=d@mp'essoi
'n ds€ase

- oLmon"to '"a- bra'' eabo

(adre ischem:)
sedoMai ehemicneDross
 Emoo sm uonseouences
. Obstruction of the aderies with
suppfession of blood circulation in the
larrit^n, r ticc,'a
^f ^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 1oq
comdcaled arhercfra Ars by thbmbG 3)
. donsequ€nc*: ischemlc necrcsis 0nfdd)in the te.dlory ol
distr burion ofa rssueor organ
'.doryora1$ue9iolgan t

. comEleres samp es or acde

. Micb.coplc.rry a@le schemia

rar:: tmphy=ceradaPrve

rc. a. no of lio tuohrc dairL

INFARCTION

C assif €l on or lhe inracbons

lintarcls aE c a$ifed basd
the amouni 01 losr b e€din9)
 Myocardial infarction

[,4yocardial infarction microscopy

 [,4yocafdial nlarcton nr rroscopy

(presef/ed er imb freme

eos nophr..n0pasm rhe

Renal Infarct
,-.- :--':.
. 1,:',.:
<1-

s (dtaoperai.a or lhe
^er.s
Splenic Infarct

Cerebral I nfarct

tr-
 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 anerl
seemenr, 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 inihmtior
Tnerc 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.d
penlonnis (!c!le abd..r.i]