Chapter 3
hemodynamic
derangements
department of pathology
Hemodynamic amount hyperaemia
ischemia
Intravascular component
appearance mass thrombosis
embolism
Vascular infarct
completion bleeding
permeability edema
caducity
artery
× blood
fluid
Section 1,hyperaemia
an increased volume of blood in
an affected tissue or pert
arterial hyperaemia ( active )
venous hyperaemia ( passive )
department of pathology
When arterial or arteriolar
dilatation produces an
increased flow of blood into
capillary beds,are called
arterial hyperaemia,also called
active hyperaemia.
‘ ear and face into red ’
department of pathology
Active hyperaemia
Physiological
Inflammatory
After reducing pressure
department of pathology
Passive hyperaemia
may be pathological meaning
When impaired venous drainage,are called passive hyperaemia
also called congestion
may occur as a systemic
occur as a localized
department of pathology
Pathogenesis of congestion
1,localized
2,Systemic,heart failure
detaining
Pressure
department of pathology
Morphology:
wet
weight
blue-red coloration
temperature
an increase of
deoxygenated
haemoglobin
department of pathology
Morphology:
Normal capillary congestion
Congestive edema
Congestive haemorrhage
Congestive sclerosis
congestion of important organs,
1.congestion of lung:
pathogenesis---
familiar in left ventricular failure
left ventricular failure
elevated left atrial pressure
elevated pulmonary venous pressure
department of pathology
detaining of pulmonary venous drainage
lung congestion
acute and chronic congestion of lung:
change of acute lung congestion to
differentiae from chronic lung congestion
why? Change?
Clinical?
Morphology:
Normal capillary congestion
Congestive edema
Congestive haemorrhage
Congestive sclerosis
急
慢
pulmonary edema
pulmonary edema
Congestion of lung
Pulmonary congestion （ acute? Chronic?）
Acute and chronic
passive hyperaemia of the liver
? result from right –sided heart
failure
? increase in liver size and weight
section:
acute passive hyperaemia is an excessive
ooze of blood and the central veins may
appear prominent
Acute
passive
hyperaemia
of the liver
department of pathology
On the cut surface:
nutmeg pattern
On the light microscopy:
congestion + fatty change
Chronic passive hyperaemia:
department of pathology
"nutmeg" liver
Chronic congestion of liver
Congestive
liver cirrhosis
department of pathology
Section 2,
Haemorrhage
simple
self-study
department of pathology
Haemorrhage of the bran (acute)
Haemorrhage of the bran (subacute)
Haemorrhage of the bran (chronic)
Why?
Acute ?chronic
Here are petechial
hemorrhages
(pinpoint
hemorrhages) seen
on the epicardium of
the heart,
? a low platelet count
? sudden hypoxia.
Section 3,Thrombosis
What is thrombosis?
Pathogenesis of thrombosis
Change and types of thrombosis
Outcome of thrombosis
department of pathology
The formation of a clotted
mass of blood within the
noninterrupted
cardiovascular system is
termed thrombosis,and the
mass itself a thrombus.
department of pathology
Thrombus defined as an
aggregate of coagulated
blood containing platelets,
fibrin,and entrapped
cellular elements,
department of pathology
A thrombus
is different from a clot!
A clot is defined as blood
coagulated outside the vascular
system,or within the vascular
system after death.
department of pathology
How distinguish between
thrombosis and clot?
Life activity
department of pathology
Thrombogenesis:
Three major influences predispose to
thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
Thrombogenesis:
Three major influences predispose
to thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
(1)Injury to endothelium
is the major and the most frequent
influence and the only one that,
by and of itself,may lead to
thrombosis
Start the factor
department of pathology
Endothelia cell
Base membrane Sub-endothelia collagen
Red cell leukocyte
platelet
Normal vascular and blood flow
department of pathology
Base membrane Sub-endothelia collagen
Injury to endothelium
department of pathology
This platelet bears a striking
resemblance to a chocolate chip cookie,
Injury expose collagen
Platelets adhesion
and aggregation TxA2,ADP
Circulating plateletsthrombin
fibrinogen
fibrin
PGI2,NO
endothelium
thrombosisPlatelets
aggregation
regulate
The role of platelet in thrombosis
start
Thrombogenesis:
Three major influences predispose
to thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
Alterations in normal blood flow
Thrombogenesis:
Three major influences predispose
to thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
Alterations in blood:
Blood hypercoagulability
Blood coagulation
department of pathology
Change and types,
(1) Thrombus formation
Red thrombus Mixed thrombus
Pale thrombus
Mixed thrombus
(2),types:
a,pale thrombus --- arterial
b,mixed thrombus --- venous
c,red thrombus --- expansive venous
d,hyaline thrombus --- DIC
Why?
Blood flow?
department of pathology
department of pathology
coronary thrombosis
Hyaline thrombus:
be made of fibrin
appearance of microvascular
department of pathology
Small fibrin thrombi
department of pathology
Consequences of thrombosis:
A,lysis and resolution
embolism infarct
B,organization
C,recanalisation
D,calcification phlebolith
department of pathology
embolism
lysis and resolution
organization
embolism
recanalisation
thrombus
Scar and residual thrombus
department of pathology
The effects of thrombosis
thrombosis
lysis and resolution
organization
recanalisation
calcification
embolism
infarction blood supply repair
blood supply blocked
large
make for?
not make for?
Define ‘ thrombosis’
What are the components of
predispose (three groups) and
how do they cause thrombosis?
How many are consequences
of thrombosis?
department of pathology
Section 4,Embolism
department of pathology
Embolism is the passage
through the venous or
arterial circulations of any
material capable of lodging
in a blood vessel and
thereby obstructing the
lumen.
These material made of
thrombus,(90%)
air,
fat,
tumour cells deposit ……
department of pathology
thrombus
Air
emboli
Fat emboli
Tumour cells deposit
Moved following blood flow
embolism
Block up blood flow
1.What is embolism?
Emboli travel in the
circulation,passing through
the vascular tree until they
reach a vessel whose
diameter is small enough to
prevent their further passage.
department of pathology
2.Embolism is different
from thrombosis!
move embolism
static thrombosis
风静静血栓成，风拂拂血栓行。
department of pathology
3.Move direction of emboli
is consistent with blood flow
(1) from venous thrombi will arrive
in the pulmonary circulation
(2) from arterial system thrombi
will arrive in systemic embolism
department of pathology
from venous emboli
Systemic embolism
( kidney,spleen )
How is emboli
circulated?
department of pathology
systemic
Venous emboli
Cross circulation
Types of embolism
Ⅰ, thromboembolism
Ⅱ, fat embolism
Ⅲ, air embolism
Ⅳ, amniotic embolism
department of pathology
Ⅰ,thromboembolism
1,Pulmonary embolism
95% of venous emboli thrombosis occurs in leg venous
large emboli
small emboli
acute respiratory and
cardiac problem
sudden death
bleeding infarct
department of pathology
"saddle" pulmonary thromboembolus
"saddle" pulmonary thromboembolus
bleeding infarct of lung
2.systemic embolism
emboli from heart:
emboli from arterial,
Myocardial infarct thrombosis
Valve vegetation drop down
Atheromatous plaque with
thrombosis
department of pathology
These emboli may travel to
Brain liquefaction necrosis
Kidney coagulation necrosis
Intestine wet gangrene
Limbs dry gangrene
may be
may be
may be
may be
department of pathology
department of pathology
department of pathology
Ⅱ,fat embolism
Fat embolism usually arises following
some severs trauma with fracture to
long bones.
Fat from the bone marrow is released
into the circulation and comes to lodge
in various organs,
A similar situation arises in severe
burns and in extensive soft tissue
injury.
department of pathology
Ⅲ,air embolism
when involving gas of vessel are
transferred too rapidly from high to
low pressure environments…
decompression sickness
when some vessels is opened to the
air…
neck veins are cut,delivery
department of pathology
Ⅳ,amniotic embolism
With the vastly increased pressures in the
uterus during delivery,the head engages
and the pressure is transferred to the
amniotic fluid which may be forced into
the maternal uterine veins.
These amniotic fluid emboli travel in the
circulation and lodge in the
lungs,causing respiratory distress like
other pulmonary emboli.
department of pathology
amniotic fluid embolism
comprisal
An embolus is a mass of material in the
vascular system able to become lodged
within a vessel and block its lumen
Most emboli are derived from thrombi
Move direction of emboli is consistent
with blood flow
Most common occurrence is pulmonary
embolism from deep leg vein thrombosis
Section 5,infarction
Infarction is ischaemic death of tissue
within the living body.
Only death of tissue due to restricted
blood supply is infarction.
different from toxins or trauma
all are necrosis but are not infarction
department of pathology
1,pathogenesis
(1) thrombosis
(2) artier of embolism
(3) artery spasm
(4) vessels inflow is blocked
department of pathology
2,Gross pathology
(1) infarcted areas are consistent
with vessels distribution
(2) the appearance of infarcted
areas depends upon the time that
infarct occurring
(3) anaemic infarct and
hemorrhagic infarct
department of pathology
department of pathology
Infarction
department of pathology
Infarction of spleen
Infarction of liver
department of pathology
infarction
department of pathology
hemorrhagic (red) infarction
department of pathology
myocardial
infarction
department of pathology
myocardial infarction
In cross section,the point of rupture of the myocardium is
shown with the arrow,
2,Gross pathology
(1) infarcted areas are consistent
with vessels distribution
(2) the appearance of infarcted
areas depends upon the time that
infarct occurring
(3) anaemic infarct and
hemorrhagic infarct
department of pathology
3,histological characteristic
(1) necrosis
(2) ischemic coagulative necrosis
department of pathology
department of pathology
Contraction band
department of pathology
department of pathology
Infarction
Normal <6 hours >24hours several days several
to weeks months
Evolution of an infarction
department of pathology
Hemodynamic amount hyperaemia
ischemia
Intravascular component
appearance mass thrombosis
embolism
Vascular infarct
completion bleeding
permeability edema
caducity
artery
× blood
fluid
Congestion
Thrombosis
Embolism
infarction
department of pathology
hemodynamic
derangements
department of pathology
Hemodynamic amount hyperaemia
ischemia
Intravascular component
appearance mass thrombosis
embolism
Vascular infarct
completion bleeding
permeability edema
caducity
artery
× blood
fluid
Section 1,hyperaemia
an increased volume of blood in
an affected tissue or pert
arterial hyperaemia ( active )
venous hyperaemia ( passive )
department of pathology
When arterial or arteriolar
dilatation produces an
increased flow of blood into
capillary beds,are called
arterial hyperaemia,also called
active hyperaemia.
‘ ear and face into red ’
department of pathology
Active hyperaemia
Physiological
Inflammatory
After reducing pressure
department of pathology
Passive hyperaemia
may be pathological meaning
When impaired venous drainage,are called passive hyperaemia
also called congestion
may occur as a systemic
occur as a localized
department of pathology
Pathogenesis of congestion
1,localized
2,Systemic,heart failure
detaining
Pressure
department of pathology
Morphology:
wet
weight
blue-red coloration
temperature
an increase of
deoxygenated
haemoglobin
department of pathology
Morphology:
Normal capillary congestion
Congestive edema
Congestive haemorrhage
Congestive sclerosis
congestion of important organs,
1.congestion of lung:
pathogenesis---
familiar in left ventricular failure
left ventricular failure
elevated left atrial pressure
elevated pulmonary venous pressure
department of pathology
detaining of pulmonary venous drainage
lung congestion
acute and chronic congestion of lung:
change of acute lung congestion to
differentiae from chronic lung congestion
why? Change?
Clinical?
Morphology:
Normal capillary congestion
Congestive edema
Congestive haemorrhage
Congestive sclerosis
急
慢
pulmonary edema
pulmonary edema
Congestion of lung
Pulmonary congestion （ acute? Chronic?）
Acute and chronic
passive hyperaemia of the liver
? result from right –sided heart
failure
? increase in liver size and weight
section:
acute passive hyperaemia is an excessive
ooze of blood and the central veins may
appear prominent
Acute
passive
hyperaemia
of the liver
department of pathology
On the cut surface:
nutmeg pattern
On the light microscopy:
congestion + fatty change
Chronic passive hyperaemia:
department of pathology
"nutmeg" liver
Chronic congestion of liver
Congestive
liver cirrhosis
department of pathology
Section 2,
Haemorrhage
simple
self-study
department of pathology
Haemorrhage of the bran (acute)
Haemorrhage of the bran (subacute)
Haemorrhage of the bran (chronic)
Why?
Acute ?chronic
Here are petechial
hemorrhages
(pinpoint
hemorrhages) seen
on the epicardium of
the heart,
? a low platelet count
? sudden hypoxia.
Section 3,Thrombosis
What is thrombosis?
Pathogenesis of thrombosis
Change and types of thrombosis
Outcome of thrombosis
department of pathology
The formation of a clotted
mass of blood within the
noninterrupted
cardiovascular system is
termed thrombosis,and the
mass itself a thrombus.
department of pathology
Thrombus defined as an
aggregate of coagulated
blood containing platelets,
fibrin,and entrapped
cellular elements,
department of pathology
A thrombus
is different from a clot!
A clot is defined as blood
coagulated outside the vascular
system,or within the vascular
system after death.
department of pathology
How distinguish between
thrombosis and clot?
Life activity
department of pathology
Thrombogenesis:
Three major influences predispose to
thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
Thrombogenesis:
Three major influences predispose
to thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
(1)Injury to endothelium
is the major and the most frequent
influence and the only one that,
by and of itself,may lead to
thrombosis
Start the factor
department of pathology
Endothelia cell
Base membrane Sub-endothelia collagen
Red cell leukocyte
platelet
Normal vascular and blood flow
department of pathology
Base membrane Sub-endothelia collagen
Injury to endothelium
department of pathology
This platelet bears a striking
resemblance to a chocolate chip cookie,
Injury expose collagen
Platelets adhesion
and aggregation TxA2,ADP
Circulating plateletsthrombin
fibrinogen
fibrin
PGI2,NO
endothelium
thrombosisPlatelets
aggregation
regulate
The role of platelet in thrombosis
start
Thrombogenesis:
Three major influences predispose
to thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
Alterations in normal blood flow
Thrombogenesis:
Three major influences predispose
to thrombosis
(1)Injury to endothelium
(2)Alterations in normal blood flow
(3)Alterations in blood
( hypercoagulability )
department of pathology
Alterations in blood:
Blood hypercoagulability
Blood coagulation
department of pathology
Change and types,
(1) Thrombus formation
Red thrombus Mixed thrombus
Pale thrombus
Mixed thrombus
(2),types:
a,pale thrombus --- arterial
b,mixed thrombus --- venous
c,red thrombus --- expansive venous
d,hyaline thrombus --- DIC
Why?
Blood flow?
department of pathology
department of pathology
coronary thrombosis
Hyaline thrombus:
be made of fibrin
appearance of microvascular
department of pathology
Small fibrin thrombi
department of pathology
Consequences of thrombosis:
A,lysis and resolution
embolism infarct
B,organization
C,recanalisation
D,calcification phlebolith
department of pathology
embolism
lysis and resolution
organization
embolism
recanalisation
thrombus
Scar and residual thrombus
department of pathology
The effects of thrombosis
thrombosis
lysis and resolution
organization
recanalisation
calcification
embolism
infarction blood supply repair
blood supply blocked
large
make for?
not make for?
Define ‘ thrombosis’
What are the components of
predispose (three groups) and
how do they cause thrombosis?
How many are consequences
of thrombosis?
department of pathology
Section 4,Embolism
department of pathology
Embolism is the passage
through the venous or
arterial circulations of any
material capable of lodging
in a blood vessel and
thereby obstructing the
lumen.
These material made of
thrombus,(90%)
air,
fat,
tumour cells deposit ……
department of pathology
thrombus
Air
emboli
Fat emboli
Tumour cells deposit
Moved following blood flow
embolism
Block up blood flow
1.What is embolism?
Emboli travel in the
circulation,passing through
the vascular tree until they
reach a vessel whose
diameter is small enough to
prevent their further passage.
department of pathology
2.Embolism is different
from thrombosis!
move embolism
static thrombosis
风静静血栓成，风拂拂血栓行。
department of pathology
3.Move direction of emboli
is consistent with blood flow
(1) from venous thrombi will arrive
in the pulmonary circulation
(2) from arterial system thrombi
will arrive in systemic embolism
department of pathology
from venous emboli
Systemic embolism
( kidney,spleen )
How is emboli
circulated?
department of pathology
systemic
Venous emboli
Cross circulation
Types of embolism
Ⅰ, thromboembolism
Ⅱ, fat embolism
Ⅲ, air embolism
Ⅳ, amniotic embolism
department of pathology
Ⅰ,thromboembolism
1,Pulmonary embolism
95% of venous emboli thrombosis occurs in leg venous
large emboli
small emboli
acute respiratory and
cardiac problem
sudden death
bleeding infarct
department of pathology
"saddle" pulmonary thromboembolus
"saddle" pulmonary thromboembolus
bleeding infarct of lung
2.systemic embolism
emboli from heart:
emboli from arterial,
Myocardial infarct thrombosis
Valve vegetation drop down
Atheromatous plaque with
thrombosis
department of pathology
These emboli may travel to
Brain liquefaction necrosis
Kidney coagulation necrosis
Intestine wet gangrene
Limbs dry gangrene
may be
may be
may be
may be
department of pathology
department of pathology
department of pathology
Ⅱ,fat embolism
Fat embolism usually arises following
some severs trauma with fracture to
long bones.
Fat from the bone marrow is released
into the circulation and comes to lodge
in various organs,
A similar situation arises in severe
burns and in extensive soft tissue
injury.
department of pathology
Ⅲ,air embolism
when involving gas of vessel are
transferred too rapidly from high to
low pressure environments…
decompression sickness
when some vessels is opened to the
air…
neck veins are cut,delivery
department of pathology
Ⅳ,amniotic embolism
With the vastly increased pressures in the
uterus during delivery,the head engages
and the pressure is transferred to the
amniotic fluid which may be forced into
the maternal uterine veins.
These amniotic fluid emboli travel in the
circulation and lodge in the
lungs,causing respiratory distress like
other pulmonary emboli.
department of pathology
amniotic fluid embolism
comprisal
An embolus is a mass of material in the
vascular system able to become lodged
within a vessel and block its lumen
Most emboli are derived from thrombi
Move direction of emboli is consistent
with blood flow
Most common occurrence is pulmonary
embolism from deep leg vein thrombosis
Section 5,infarction
Infarction is ischaemic death of tissue
within the living body.
Only death of tissue due to restricted
blood supply is infarction.
different from toxins or trauma
all are necrosis but are not infarction
department of pathology
1,pathogenesis
(1) thrombosis
(2) artier of embolism
(3) artery spasm
(4) vessels inflow is blocked
department of pathology
2,Gross pathology
(1) infarcted areas are consistent
with vessels distribution
(2) the appearance of infarcted
areas depends upon the time that
infarct occurring
(3) anaemic infarct and
hemorrhagic infarct
department of pathology
department of pathology
Infarction
department of pathology
Infarction of spleen
Infarction of liver
department of pathology
infarction
department of pathology
hemorrhagic (red) infarction
department of pathology
myocardial
infarction
department of pathology
myocardial infarction
In cross section,the point of rupture of the myocardium is
shown with the arrow,
2,Gross pathology
(1) infarcted areas are consistent
with vessels distribution
(2) the appearance of infarcted
areas depends upon the time that
infarct occurring
(3) anaemic infarct and
hemorrhagic infarct
department of pathology
3,histological characteristic
(1) necrosis
(2) ischemic coagulative necrosis
department of pathology
department of pathology
Contraction band
department of pathology
department of pathology
Infarction
Normal <6 hours >24hours several days several
to weeks months
Evolution of an infarction
department of pathology
Hemodynamic amount hyperaemia
ischemia
Intravascular component
appearance mass thrombosis
embolism
Vascular infarct
completion bleeding
permeability edema
caducity
artery
× blood
fluid
Congestion
Thrombosis
Embolism
infarction
department of pathology
