Edema, congestion and hemorrage

seminar in pathology

1. Edema

2. General Approximately 60% of lean body weight is water Two thirds of which is intracellular and one third is extracellular. Extracellular is further divided into intravascular , interstitial and trans vascular

3. Normal Fluid Circulation

4. HPc = hydrostatic pressure of the capillary OPc = osmotic pressure of the capillary venular arteriolar Capillary

5. What is Edema?

6. Edema

7. Edema is the result of the movement of fluid from the vasculature into the interstitial spaces; the fluid may be protein-poor (transudate) or protein-rich (exudate). Edema may be caused by: increased hydrostatic pressure (e.g., heart failure) increased vascular permeability (e.g., inflammation) decreased colloid osmotic pressure, due to reduced plasma albumin • decreased synthesis (e.g., liver disease, protein malnutrition ) • Increased loss (e.g., nephrotic syndrome) lymphatic obstruction (e.g., inflammation or neoplasia). sodium retention ( e.g ., renal failure )

8. Treatment When possible, treatment involves resolving the underlying cause. Treatment may also involve positioning the affected body parts to improve drainage. For example, swelling in feet or ankles may be reduced by having the person lie down in bed or sit with the feet propped up on cushions. Intermittent pneumatic compression can be used to pressurize tissue in a limb, forcing fluids – both blood and lymph – to flow out of the pressurized area. Treatment of persistent edemas, such as idiopathic bilateral lymphedema, may also use manual lymphatic drainage, a low-pressure massage technique designed to pump lymphatic fluid by a similar mechanism

9. CONGESTION Hyperemia and Hyperemia and congestion both refer to an increase in blood volume within a tissue but they have different underlying mechanisms.

10. HEMORRAHGE Is escape of blood from a blood vessel bleeding may occur externally or internally into serious cavities (e.g hemothorax- hemoperitonium- hemopericardium ) or it’s called revealed hemorrhage which starts internal The reveals it self e.g. vomiting blood This form of blood loss can be large and sudden ( Acute ) Or small repeated amount of blood loss over a period of time ( Chronic )

11. Causes of Hemorrhage Trauma to vessel wall – penetrating wound. Spontaneous Hemorrhage – Rapture of aneurysm, acute anemia, scurvy. Inflammatory lesion of vessel wall – Bleeding from chronic peptic ulcer, polyarteritis nodosa. Neoplastic invasion – following vascular invasion in carcinoma (of tongue). Vascular Diseases – Atherosclerosis. Elevated pressure within vessels – Retinal hemorrhage in systemic hypertension.

12. Types of hemorrhage Arterial Venous Capillary

13. Arterial hemorrhage Bright red Emitted as spurting jet which rises and falls in time with the pulse. Can lead to severe blood loss Blood becomes watery if too much fluids given in protracted bleed.

14. Venous hemorrhage Darker red Steady and copious flow Color becomes further darker with oxygen desaturation Bleed from jugular, femoral, portal veins and esophageal varices is fatal if not controlled

15. Capillary hemorrhage Bright red Rapid and oozing Blood loss becomes serious if continues for hours Common in haemophiliacs .

16. Types of hemorrhage Primary Reactionary Secondary

17. Primary hemorrhage Occurs at the time of injury or operation. Cause is injury to vessels. May be arterial, venous or capillary. More common in surgery on malignancies.

18. Reactionary hemorrhage Bleeding within 24 hours ( usually 4-6 hrs ) of primary hemorrhage Cause is slipping of ligature, dislodgement of clot or cessation of reflex vasospasm Bleed starts when there is a rise in the arterial or venous pressure.

19. Secondary hemorrhage Occurs after 7-14 days of primary hemorrhage Cause is sloughing of vessel due to infection 1 st a warning stain followed by a sudden severe bleed Common after hemorrhoids surgery, GI surgery & amputations.

20. Cutaneous H emorrhage Petechiae : A tiny, purplish-red spot on the  skin(1 to 2 mm in diameter).  Caused by the leakage of a bit of blood out of a vessel and  into  the  skin, mucous membranes, or serosal surfaces Causes: Physical trauma (coughing, sunburn) Non-infectious agents low platelet counts (thrombocytopenia) defective platelet function and loss of vascular wall support, as in vitamin C deficiency Infectious agents Typhus

21. 2. Purpura: a small hemorrhage in the skin, mucous membrane, or  serosal  surface . Slightly larger than petechiae (3-5 mm in diameter)  The color is first red, gradually darkens to purple, fades to  a brownish  yellow, and usually disappears in 2-3  weeks Causes: can result from the same disorders that cause petechiae , as well as trauma vascular inflammation ( vasculitis ) increased vascular fragility.

22. 3. Ecchymoses : bluish  discoloration of an area of skin or mucous membrane caused by the extravasation of blood into  the subcutaneous tissues  as a result of trauma to the underlying blood vessels or fragility of the vessel walls. Also called  bruise . (1-2 cm) The characteristic color changes of a bruise are due to the enzymatic conversion of H emoglobin (red - blue color) Bilirubin (blue-green color ) Hemosiderin (golden-brown ).

23. C linical significance of hemorrhage The clinical significance of any particular hemorrhage depends on the volume of blood lost and the rate of bleeding . Loss of 20% of blood volume = little clinical effect due to compensatory mechanism Sudden loss of 33% of blood volume may cause death 50% loss of blood volume over longer period of time (24 hours) may not be fatal However chronic blood loss generally produce iron deficiency anaemia , where as acute hemorrhage may lead immediate consequences like HYPOVOLMIC SHOCK