stagnation, edema, shock attila zalatnai
TRANSCRIPT
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STAGNATION, EDEMA, SHOCK
Attila Zalatnai
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Hyperemia (local eccess of blood)
Active Passive (congestion)
- loss of sympathetic activity - venous block
- vasoactive compounds a.) local
venous thrombus
vasodilatation venous compression
torsion
-inflammations (rubor, calor) invagination
-excercise vena cava superior syndr.
-meal
-psychological effects (blushing) b.) systemic
-hormones (postmenopause) right sided heart failure
-carcinoid flush (chronic cor pulmonale)
-reperfusion
-medicinal drugs (Na-nitrite, blue tablet)
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Passive hyperemia (congestion)
local
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systemic – right sided heart failure
- cyanosis- congestiv gastritis, duodenitis- bilateral hydrothorax- hydropericardium / tamponade- ascites- hepato-splenomegaly- „nutmeg liver”- kidneys: dilated stellate veins,
livid pyramids- anasarca
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Consequences of chronic congestion
- organ enlargement (hepatomegaly, splenomegaly)
- induration (spleen, liver, lung, skin)
- atrophy (skin)
- necrosis (bowel, testicle)
- edema
brown Induration of lungs
„heart failure cells”
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postthrombotic
syndrome
crural ulcer
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EDEMA
Accumulated, extravasal fluid with low protein content
(transudate)
- in the interstitial tissues
- freely in body cavities
Special gravity: < 1.012
Background: disturbed balance in the microcircular unit
Determinants:
- intravasal hydrostatic pressure
- colloidosmotic pressure in the vessels
- tissue colloidosmotic pressure
- lymphatic circulation
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EDEMA FORMATION
- decreased colloidosmotic pressure in the blood
- increased capillary permeability
- increased hydrostatic pressure in the venous part
- lymphatic insufficiency
- sodium and water retention
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
- cerebral space-occupying lesions
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
- cerebral space-occupying lesions
superior vena cava syndrome
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
- cerebral space-occupying lesions
lymphedema
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
-cerebral space-occupying lesions
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
- cerebral space-occupying lesions
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
- cerebral space-occupying lesions
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility,
- allergy
- hypoxia
- cerebral space-occupying lesions
Perifocal edema (vasogenic)
brain tumors (primary, metastatic)
hemorrhage (apoplexia)
emollition
abscess (bacterial, fungal)
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
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Structure of the glomerulus
vascular pole
urinary pole
JGA
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxiahydropericardium
bilateral hydrothorax
ascites
anasarca (pitting edema)
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EDEMA
localized generalized
- disturbed venous outflow - hypalbuminemia
- disturbed lymphatic circulation - right sided heart failure
- inflammation - Rh (ABO) incompatibility, infection
- allergy
- hypoxia
fetal hydrops
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Shock
- Acute circulatory catastrophy, inadequate blood flow, impaired
perfusion, generalized tissue hypoxia, complex organ
dysfunctions
- Stereotypic reaction
- Extremely increased sympathetic activity (arteriole + venuleconstrictions) capillary stasis, hypoxia, acidosis
- Severe systemic hypotension, oliguria, CNS malfunctions
Hypovolemic (blood loss, fluid loss)
Traumatic
Anaphylactic (blood pooling at the level of capillaries)
Cardiogenic (reduced cardiac output)
Septic (peripheral vasodilatation, endothelial injury, DIC, activation of cytokine)
cascade…. )
Toxic (TSS-1)
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