Hemodynamic Disorders

1
Hemodynamic Disorders
2
Fluid Homeostasis

• Homeostasis is maintained by the opposing effects
  of
• Vascular Hydrostatic Pressure
• and
• Plasma Colloid Osmotic Pressure

3
Edema
ASCITES
4
Pitting Edema
PERIORBITAL (RENAL)
5
Pulmonary Edema

• The Lungs are typically 2-3 times normal weight
• Cross sectioning causes an outpouring of frothy,
• sometimes blood-tinged fluid
• It may interfere
• with pulmonary function

6
Pulmonary Edema
the alveolar capillaries are engorged, and an
intra-alveolar granular pink precipitate is seen
7
Brain Edema
The surface of the brain with cerebral edema
demonstrates widened gyri with a flattened
surface. The sulci are narrowed
8
Brain Edema

• Clinical Correlation The big problem is There
  is no place for the fluid to go!
• Herniation into the foramen magnum will kill

9
Effects of LipopolysaccharideSeptic Shock
LPS lipopolysaccharide TNF tumor necrosis
factor IL interleukin NO nitric oxide PAF
platelet-activating factor
10
ARDS/diffuse alveolar damage in shock
Some of the alveoli are collapsed others are
distended. Many contain dense proteinaceous
debris, desquamated cells, and hyaline membranes
11
MYOCARDIAL NECROSIS in Shock
lower field contains intact myocardium, while the
upper field exhibits coagulation necrosis of
myocardium. the hypoperfusion is greatest in the
subendeocardium, which is perfused mainly in
diastole.
12
ATN
ATN in shock , extensive tubular isghaemia , note
relative sparing of the glomeruli.