hemodynamic disorders

HEMODYNAMIC DISORDERS : 

HEMODYNAMIC DISORDERS

HEMODYNAMIC DISORDERS : 

HEMODYNAMIC DISORDERS The common derangement of body fluids are as follows : Edema Over hydration Dehydration

EDEMA : 

EDEMA DEFINITION : abnormal or excessive accumulation of fluid in interstitial tissue space & serous cavity. TYPES : Localised Generalised Pitting edema Non pitting edema

TRANSUDATE /EXUDATE : 

TRANSUDATE /EXUDATE

EDEMA : 

EDEMA PATHOGENESIS : Decreased plasma oncotic pressure Increased capillary hydrostatic pressure Lymphatic obstruction Tissue factors Increased capillary permeability Sodium & water retention

RENAL EDEMA : 

RENAL EDEMA RENAL ISCHEMIA HYPOPERFUSION BARORECEPTORS DECREASED Na IN RENAL TUBULES VASOMOTOR CENTER ANGIOTENSINOGEN SYMPATH. OUTFLOW ANGIOTENSIN I RENAL ISCHEMIA ANGIOTENSIN II GFR ALDOSTERONE EXCRETION OF Na INCREASED Na REABSORPTION renal retention of Na /Water

RENAL EDEMA : 

RENAL EDEMA

CARDIAC EDEMA : PATHOGENESIS : 

CARDIAC EDEMA : PATHOGENESIS C.H.F CENTRAL VENOUS PRESSURE CARDIAC OUTPUT HYPOXIA CAPILLARY HYDRO. PRESSURE HYPOVOLUMIA CAPILLARY PERMEABILITY extra renal mech. Intrinsic renal mech. ADH RENAL RETENTION OF Na/WATER CARDIAC EDEMA

PULMONARY EDEMA : 

PULMONARY EDEMA ETIOPATHOGENESIS : HEMODYNAMIC EDEMA Heart failure Cap.Endothelium dev.fenestration pressure in pulm. Vein interstitial edema Transmitted to pulm. capillaries Thick. of alveolar septae HP alveolar lining cell break Edema alveolar edema

PULMONARY EDEMA : 

PULMONARY EDEMA ACUTE HIGH ALTITUDE EDEMA : Deleterious effects begin to appear after an altitude of 2500 m is reached. These changes include : Appearance of edema fluid in the lungs Congestion Minute hemorrhages

PULMONARY EDEMA : 

PULMONARY EDEMA If acclimatization to high altitude is allowed to take place, the individual develops : Polycythemia pulmonary arterial pressure pulmonary ventilation HR, CO

PULMONARY EDEMA : 

PULMONARY EDEMA MICROSCOPIC SECTION : Alveolar capillaries are congested fluid in interstitium & alveoli Hyaline membranes : Pink line along the alveolar margin

CEREBRAL EDEMA : 

CEREBRAL EDEMA No lymphatics Fluid – electrolyte exchange by Blood brain barrier 3 types

CEREBRAL EDEMA :VASOGENIC : 

CEREBRAL EDEMA :VASOGENIC Most common Due to filtration pressure & capillary permeability E.g. : around cerebral contusion, infarct, brain abscess, tumor GROSS : White matter swollen, flattened gyri & narrowed sulci MICROSCOPIC : Separation of tissue spaces by edema fluid & swelling of astrocytes. Perivascular space is widened Clear halos around blood vessels

CEREBRAL EDEMA :CYTOTOXIC : 

CEREBRAL EDEMA :CYTOTOXIC Intra cellular fluid accumulation Disturbance in cellular osmoregulation Due to metabolic disarrangement, toxins, acute hypoxia etc MICROSCOPIC : Cells are swollen & vacuolated

CEREBRAL EDEMA :INTERSTITIAL EDEMA : 

CEREBRAL EDEMA :INTERSTITIAL EDEMA Fluid crosses the ependymal lining the ventricles & periventricular accumulation of fluid E.g. in non communicating hydrocephalus

OVER HYDRATION : 

OVER HYDRATION DEFINITION : state of pure water excess or water intoxication CAUSES : Acute or chronic renal failure Addison’s disease Cirrhosis of liver Tumor producing ADH Early post operative period

OVER HYDRATION : 

OVER HYDRATION CLINICAL & BIOCHEMICAL EFFECTS : Disordered cerebral function = nausea, vomiting, headache, confusion & in severe cases convulsion, coma & even death. Plasma changes = reduced plasma electrolytes with decreased osmolality, lowered plasma proteins & reduced PCV.

DEHYDRATION : 

DEHYDRATION DEFINITION : state of deprivation of water without corresponding loss of electrolytes. CAUSES : DEFICIENT WATER INTAKE : Dysphagia Obstructive lesion in esophagus Starvation EXCESSIVE LOSS OF WATER : Diabetes insipidus Hyperparathyroidism Pyrexia

DEHYDRATION : Mechanism : 

DEHYDRATION : Mechanism Blood volume Movement of fluid from IC EC compartment Hyperosmolality sodium retention Cellular dehydration renin aldosterone mech. ADH renal water excretion

DEHYDRATION : 

DEHYDRATION CLINICAL FEATURES : Intense thirst Mental confusion Fever Oliguria Plasma changes Na PCV BUN K

DISTURBANCES OF ELECTROLYTES : 

DISTURBANCES OF ELECTROLYTES Combined sodium & water deficiency = Salt Depletion Loss of water & Na volume of IVF ECF Hypovolemia ADH Water retained hyponatremia

ABNORMALITIES OF pH : 

ABNORMALITIES OF pH pH = negative log. of H+ ion conc. of a solution Normal values = 7.4 + 0.05 pH depends upon : Concentration of HCO3 Metabolic acidosis Metabolic alkalosis pCO2 Respiratory acidosis Respiratory alkalosis

METABOLIC ACIDOSIS : 

METABOLIC ACIDOSIS A fall in blood pH due to HCO3 & H+. CAUSES : Production of Lactic acid Uncontrolled diabetic ketoacidosis Starvation CRF Acetazolamide Ammonium chloride CLINICAL FEATURES : kussmaul’s respiration

METABOLIC ALKALOSIS : 

METABOLIC ALKALOSIS pH due to HCO3 & H+ CAUSES : Prolonged vomiting Administration of alkaline salts Hypokalemia CLINICAL FEATURES : Depression of respiration renal function Uremia bicarbonate excretion in urine

RESPIRATORY ACIDOSIS : 

RESPIRATORY ACIDOSIS in pH due to pCO2 CAUSES : Air obstruction Chronic bronchitis emphysema Restricted thoracic movement Pleural effusion ascitis Impaired neuromuscular function Polio

RESPIRATORY ALKALOSIS : 

RESPIRATORY ALKALOSIS in blood pH due to pCO2 CAUSES : Hysterical over breathing Working at high temp. At high altitude Meningitis, encephalitis Salicylate intoxication CLINICAL FEATURES : Peripheral vasoconstriction Pallor Light headedness tetany

Slide 28: 

Thank you By: dr ravi jain