Congestion Hemorrhage Thrombosis Embolism...

CHAPTER 3

12/1/2019 [email protected]

CHAPTER 3

12/1/2019 PATHOLOGY (reform)-DH 2

◼ Congestion

◼ Hemorrhage

◼ Thrombosis

◼ Embolism

◼ Infarction

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SECTION 1

HYPEREMIA & CONGESTION

A local increased volume of blood in a

particular tissue

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Hyperemia

Congestion

An active process

A passive process

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Hyperemia

an active process

resulting from augmented tissue inflow

because of arteriolar dilation

◆ Skeletal muscle during exercise

◆ Sites of inflammation

redder

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Congestion

a passive process

resulting from impaired outflow from a tissue

◆ a blue-red color (cyanosis)

◆ cut surfaces: hemorrhagic and wet

◆ capillaries engorged with blood

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◆ Systemical Congestion

◆ Local Congestion

Etiology

Cardiac failure

An isolated venous obstruction

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◆ Edema

◆ Parenchymal cell degeneration or death

◆ Small foci of hemorrhage

◆ Fibrosis

◆ Infection

OUTCOME

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e.g. Pulmonary Congestion

⚫ alveolar capillaries engorged with blood

⚫ alveolar septal edema

⚫ focal intra-alveolar hemorrhage

ACUTE

(1)

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e.g. Pulmonary Congestion

CHRONIC

(2)

⚫ Thickened and fibrotic septa

⚫ Numerous hemosiderin-laden macrophages

in the alveolar spaces (heart failure cells)

⚫ Brown induration

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e.g. Hepatic Congestion

⚫ Distended central vein and sinusoids

with blood

⚫ Hepatocyte degeneration

ACUTE

(1)

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⚫ Central regions: red-brown

⚫ Surrounding zones: tan /or yellow

CHRONIC

(2)

Nutmeg Liver

Hepatic Lobules

Necrosis & hemorrhage

Fatty change

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CHRONIC

(3)

Hepatic Fibrosis (cardiac cirrhosis)

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SECTION 2

HEMORRHAGE

Extravasation of blood due to vessel rupture

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◆ Capillary bleeding: chronic congestion

◆ Rupture of a large artery or vein:

vascular injury

ETIOLOGY

⚫ Trauma

⚫ Atherosclerosis

⚫ Inflammatory or neoplastic erosion

of the vessel wall

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Hematoma: accumulation of blood

within tissue

PATTERNS

Depending on the size, extent,

and location of bleeding

Petechiae: 1- to 2-mm hemorrhages

into skin, mucous membranes,

or serosal surfaces

(1)

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PATTERNS

Purpura: slightly larger (≥3 mm)

hemorrhages

Ecchymoses: larger (>1 to 2 cm)

subcutaneous hematomas (i.e., bruises)

(2)

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◆ Hemothorax

◆ Hemopericardium

◆ Hemoperitoneum

◆ Hemarthrosis

…

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Depending on the volume

the rate of bleeding

the site

CLINICAL SIGNIFICANCE

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SECTION 3

THROMBOSIS

Process of formation of a solid mass

from the constituents of the blood

within the heart or the vascular system

in a living organism

A thrombus

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PATHOGENESIS

Virchow’s Triad

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ENDOTHELIAL INJURY

◆ Exposure of subendothelial collagen

◆ Adherence of platelets

◆ Release of tissue factor

◆ Depletion of PGI2 & PA

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Activation of platelets

◆ Adhesion and shape change

◆ Secretion (release reaction)

◆ Aggregation

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Virchow’s Triad

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ABNORMAL BLOOD FLOW

◆ Turbulence

◆ Stasis

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Virchow’s Triad

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HYPERCOAGULABILITY

◆ Genetic (primary)

◆ Acquired (secondary)

Pathology


Genetic (Primary)

Common

Mutation in factor V gene (factor V

Leiden)

Mutation in prothrombin gene

Mutation in methyltetrahydrofolate gene

Rare

Antithrombin III deficiency

Protein C deficiency

Protein S deficiency

Very rare

Fibrinolysis defects

Pathology


Secondary (Acquired) (1)

High risk for thrombosis

Prolonged bed rest or immobilization

Myocardial infarction

Atrial fibrillation

Tissue damage (surgery, fracture, burns)

Cancer

Prosthetic cardiac valves

Disseminated intravascular coagulation

Heparin-induced thrombocytopenia

Antiphospholipid antibody syndrome

(lupus anticoagulant syndrome)

Pathology


Secondary (Acquired) (2)

Lower risk for thrombosis

Cardiomyopathy

Nephrotic syndrome

Hyperestrogenic states

(pregnancy)

Oral contraceptive use

Sickle cell anemia

Smoking

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Virchow’s Triad

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PROCESS OF THROMBOSIS

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TYPES OF THROMBUS

◆ Pale Thrombus

◆ Red Thrombus

◆ Mixed Thrombus

◆ Hyaline Thrombus

or Microthrombus

Vegetations

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SITES OF THROMBOSIS

◆ Arterial Thrombosis

◆ Cardiac Thrombosis

◆ Venous Thrombosis

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FATE OF THE THROMBUS

◆ Dissolution

◆ Propagation

◆ Embolization

◆ Organization and Recanalization

◆ Calcification (phlebolith)

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Potential outcomes of venous thrombosis.

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SIGNIFICANCE OF THE THROMBUS

◆ Prevention of excessive bleeding

◆ Obstruction of arteries and veins

◆ Possible sources of emboli

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SIGNIFICANCE OF THE THROMBUS

◆ Venous Thrombosis (Phlebothrombosis)

◆ Arterial and Cardiac Thrombosis

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SECTION 4 EMBOLISM

Occlusion or obstruction of a vessel

by an abnormal mass (solid, liquid, or gaseous)

transported from a different site by the circulation

An Embolus Thromboembolism

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Moving Pathway of An Embolus

The same direction as the blood

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Types & Sequences

◆ Thromboembolism

◆ Fat embolism

◆ Air embolism

◆ Amniotic fluid embolism

◆ Others

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Types & Sequences

◆ Thromboembolism

1. Pulmonary Thromoembolism

2. Systemic Thromboembolism

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➢ Small &/or a few

--- clinical silent

infarction, if left cardiac failure

➢ Small & massive /or large

--- sudden death

1. Pulmonary Thromoembolism

Sites of Originthe large deep veins of the lower leg

Effects Emboli

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Pulmonary embolism

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2. Systemic Thromoembolism

Sites of OriginLeft cardiac thrombi(85%), arterial thrombi

Effects

➢the size

➢the lodged vessel

➢the collateral blood supply in the tissue

➢the vulnerability of the tissue to ischemia

Depending on

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Types & Sequences

◆ Thromboembolism

◆ Fat embolism

◆ Air embolism

◆ Amniotic fluid embolism

◆ Others

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SECTION 5

INFARCTION

Ischemic Necrosis

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Etiology

◆ Thrombosis

◆ Embolism

Arterial occlusion

◆ Local vasospasm

◆ Twisting of the vessels

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Morphology

◆ Red (hemorrhagic) infarcts

◆ White (anemic) infarcts

◆ Septic infarcts

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Morphology



◆ Septic infarcts

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Sequences

◆ Nature of the vascular supply

◆ Rate of development of occlusion

◆ Vulnerability to hypoxia

◆ Oxygen content of blood

Site & Size

Congestion Hemorrhage Thrombosis Embolism...

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