Hemodynamic disorder
- 1. HEMODYNAMIC DISORDER 犖犖..犖犖園犖犢 犖犖犖犢犖犖 犖 犖犖∇幻犖犖∇顕 犖犖
- 2. Topic 5. Normal fluid balance Hyperemia , Congestion and Edema Bleeding , Hemorrhage and hemostasis Thrombosis and embolism Shock 6. Infarction 1. 2. 3. 4.
- 4. Normal fluid balance Male 60% of total body weight Female 55% of total body weight Fat
- 5. Compare percent of water
- 10. Body fluid Total body fluid ( assume at 60% ) 40% Intra cellular fluid 20% Extra cellular fluid 14-15% Interstitial fluid 4-5% Intravascular fluid 犖犖犖 犖 plasma 1-3% Transcellular fluid ex.Cerebrospinal fluid , Intraocular fluid , Pleural fluid , Synovial fluid , Pericardial fluid ,Peritoneal fluid PV-PLASMA VOLUME ISF-INTERSTITIAL FLUID PV+ISF=ECF ECF-EXTRACELLULAR FLUID ICF-INTRACELLULAR FLUID ECF+ICF=TOTAL BODY WATER
- 11. Body fluid
- 12. 犖ム賢犖犖犢犖迦犖о 1. 2. 3. 4. 5. 6. Body 70 kg TBW 42 L ICF 28 L ISF 10.5 L IVF 3.5 L Blood ?
- 13. BLOOD 5 liters
- 15. Hyperemia Active process , result from augmented blood flow due to arteriolar dilatation ex. Inflammation , exercise -> Redder color
- 16. Hyperemia
- 17. Congestion Passive process , Result from impair venous return from tissue ex.Heart failure , venous obstruction -> Blue-red color (Cyanosis)
- 18. Pulmonary edema (犢犖犖迦検犖迦犖犖朽権犖) Interstitial edema (in Pleural septum) Fluid inaveolar space
- 20. Edema Increase of interstitial fluid in any organ
- 21. Mechanism of Edema 1. Increase Intra-capillary pressure ex. congestive heart failure 2. Decrease osmotic pressure or decrease albumin in plasma : ex. Protein malnutrition Hepatic failure , Hepatic cancer Cirrhosis ( Decrease protein synthesis ) Nephrotic syndrome ( Loss protein in urine )
- 22. Mechanism of Edema 3. Increase permeability : ex. Inflammation , Allergic reaction , Endothelium anoxia , Toxin 4. Lymphatic duct obstruction : So call Lymphedema Elephantiasis from Filaria parasite infection (ex.Wuchereria bancrofti , Brugia malayi and etc) Metastasis malignancy ex.Lung cancer Superficial lymphatic channels in Local invasion of malignancy ex. Breast cancer may be show skin lesion call Orange peel peau dorange 5. Sodium and water retension
- 27. Elephantiasis
- 28. Lymphoedma
- 29. Orange peel skin peau dorange peau dorange
- 30. Effusion
- 32. x
- 33. Transudate extravascular fluid collection that is basically an ultrafiltrate of plasma with little protein and few or no cells. Fluid appears grossly clear 犖犖犖犢犖犖ム硯犢犖 犖犖犖 犖犢犖÷犖÷元犖犖 犢犖÷犖÷元犖犖ム鹸犖 犢犖÷犢犖犢犖犢犖犢 犖犖犢犖犖犢犖÷厳犖犖犖#犖犖犖#犖犢犖о (coagulate) 犖÷元犢犖犖犖犖朽犖犢犖犖∇犖о犖 3 g% 犢犖ム鍵犖犖о顕犖÷犢犖о犖犢犖迦犖犖迦鍵 犖犢犖犖∇犖о犖 1.017
- 34. Exudate extravascular fluid collection that is rich in protein and/or cells. Fluid appears grossly cloudy 犖犖犖犢犖犖ム硯犖犖伍犖犖犖犖 犖犢犖犖÷元犖犖巌犢犖犖劇賢犖犖 犖÷元犖犖ム顕犖犖犖ム顕犖∇肩犖 犖犖迦犖犖犖#犖犖÷元犖犖ム鹸犖 犢犖ム鍵犖犖萎犖園犖犖園硯犢犖犢 犖犖犢犖犖犢犖犢犖犢犖÷厳犖犖犖#犖犖犖#犖犢犖о 犖÷元犢犖犖犖犖朽犖÷顕犖犖犖о犖 3 g% 犢犖ム鍵 犖犖о顕犖÷犢犖о犖犢犖迦犖犖迦鍵犖÷顕犖犖犖о犖 1.017
- 35. Effusions into body cavities can be further described 1. 2. 3. 4. Serous: a transudate with mainly edema fluid and few cells. Serosanguinous: an effusion with red blood cells. Fibrinous (serofibrinous): fibrin strands are derived from a protein-rich exudate. Purulent: numerous PMN's are present. Also called "empyema" in the pleural space
- 36. Serosanguinous
- 37. Chylous
- 38. Site of effusion 1. 2. 3. 4. Pericardial effusion Pleural effusion ( Hydrothorax) Pericardial effusion ( Hydropericardial) Peritoneal effusion ( Ascites )
- 39. Pleural effusion
- 41. Pleural effusion
- 42. Ascites
- 43. Optic disc edema
- 44. Ascites
- 45. Clinical correlation Brain edema and herniation Pulmonary edema
- 46. Pulmonary edema Interstitial edema (in Pleural septum) Fluid inaveolar space
- 47. x
- 48. Brain edema and herniation
- 49. Clinical correlation of chronic passive congestion
- 50. Heart failure
- 51. Right side heart failure or Right ventricular failure Congestion in Superior , Inferior vena cava and Hepatic vein Sign and symptom Nutmeg liver Result from congestion of central vein in liver lobules Cardiac cirrhosis Ascites Edema at legs or arms
- 52. Left side heart failure or Left ventricular failure Sign and symptom Increase pulmonary wedge pressure can cause to Pulmonary edema Pulmonary congestion and edema Heart failure cell 犖犖犖 犖 Hemosiderin laden macrophage in pulmonary edema Dyspnea and Orthopnea
- 53. Heart failure
- 55. Ascites
- 57. x
- 58. x
- 59. Nutmeg liver
- 60. Nutmeg liver
- 61. Hemorrhage loss of blood from the circulatory system (Extravasation)
- 62. Clinical correlation Loss of 10-15% of total blood volume can be endured without clinical sequelae in a healthy person, and blood donation typically takes 8-10% of the donor's blood volume 400-450 cc
- 63. Mechanism of hemorrhage 1. Rhexis : Rupture of blood vessel 2. Diapedesis : Leukocytes migrate along a chemotactic gradient towards the site of injury or infection
- 65. Cause of hemorrhage 1. 2. Trauma Diseases of blood vessels themselves ex.scurvy , syphilitic , aortic aneurysm 3. Diseases around blood vessels ex.local infections, metastasis cancer 4. 5. 6. Lack of clotting factors Lack of platelets High blood pressure ex.Stroke or cerebro-vascular accident
- 66. Clinical finding of hemorrhage 1. Petechial or Petichia hemorrhage (Petechiae) : small spots of hemorrhage ( 1-3 mm) 2. 3. Purpura : medium size of hemorrhage ( 3-10 mm) Ecchymosis (Bruise or contusion wound ) : large size of hemorrhage (>10 mm) 4. Hematoma : Collection of blood
- 67. Petechia
- 68. Petechia
- 70. Purpura
- 71. Ecchymosis
- 72. Hematoma
- 73. Hematoma
- 74. Sign and symptom of hemorrhage 1. 2. 3. 4. 5. 6. 7. 8. 9. Epistaxis Hematemesis Hemoptysis Hematochezia Melena Hematuria Hemoperitoneal Hemothorax Hemopericardium
- 75. Hemopericardium
- 76. The significance of hemorrhage 1. 2. 3. 10-20 % of effective blood volume (Mild shock) 20-40 % of effective blood volume ( Moderate shock ) >40 % of effective blood volume ( Severe shock ) LOCATION !
- 77. Basal SAH
- 78. Body response to hemorrhage 1. Hemostasis Vasoconstriction Platelet plug Coagulation 2. Physiologic response Spleen wrinking Rapid pulse (heart rate) Rapid breathing Recall fluid from interstitial space
- 80. Hemostasis 1. 2. Endothelium Platelet Platelet adhesion Platelet activation 犢犖ム鍵 secretion Platelet aggregation Platelet associated coagulation 3. Coagulation factors procoagulant, anticoagulant and fibrinolysis
- 81. x
- 82. x
- 83. x
- 84. x
- 85. Major Causes of Excessive Bleeding Platelet Deficiency 1. 1. 2. Clotting Factor Deficiency 2. 1. 2. 3. quantitative (thrombocytopenias) qualitative (von Willebrand鱈s disease) single, i.e. hemophilia A (VIII) , B (IX), C(XI) multiple, i.e. Vit. K deficiency II ,VII , IX , X Fibrinolytic hyperactivity
- 86. Thrombosis Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system
- 87. x
- 88. Factor to induce Thrombosis 1. Endothelium injury ex.vasculitis , hypertension, smoking , electrocution , radiation injury 2. Alterations in normal blood flow : Mean to Turbulence blood flow or Static blood flow. Result from Cardiac arrhythmia, Turbulence blood flow in Aneurysm , Valvular heart disease , Prolonged bed-rest or immobilization 3. Hypercoagulability state
- 89. Hypercoagulability state Polycythemia vera Hyperlipidemia Malignancy : thrombogenic factor Oral contraceptive use Late pregnancy Smoking Sickle cell anemia Congenital factor deficiencies : Lack of antithrombin III , protein S , Factor V-Leiden Nephrotic syndrome : loss of protein S in urine
- 90. Effect of thrombosis 1. 2. 3. Obstruction (complete or incomplete) : cell or tissue Ischemia and necrosis Embolism Infection
- 91. Fate of Thrombus 1. Dissolution ( Fibrinolysis and hemolysis) : after 48-72 hrs 2. 3. 4. Propagation 犢犖犖犖 犖犖犢犖犢犖 Embolism Organization and Recanalization
- 92. x
- 93. Type of thrombus 1. 2. 3. 4. 5. Arterial Thrombosis Venous thrombosis Cardiac thrombosis Septic thrombosis : ex.Aspergilus Neoplastic thrombosis
- 94. Embolism embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body
- 95. Type of embolism 1. Thrombotic embolus : embolus result from Thrombus 2. Air embolism : Caisson disease Oil/Fat embolus ex.Bone marrow embolism , fat embolism Foreign body embolism Neoplastic embolism Amniotic fluid embolism 3. 4. 5. 6.
- 96. The significance of Embolism 1. Obstruction : Ischemia and necrosis (infarction) Coronary artery embolism : Myocardial infarction Cerebral embolism : Cerebral infarction Pulmonary embolism : Asphyxia 2. Septic embolism -> Mycotic aneurysm
- 98. DIC is a pathological process in the body where the blood starts to coagulate throughout the whole body. This depletes the body of its platelets and coagulation factors, and there is a paradoxically increased risk of hemorrhage. It occurs in critically ill patients, especially those with Gram-negative sepsis (particularly meningococcal sepsis ) 犢犖犢 犖犖犖迦硯犖萎犖朽検犖朽犖迦牽犖犖犖萎犖伍犖犖犖о犖犖迦牽犢犖犢犖犖犖園硯犖犖犖犢犖ム厳犖犖 犖犢犖迦犖犢犢犖犖巌犖ム鹸犖÷犖ム厳犖犖犢犖ム犖 犢 犢 犖犢犖迦犖о犖÷顕犖 犖犖謹犖犢 犖о犢犖犖犢犖犖萎犖犖萎犖犖犖犢犖о権犢犖犖ム犖犢犖ム厳犖犖 犢犖ム鍵犢犖犖犖犖 犖 犢犖犖犖伍犖犖園 犖犖迦検犖犖ム賢犖犢犖ム厳犖犖犖犖犖迦犢犖ム犖犖犖犖犖犖о険犖∇硯犖萎犢犖迦 犢 犢犖犢犖犖犖園硯犢犖 犖犖犖 犖犖園 犖÷犖迦検 犢犖 犖ム犖迦犖犢 犖犖巌硯犖犖犖園犖犖犖 犖犖犖÷賢犖 犢犖犢 犖犖犢犖
- 99. 犖犖迦犖犖犖伍犖ム鍵犖犖∇顕犖犖巌犖迦犖犖巌 犢 犖犖ム犖犖犖 1 犢犖犖巌犖犖迦犢犖犖 犖犖犖 犖犖犖迦硯犖萎犖朽犢犖迦犖犢犖÷元犖犖迦牽犖犖ム犖犖 tissue factor 犖犖犖 犖犖÷元 thromboplastic substance 犢犖犢犖迦肩犖項犖犖犖萎犖犢犖ム厳犖犖犖÷顕犖犖犖#犖 犢犖犢犖犢犖犖犖迦権犢犖犖#犖犖犖犖 犖犖巌県犖犖 犢犖犢 犖犖犢犖 犖犖ム犖犖犖 2 犢犖犖巌犖犖迦犖犖迦牽犖犢犖迦献犖迦権犢犖犖ム献犢犖犖伍犖犖園犖犖ム賢犖犢犖ム厳犖犖 犢犖犢 犖犖犢犖迦犖о犖÷顕犖 犖犖 犖犢犖犖ム献犢犖犖伍犖犖園 犖犖ム賢犖犢犖ム厳犖犖犖犖朽犖項犖犢犖迦献犖迦権犖犖萎見犖ム険犖 tissue factor 犢犖犢犖迦肩犖項犖犖犖萎犖ム厳犖犖犖÷顕犖犖犖#犖 犖犢犖迦犖犢犢犖犖巌犖犖迦牽 犢犖犖迦鍵犖犖ム幻犢犖÷犖園犖犖犖犢犖犖ム犖犢犖ム厳犖犖 犢犖ム鍵犖犖犖萎犖伍 intrinsic pathway 犖犖犖犖犖犖о犖犖迦牽 犢 犢犖犢犖犖犖園硯犖犖犖犢犖ム厳犖犖 犢犖犢犖犢犖犖犖迦権犖犖巌犢犖犖#犖犢犖犖犖犖萎犖犢犖ム厳犖犖 犢犖犖犖迦権犖犖迦犢犖犖ム犖犢犖犖÷ 犖犢#犖迦牽犢犖犖犖ム硯犖 犖犖∇犖迦犖犖 犖犢犖犖 犖犖犖 犖 犢犖犢犖犖犖犖迦犖犖項検犖巌犖伍検犖犖園犖犖朽犢犖迦献犖迦権犖犖犖園犖犖ム賢犖犢犖ム厳犖犖 犢犖犢犖犢犖犖 systemic 犢 lupus erythematosus (SLE )
- 100. DIC 犖犖ム犖犖萎犖犢犖ム鍵犖ム険犖犖犖犖萎犖∇顕犖犖巌肩犖犖迦犖犖朽犖萎犖犢犖犖犖迦権犖犖朽犖犖巌犖犖迦硯犖 DIC 犖犖朽犖犖÷元 2 犖ム険犖犖犖犖 犖犖劇賢犖犖迦硯犖萎犖ム厳犖犖犖犖犖犖犖巌犖犖犖犖 犢犖ム鍵犖犖朽犖犖巌犢犖犖#犖犢犖∇厳犖犖犖迦権犢犖犖劇賢犖犖犖迦犖犖迦牽犖犖迦 犢犖ム厳犖犖犖犖迦検犖÷顕 犢犖犢犖 犖犖÷賢犖 犖犖萎犖犢犖ム厳犖犖犖犖犖 犢犖犖#犖犢犖∇厳犖犖犖迦権犢犖犖劇賢犖犖犖迦犖犖迦牽犖犖迦犢犖ム厳犖犖犢犖 犖犖÷賢犖 犖犖萎犢犖迦犖犢犖犖犖о犖÷元犖犖迦犖迦牽犖犖迦犖犖萎犖犖犖犖萎肩犖迦 犖犖園犢犖ム鍵犖犖迦権犢犖犢 犖犢 犖о犖犖犖 犖犖 犖 犖犖犢犖ム厳犖犖犖犖犖 犢犖犖#犖犢犖∇厳犖犖犖迦権犢犖犖劇賢犖犖犖迦犖犖迦牽犖犖迦犢犖ム厳犖犖犢犖犖犖犖 犖犢犖迦犖犢犖犖迦硯犖萎犖犖犖犖о検 犖犢#犖 犖犖迦権犢犖犖ム犖迦犖迦 犖犖犖 犢犖犖犖劇賢犖∇犢犖迦権犢犖ム鍵犖犖迦権犢犖犢 犢犖犢 犖犖犢犖
- 101. DIC
- 102. Shock Shock so call Circulatory failure or Systemic hypoperfusion result from hypotension
- 103. Shock 犖犖÷顕犖∇犖謹犖犖犖迦硯犖萎献犢犖÷犖犖ム硯犖犖犖犖犖萎犖犖犖迦牽犢犖犖ム犖о元犖∇犖犖犖犢犖ム厳犖犖 犖犢犖迦犖犢 犢犖犖#犖犢犖∇厳犖犖犢犖迦 犢 犢犖犢犖犖園犢犖ム厳犖犖犢犖ム鍵犖犖犖犖犖 犢犖犖犢犖犢犖ム元#犖∇犢犖÷犢犖犖朽権犖犖犖
- 104. Classified of shock 1. Cardiogenic shock or Pump failure ex.Cardiac failure , Myocardium infarction , Myocardial rupture, arrhythmia , Cardiac tamponade ,Myocarditis 2. Hypovolemic shock Mild shock (10-20%) Moderate shock (20-40%) Severe shock (> 40%) 3. 4. 5. Neurogenic shock Septic shock Anaphylaxis shock
- 105. State of shock 1. 2. 3. Compensated or recovering shock Progressive degenerating shock Irreversible shock
- 106. Sign and symptom of shock 1. 2. 3. 4. 5. Oliguria Rapid pulse and weak Thirsty Rapid shallow breathing Cold skin : but in Septic shock may be Warm skin
- 107. Sign and symptom of shock
- 109. Red infarction Area of infarction
- 110. White infarction Area of infarction
- 111. Kidney infarction Area of infarction
- 112. THE END