CIRCULATORY DISTURBANCE DUE TO DERANGED VOLUMES

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AWADH DENTAL COLLEGE AND HOSPITAL ANAND 2ND YEAR BDS (BATCH 2008-13) (PRESENTATION )

CIRCULATORY DISTURBANCE DUE TO DERANGED VOLUMES : 

CIRCULATORY DISTURBANCE DUE TO DERANGED VOLUMES

Derangements of blood flow or haemodynamic disturbance are considered under two broad headings : 

Derangements of blood flow or haemodynamic disturbance are considered under two broad headings 1.Disturbances in the volume of the circulating blood- It includes a)hyperaemia and congestion ,b)haemorrhage and shock...

2.Circulatory disturbance of obstructive nature,it includes a)thrombosis and embolism b)ischaemia and infarction : 

2.Circulatory disturbance of obstructive nature,it includes a)thrombosis and embolism b)ischaemia and infarction

HYPERAEMIA AND CONGESTION : 

HYPERAEMIA AND CONGESTION Hyperaemia and congestion are the term used for increased volume of blood within dilated vessels of an organ and tissue ;;;; The increased volume from arterial and arteriolar dilatation being referred to as hyperaemia or active hyperaemia ,, whereas the impaired venous drainage is called venous congestion or passive hyperaemia ;;;……….

Active Hyperaemia : 

Active Hyperaemia The dilation of arteries,arterioles and capillaries is effected either through sympathetics mechanism or via the release of vasoactive substance. The affected tissue or organ is pink or red in appearance Ex. are Inflammation eg. congested vessels in the walls of alveoli in pneumonia Blushing i.e.flushing of the skin of face in response to emotions Menopausal flush Muscular exercise High grade fever …

Passive hyperaemia : 

Passive hyperaemia The dilation of veins and capillaries due to impaired venous drainage results in passive hyperaemia or venous congestion,commonly referred to as congestion may be acute or chronic,the latter being more common and called chronic venous congestion(CVC) due accumulation of venous blood(cyanosis) Venous congestion is of two type (a)Local venous congestion. (b)systemic venous congestion

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HEART FAILURE LEFT-SIDED RIGHT -SIDED BACK PRESSURE BACK PRESSURE CVC LUNGS CVC LIVER CVC SPLEEN CVC KIDNEY CONGESTED LEG VEINS

Chronic venous congestion of lungs occur in left heart failure ,especially in rheumatic mitral stenosis so that there is consequent rise in pulmonary venous pressure. : 

Chronic venous congestion of lungs occur in left heart failure ,especially in rheumatic mitral stenosis so that there is consequent rise in pulmonary venous pressure. CVC LUNG

Chronic venous congestion of the liver occurs in right heart failure and sometimes due to occlusion of inferior vena cava and hepatic vein . : 

Chronic venous congestion of the liver occurs in right heart failure and sometimes due to occlusion of inferior vena cava and hepatic vein . CVC LIVER NUTMEG LIVER.

Morphology of cvc of organs : 

Morphology of cvc of organs IN CVC KIDNEY The kidneys are slightly enlarged and the medulla is congested. Microscopically,the changes are rather mild. the tubules may show degenerative changes like cloudy swelling and fatty changes.the glomeruli may show mesangial proliferation. Kidney

Chronic venous congestion of the spleen occurs in right heart failure and in portal hypertension from cirrhosis of liver : 

Chronic venous congestion of the spleen occurs in right heart failure and in portal hypertension from cirrhosis of liver Spleen, chronic passive congestion (case of heart failure

HAEMORRHAGE : 

HAEMORRHAGE Haemorrhage is the escape of blood from a blood vessels.The bleeding may occur externally,or internally into the serous cavities(eg.haemothorax,haemoperitonium,haemopericardium)or into a hollow viscus. Extravassation of blood into the tissue with resultant swelling is known as HAEMATOMA. Large extravasations of blood into the skin and mucous membrane are called ECCHYMOSES.

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PURPURAS are small areas of haemorrhages (upto 1 c.m) into the skin and mucous membrane ,whereas PETECHIAE are minute pinhead-sized haemorrhages . Microscopic escape of erythrocytes into loose tissue may occur following marked congestion and is known as DIAPEDESIS .

CAUSES OF HAEMORRHAGE : 

CAUSES OF HAEMORRHAGE 1.TRAUMA 2.SPONTANEOUSHAEMORRHAGE 3.INFLAMMATORY LESIONS OF THE VESSEL WALL NEOPLASTIC INVASION VASCULAR DISEASES ELEVATED PRESSURE WITHIN THE VESSELS.

EFFECTS OF HAEMORRHAGE : 

EFFECTS OF HAEMORRHAGE the amount of blood loss; the speed of blood loss ;and the site of haemorrhage .

SHOCK : 

SHOCK DEFINITION AND TYPES Shock is defined as a clinical state of cardiovascular collapse characterised by : an acute reduction of effective circulating blood volume and An adequate perfusion of cells and tissues . Shock may be of two type Primary or initial shock. Secondary or true shock

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Shock 1.HYPOVOLAEMIC SHOCK 2.SEPTIC SHOCK CARDIOGENIC SHOCK 1)Severe haemorrhage (external or internal) 2)Fluid loss 1)Gram-negative septicaemia(endotoxic shock) 2)gram positive septicaemia(exotoxic shock)

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ETIOLOGY Effective circulating blood volume Venous return to heart cardiac output Blood flow supply of oxygen Anoxia HAEMORRHAGE TRAUMA SURGERY BURNS DEHYDRATION HYPOVOLAEMIC SHOCK PATHOGENESIS SHOCK

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ETIOLOGY Effective circulating blood volume Venous return to heart cardiac output Blood flow supply of oxygen Anoxia SEPTIC SHOCK PATHOGENESIS SHOCK 1.GRAM –VE SEPTICEMIA 2.GRAM +VE SEPTICEMIA

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ETIOLOGY Effective circulating blood volume Venous return to heart cardiac output Blood flow supply of oxygen Anoxia CARDIOGENIC SHOCK PATHOGENESIS SHOCK DEFICIENCY OF EMPTYING DEFICINCY OF FILLING OUTFLOW OBSTRUCTION

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STAGE PATHOGENESIS EFFECTS INITIAL SHOCK BARORECEPTOR CATECHOLAMINE RELEASE RENIN-ANGIOTENSIN ACTIVATION ADH RELEASE SYMPATHETIC STIMULATION PERPHERAL VASOCNSTRICTION COOL CLAMMY SKIN TACHYCARDIA FLUID CONSERVATION BY KIDEY PROGRESSIVE SHOCK ARDS ANAEROBIC GLYCOLYSIS LACTIC ACIDOSIS,LOW TISSUE PH IMPAIRED VASOMOTOR RESPONSE CARDIAC OUTPUT DIC MENTAL CONFUSION URINARY OUTPUT IRREVERSIBLE SHOCK PERSISTENT VASOCONSTRICTION VASODILATION &VASCULAR PERMEABILITY MYOCARDIAL ISCHAEMIA(MDF) CEREBRAL ISCHAEMIA VDM TNF INTESTINAL FACTOR BACTERIAL FACTOR HYPERCOAGULABILITY BRAIN:DEATH LUNGS:ARDS HEART:FOCAL MYOCARDIAL NECROSIS SPLEEN :HYPERPLASIA STOMACH: ULCER INTESTINE :NECROSIS SPLANCHNIC:VASODILATON

MORPHOLOGICAL COMPLICATIONS IN SHOCK : 

MORPHOLOGICAL COMPLICATIONS IN SHOCK HYPOXIC ENCEPHALOPATHY HEART IN SHOCK SHOCK LUNG SHOCK KIDNEY ADRENALS IN SHOCK HAEMORRHAGIC GASTROENTEROPATHY LIVER IN SHOCK

CLINICAL FEATURES : 

CLINICAL FEATURES VERY LOW BLOOD PRESSURE SUBNORMAL TEMPERATURE FEEBLE AND IRREGULAR PULSE SHALLOW AND SIGHING RESPIRATION

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SPECIAL THANKS TO DR.BALAKANT SHRMA SIR