hyperemia&congestion 2003

7/26/2019 Hyperemia&Congestion 2003

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Over Hydration Normally excess of water consumed are shade o

by body & no ill eect are there. In condition kidney ability to diluteurine has been reduced the overload of water take place leading toexpansion of extracellular compartment uid. It lead early diaurasisfollowed by oliguria or anuria due to damage renal tubules

Causes Acute & chronic renal failure !ever "#$ Addision%sdisease cirrhosis liver & early post operative phase.

Clinical efect isordered cerebral functionNauseavomitingheadachconfusion

Plasma changes are reduce serum electrolyte& 'osamolity'plasma protein & low (")

Dehydration*ay be either pure water de+ciency or water &

electrolyte combined de+ciency Pure water is relative uncommon +rstly there is withdrawal of uid

from interstial space & cellular depletion of water along withpotassium which in result in renal insu,ciency leading to sod.-etention & potassium depletion


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Causes e+cient water intake due to obstructiondysphagiaor excessive loss of water in diabetesinsipidushyperparathyroidismhyperapnoea

Clinical efect intense thirst mentalconfusionfeveroliguria(lasma changes in (")plasmaprotein /lood urea !erum sodium

Combined sodium & water deciency more common fallin volume of intra vascular uid in early stage sod. 0evelremain normal but later fall

Causes1I disorder sever vomitingdirrhea excessiveperspiration diurasisexcessive blood loss

Clinical efect sign & symptom of dehydration shrunkeneye thready pulse cold & calmly skin perspiration dry tongue

Plasma changes ' sodium(")/lood urea (lasmaprotein


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Hypernatremia#igh sodium contain of plasma normal

234 to 254 m678l Causes(ure sodium excess -etention in "ushing

syndromehyperaldosteronism

"ombined water & sod loss 6xcessive sweating

heat stroke(olyurea (ure water de+ciency 0ake of water

intakedysphegiaobstruction

Hyponatremia0ow !od. "ontent

Cause 6xcessive use of iuretics Addisiondiseaseirrheavomitingchronic renalfailurehypoaldosteronism


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Hypokelemia low Potassium in serum Normal 3.8 to4.5mEq/l

Cause Excessive retention Oliguria,Renal tubular

!s"unction,#ernal cortical insu""icienc!

Excessive inta$e o" iureticExcessive mobilisation o" intracellular Pot. %uscle necrosis,

&iabetic aciosis, 'se o" igitalis grou( o" rugs

Hypokelamia)ow Pot. *n serum

Causes Excessive loss "rom +.*.,ien! *nsulin t-era(!


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Metabolic Acidosis $all in /lood p# due to low bicarbonat & high#9 inos inblood

Causes0actic Acidosisin vigrous excerisesshock iabeticketoacidosisstarvation

It stimlate respiratory center so deep & rapid respiration & fall in plasmabicarbonate

Metabolic alalosis cause due to loss of #9 ions & in bicarbonate

Causessever & prolonged vomitingAdminstration of strong alkaline saltlike sod.bicarbonate#ypokalaemia

Cinicallycharacterised by 'respiration '-enal function with :remia bloodbicarbonate level

!espiratory Acidosis $all of /lood p# due to (co; leadingunderventilation

cause co; retention & acidosis CausesAirway obstruction in Asthma"hronic /ronchitis

-estractive respiratory movement (leural eusionAscitis(regnancy

Impaired Neromuscular function (oilomylitis(olyneuritis

Clinicallyperipharal vasodilation& Intracrainal pressure ue to "o;retention (t. evelop confusiondrowsiness & coma


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!espiratory Acidosis $all of /lood p# due to (co; leadingunderventilation

cause co; retention & acidosis CausesAirway obstruction in Asthma"hronic /ronchitis

-estractive respiratory movement (leuraleusionAscitis(regnancy

Impaired Neromuscular function

(oilomylitis(olyneuritis Clinicallyperipharal vasodilation& Intracrainal pressure ue

to "o; retention (t. evelop confusiondrowsiness & coma

!espiratory Alalosis blood p# due to lower (co; due tohyperventilation of lung

Causes #ysterical overbreathing


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"ype Acidosis Alalosis

Metabolic '(lasma /icarbonate iabetic (lasma/icarbonate sever

"oma!tarvation(rolonged dehydration massiveblood

exceriseAsthama:remia !hock transfusion

!espiratory '"o; clerancepco; ' /lood p# co;loss'pco;/lood p#

"=(6mphysmaAsthama #yperventilation inhypoxia high

(ulmonary oedema

alltitudeconvelsionhigh fever :nconsciousness septicaemia

Combined pco; with 0actic acidosis 'pco; with loss ofbicarbonate

circulatory failure cardiac excessive treatmentfor acidosis

arrest respiratory distress


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HYPEREMIA ( ACTIVE )

CONGESTION ( PASSIVE )

Acute

OrChronic


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Increased volume of blood in dilated blood vessels oforgan or tissue

Increase volume of blood in arteries or arterioles isactive hyperemia

Impaired drainage of blood from venous drainage called

venous congestionAC"#$% HP%!M#A

Inammation any where cause hyperemia in local part

/lushing response of emotions

*enopausal ush

*uscular exercise

#igh grade fever


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ilation of veins & capillaries due to impaired

venous return is passive hyperemia or venouscongestion

It may be local in any part of body due to obstructionor in case of portal hypertension or due to pressure

on vessels in tight bandage plasters tumorspregnancy hernia etc.

'ystemic venous congestion

ue to heart failure -ight side failure all systemic

organ except lung 0eft sided failure cause

congestion lung


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0

CHRONIC VENOUS CONGESTION ( C.V.C ) LUNG

CHRONIC VENOUS CONGESTION ( C.V.C ) LIVER

CHRONIC VENOUS CONGESTION ( C.V.C ) SPLEEN


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=ccur in left sided failure due to rheumatic mitral stenosis sever *.I.

Mechanism "#$>reduce blood ow to lung>"hronic passive pulmonary

congestion>Increase pressure in alveolar capillaries & +lles with bloodConse(uences

Micro haemorrhage minute haemorrhage in alveolar capillaries -elaseof -/" #b breakdown liberation of haemosidrin engulf by alveolarmacrophages.

Pulmonaery odema

)ibrosis

Pulmonary hypertension

*ross0ung is heavy +rm on cut section surface dark brown congestedcalled brown induration of lung

MicroscopicallyAlveolar septa widened due to edema & dilated

congested blood vessels. "apillary slightly thickened. -upture of capillariescause intra alveolar hemorrhage. /reakdown of -/" released hemosiderinpigment which are taken up by macrophages giving brown discolorationcalled heart failure cells


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4

C+$+C+ ,-.*


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C.V.C LIVER

Occur in rig-t sie "ailure rarel! in constractive

(ericaritis 1 obstruction o" in"erior venacava%ec-anism &ilatation o" central vein2ransmission o"

(ressure to sinusoi2ilartion o" sinusoi2isc-emic

necrosis o" centrilobular region

Grosslyliver enlarge tener tense ca(sule cut sur"ace

s-ow nutmeg a((earance re 1 !ellow mottle

a((earance

Microscopicallycentrilobular congestion lea to

-!(oxia at (eri(-ar! causes "att! c-anges .

entrilobular -e(atoc!te unergo -emorr-agicnecrosis -eale b! "ibrosis 1 causes istortion o"

lobular structure leaing to cariac cirr-osis


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ue to ri!ht"#i$e$ c%r$i%c E

co&'en#%tion En%r!e$ * ten#e * c+%notic i,er -ithroun$e$ e$!e#

Con!e#tion o centrio/u%r #inu#oi$#Atro'hic centrio/u%r he'%toc+te#

M%r0e$+ %ttenu%te$ i,er ce cor$#

Let"#i$e$ c%r$i%c %iure or#hoc0

Le%$# to he %tic h o eru#ion %n$


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8

Co&/in%tion o h+'o 'eru#ion

%n$ con!e#tionLe%$# to centrio/u%r he&orrh%!icnecro#i#V%rie!%te$ &otte$ %''e%r%nce

Sh%r' $e&%rc%tion o ,i%/e 'erior%2 necrotic centrio/u%rhe'%toc+te#

Re$"/ro-n $e're##e$ %re%#( centrio/u%r )T%n cooure$ #urroun$e$ %re%#( 'eri'ort% )


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0


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03

C+$+C+,#$%!


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=ccur in right sided failure

*rossly In early stage spleen is moderately enlargeup to ;4? gm in comparison normal 24? gm. Inprogressively failure it may weigh 4?? to 2???gm.eeply congested capsule tense cyanotic cut surfacegrey tan color

Microscopically -ed pulp shows congestion &marked sinusoidal dilation with area of recent & oldhemorrhage. #emorrhage gate organi@e & formed1amma 1andy bodies !idero+brotic noduleB which

have deposit of hemosiderin pigment calciumdeposit & +brosis. -eticulin net work& +brousnetwork thickened


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06

C+$+C+ 'P,%%.


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6scape of blood from vessel either out side or in internalorgan is hemorrhage

6xtravasation of blood into skin called #ematoma (urpara are small areas of hemorrhage less than 2cm. In

si@e

(etechiae are minute pinheaded hemorrhage

Causes o/ Hemorrhage Crauma of vessels or penetrating wound -oad side

accident

!pontaneous hemorrhage rupture aneurysm /leedingdiathesisvericose veins (eptic ulcer

Neoplastic invasion

)ascular disease

6levated pressure in /lood vessels


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6ect depend on 3 main factors Che amount of blood loss

Che speed of blood loss

Che site of hemorrhage

0oss of ;?D suddenly or slowly up to 4? D have littleclinical eect

A sudden loss of 33D may cause death while loss upto 4?D slowly in ;5 hours is not fatal

hyperemia&congestion 2003

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