Hemodynamic Disorders . Edema , Effusion , Hyperemia Congestion.pptx Dr. Abhinav Golla , Associate Professor , Lab Director & Consultant Pathologist . Aadhya Medicure Pathlabs .

hemodynamic disorders

1. Hemodynamic Disorders Edema & Effusion . Hyperemia & Congestion . Dr . Abhinav Golla MBBS  . MD Pathology Associate Professor. Lab Director & Consultant Pathologist Aadhya Medicure Pathlabs .

2. Introduction to Hemodynamics Definition : The study of blood flow and its forces within the circulatory system. Importance : Key to understanding cardiovascular function, perfusion, and pathological states. Components : Blood pressure, cardiac output, vascular resistance.

3. Key Principles of Hemodynamics Blood Pressure (BP): Force exerted by circulating blood on vessel walls. Systolic vs Diastolic Pressure Cardiac Output (CO): Volume of blood the heart pumps per minute. Stroke Volume × Heart Rate Vascular Resistance: Opposition to blood flow within vessels. Affected by vessel diameter, blood viscosity.

4. Hemodynamic Regulation Mechanisms Neural Control: Baroreceptors, chemoreceptors, sympathetic/parasympathetic nervous systems. Hormonal Control: Renin-Angiotensin-Aldosterone System (RAAS), Antidiuretic Hormone (ADH). Local Factors: Autoregulation, endothelial factors (nitric oxide, endothelin).

5. Hydrostatic Pressure What it is: The pressure that pushes fluid out of the blood vessels into surrounding tissues. How it works: It’s like water being pushed out of a hose. In your body, this force comes from the pumping action of your heart . Where it happens: Higher at the arterial end of capillaries (blood vessels) and lower at the venous end . Role: Helps deliver nutrients and oxygen to tissues by pushing fluid out of the blood.

6. Example of problems hydrostatic pressure : Heart failure : Increases hydrostatic pressure, leading to edema (swelling) because too much fluid leaks into the tissues.

7. Oncotic Pressure (Colloid Osmotic Pressure) What it is: The pressure that pulls fluid back into the blood vessels . How it works: Proteins, mainly albumin , in your blood act like sponges, pulling fluid back into the capillaries from the tissues . Where it happens: Stronger at the venous end of capillaries, where it helps to reabsorb the fluid that was pushed out earlier. Role: Keeps fluid inside the blood vessels, preventing too much fluid from leaking out.

8. Example of problems Oncotic Pressure Liver disease or malnutrition : Reduces the amount of proteins in the blood, decreasing oncotic pressure and leading to swelling or edema .

9. Balance Between the Two: Hydrostatic pressure pushes fluid out of blood vessels. Oncotic pressure pulls fluid back into blood vessels. When these are balanced, fluid moves in and out normally. If there’s too much pushing (hydrostatic) or not enough pulling (oncotic), it leads to fluid buildup (edema) in tissues.

10. Transudate Definition: A fluid with low protein content and few cells. Cause: Caused by an imbalance in hydrostatic or oncotic pressure, without inflammation. Common Conditions: Heart failure : Increased hydrostatic pressure. Liver disease (cirrhosis): Low protein levels (low oncotic pressure). Appearance: Clear, watery. Protein Content: Low (< 3 g/dL). Specific Gravity: Low (< 1.012).

11. Exudate Definition: A fluid with high protein content and many cells, typically due to inflammation. Cause: Caused by increased vascular permeability (capillaries become "leaky") due to inflammation, infection, or injury . Common Conditions: Infections (e.g., pneumonia). Cancer or inflammatory conditions (e.g., pleuritis). Appearance: Cloudy, thick. Protein Content: High (> 3 g/dL). Specific Gravity: High (> 1.020).

12. EDEMA May be: INFLAMMATORY NON - INFLAMMATORY

13. EDEMA Disorders that upset  Cardiovasular   Renal  Hepatic . Are often Marked by accumulation of fluid in Tissues ( EDEMA ) In body cavities are called as ( EFFUSSIONS )

14. INFLAMMATORY EDEMA Caused by  Inflammatory Mediators . These fluids are PROTEIN RICH (EXUDATES) . Accumulates due to  INCREASE IN VASULAR PERMEABILITY. Usually Inflammatory Associated edema is localized to one or few tissues.

15. NON INFLAMMATORY EDEMA Common in many diseases Seen in severe Nutritional disorders  PROTEIN POOR FLUIDS (TRANSUDATES)

16. 1. Peripheral Edema Location: Legs, feet, arms, and hands. Causes: Venous insufficiency ( poor blood flow in the veins ). Congestive heart failure (fluid retention due to poor heart function). Kidney disease (inability to remove excess fluid). Lymphatic obstruction (lymphedema). Symptoms: Swelling of the limbs, often more noticeable in the lower legs and ankles.

17. 2. Pulmonary Edema Location: Lungs. Causes: Heart failure ( especially left-sided heart failure ). Acute respiratory distress syndrome (ARDS) . Inhalation of toxins or severe infections. High altitude pulmonary edema (HAPE). Symptoms: Shortness of breath, difficulty breathing, coughing up pink frothy fluid, wheezing

18. 3. Cerebral Edema Location: Brain. Causes: Trauma (head injury). Stroke (ischemic or hemorrhagic). Infections (e.g., meningitis, encephalitis). Brain tumors or toxins (e.g., hyponatremia, toxins like alcohol). Symptoms: Headache, confusion, seizures, unconsciousness, coma.

19. 4. Macular Edema Location: Retina of the eye ( specifically in the macula, responsible for central vision). Causes: Diabetic retinopathy (common in people with diabetes). Retinal vein occlusion . Eye surgery or inflammation (e.g., uveitis). Symptoms: Blurred or wavy vision, color changes, dark spots in the visual field.

20. 5. Lymphedema Location: Arms or legs. Causes: Lymphatic system damage or blockage (e.g., after surgery, radiation, or cancer treatment ). Congenital lymphedema (present at birth). Symptoms: Persistent swelling, heaviness in the affected limb, skin thickening.

21. 6. Angioedema Location: Deep layers of the skin and mucous membranes ( commonly in the face, throat, and genitals ). Causes: Allergic reactions (e.g., food, insect bites, medications). Hereditary angioedema (a genetic condition). Drug reactions (ACE inhibitors). Symptoms: Rapid swelling of the skin, difficulty breathing if it affects the airways, swelling around the eyes and lips.

22. 7. Pitting Edema Location: lower legs and ankles. Causes: Congestive heart failure , kidney disease , liver disease , or deep vein thrombosis (DVT). Symptoms: When you press on the swollen area, a "pit" or indentation remains for a few seconds.

23. 8. Non-Pitting Edema Location: legs and arms. Causes: Lymphedema or thyroid disorders (e.g., hypothyroidism, myxedema). Symptoms: When you press on the swollen area, no indentation forms.

24. 9. Generalized Edema (Anasarca) Location: All over the body. Causes: Heart failure , kidney failure , liver failure (e.g., cirrhosis). Severe protein deficiency (e.g., nephrotic syndrome or malnutrition). Symptoms: Swelling all over the body, weight gain, difficulty breathing.

25. 10. Localized Edema Location: In a specific area of the body (e.g., after injury, surgery, or infection). Causes: Trauma (e.g., sprains, fractures). Infection or inflammation (e.g., cellulitis). Insect bites or allergies . Symptoms: Swelling, redness, pain, warmth around the affected area.

26. Key Distinctions: Pitting vs. Non-pitting Edema: Pitting edema leaves an indentation when pressed, while non-pitting edema does not. Localized vs. Generalized Edema: Localized edema affects specific areas, while generalized edema (anasarca) affects the whole body.

27. EFFUSIONS Effusion refers to the abnormal accumulation of fluid in body cavities , often as a result of disease. The fluid can be classified as either transudate or exudate , depending on the underlying cause.

28. 1. Pleural Effusion Location: Between the layers of the pleura (the thin membranes surrounding the lungs). Causes: Transudative : Caused by conditions like heart failure , cirrhosis , or nephrotic syndrome . Exudative : Due to infections (e.g., pneumonia, tuberculosis), malignancies , or pulmonary embolism . Symptoms: Shortness of breath, chest pain, dry cough.

29. 2. Pericardial Effusion Location: In the pericardial cavity (around the heart). Causes: Transudative : Caused by heart failure or hypothyroidism . Exudative : Due to pericarditis , autoimmune diseases (e.g., lupus), or cancer . Symptoms: Chest pain, difficulty breathing, low blood pressure. It can lead to cardiac tamponade (compression of the heart).

30. 3. Peritoneal Effusion (Ascites) Location: In the peritoneal cavity (abdomen). Causes: Transudative : Most commonly caused by liver cirrhosis , heart failure , or kidney disease . Exudative : Due to infections (e.g., peritonitis), cancer , or pancreatitis . Symptoms: Abdominal swelling, pain, difficulty breathing.

31. 4. Joint Effusion (Synovial Effusion) Location: Within the joints (often the knee). Causes: Transudative : Often related to osteoarthritis or trauma. Exudative : Caused by inflammatory conditions like rheumatoid arthritis , gout , or joint infections . Symptoms: Swelling, stiffness, pain, reduced joint movement.

32. 5. Paracentesis Effusion Location: Various, especially abdominal or thoracic cavities . Causes: This term is often used more generally to refer to the accumulation of fluid in spaces from any of the above categories.

33. HYPEREMIA & CONGESTION . Introduction Definition of Hyperemia: Increased blood flow to a tissue. Can be active (physiological) or reactive. Definition of Congestion: Accumulation of blood in a tissue due to impaired venous outflow. Usually pathological.

34. Hyperemia Mechanism: Arterial dilation leading to increased blood flow. Can occur due to increased metabolic demand (e.g., exercise) or inflammation. Types: Active Hyperemia : Increased blood flow due to physiological mechanisms (e.g., exercise, digestion). Reactive Hyperemia : Increased blood flow following a period of ischemia (temporary restriction of blood flow).

35. Examples of Hyperemia Physiological Examples: Exercise: Muscles require more oxygen. Postprandial: Blood flow increases to digestive organs after eating. Pathological Examples: Inflammation: Blood vessels dilate in response to injury or infection, leading to redness and warmth.

36. Congestion Mechanism: Impaired venous return leads to blood accumulation. Often due to obstruction or heart failure . Types: Acute Congestion : Sudden obstruction (e.g., thrombus formation). Chronic Congestion : Long-term conditions (e.g., congestive heart failure).

37. Examples of Congestion Systemic Congestion: Congestive Heart Failure: Blood backs up in the heart and lungs, causing pulmonary congestion. Local Congestion: Deep Vein Thrombosis (DVT): Blood clot obstructs a vein, leading to localized swelling.

38. Histological Differences Hyperemia : Increased arterial blood flow . Vasodilation observed in tissue sections. Congestion : Venous distension and engorgement. Red blood cell accumulation in capillaries. Potential tissue damage due to hypoxia.

39. HYPEREMIA Active process. ( site of inflammation or in skeletal muscle during exercise.) increase blood flow .

40. CONGESTION PASSIVE PROCESS . Results from REDUCED OUTFLOW OF BLOOD FROM TISSUES. COMMOMLY LEADS TO EDEMA.

41. Pulmonary Congestion Causes: Congestive Heart Failure (CHF) Acute Respiratory Distress Syndrome (ARDS) Pulmonary Embolism Terms/Names: Pulmonary Edema: Fluid accumulation in the alveoli. Atelectasis: Collapse of alveoli. "pink, frothy sputum." Morphological Changes: Increased Alveolar Fluid: Lungs appear heavy and congested with fluid. Hyaline Membranes: Seen in ARDS; a result of protein-rich fluid in the alveoli. Heart Failure Cells : Hemosiderin-laden macrophages in the alveolar spaces due to chronic congestion.

42. Hepatic Congestion Causes: Right-sided Heart Failure Portal Hypertension Budd-Chiari Syndrome Terms/Names: Nutmeg Liver : Characteristic appearance due to alternating zones of congestion and normal liver tissue. Ascites: Fluid accumulation in the abdominal cavity. Morphological Changes: Hepatomegaly: Enlarged liver with a dark, congested appearance. Sinusoidal Dilatation: Expansion of the hepatic sinusoids due to increased venous pressure. Fibrosis: Chronic congestion may lead to liver fibrosis or cirrhosis.

43. HEPATIC CONGESTION ACUTE HEPATIC CONGESTION . CENTRAL VEIN & SINUSOIDS ARE DISTENDED. Distal end of the hepatic blood supply (centrilobular area) hepatocytes in this area undergo ischemic necrosis. Periportal hepatocytes may develop  fatty change due to oxygenation from hepatic arterioles.

44. CHRONIC HEPATIC CONGESTION  GROSS Centrilobular are red brown and slightly depressed. Because of cell death . More prominent against the surrounding zones of uncongested tan liver . NUTMEG   LIVER

45. NUTMEG LIVER Microscopically  Centrilobular hemorrhage . Hemosiderin laden macrophages  Variable degree of hepatocytes dropout & necrosis.

46. Renal Congestion Causes: Congestive Heart Failure (CHF) Renal Vein Thrombosis Ureteral Obstruction Terms/Names: Hypoperfusion: Reduced blood flow to the kidneys. Morphological Changes: Swollen Kidneys: Increased size and weight due to fluid retention. Cortical Edema: Fluid accumulation in the renal cortex. Congested Renal Veins: Dilated renal veins observed on gross examination.

47. Cerebral Congestion Causes: Cerebral Venous Thrombosis Heart Failure Intracranial Hemorrhage Terms/Names: Venous Sinus Thrombosis: Thrombus formation in the dural venous sinuses. Morphological Changes: Cerebral Edema: Swelling of brain tissue due to increased fluid. Increased Intracranial Pressure (ICP): Can lead to herniation or brain ischemia. Dilatation of Veins: Enlarged cerebral veins and sinuses.

48. Splenic Congestion Causes: Portal Hypertension Right-sided Heart Failure Splenic Vein Thrombosis Terms/Names: Splenomegaly: Enlargement of the spleen due to congestion. Morphological Changes: Dark Red Appearance: Due to engorged red pulp. Increased Lymphoid Tissue: Hyperplasia of lymphoid follicles in response to congestion. Fibrosis: Chronic congestion may lead to splenic fibrosis.

49. Intestinal Congestion Causes: Mesenteric Ischemia Portal Hypertension Acute Mesenteric Venous Thrombosis Terms/Names: Ischemic Colitis: Inflammation and injury to the colon due to inadequate blood flow. Morphological Changes: Edematous Bowel Wall: Thickened and swollen bowel wall due to fluid accumulation. Hemorrhagic Infarcts: Areas of necrosis with bleeding in severe cases. Mucosal Ulceration: Seen in cases of chronic ischemia.

50. Testicular Congestion Causes: Varicocele Hydrocele Testicular Torsion Terms/Names: Scrotal Edema: Swelling of the scrotum due to fluid accumulation. Morphological Changes: Swollen Testis: Enlargement due to fluid accumulation or venous engorgement. Dilated Pampiniform Plexus: Enlarged veins in the spermatic cord. Testicular Atrophy: Chronic congestion may lead to testicular tissue damage and shrinkage.

51. Edema is the abnormal accumulation of fluid in tissues , categorized as localized or generalized. Effusion refers to fluid accumulation in body cavities , classified as transudate (clear, low protein) or exudate (cloudy, high protein). Hyperemia is an increase in blood flow to tissues due to arteriolar dilation , either from physiological (active) or pathological (passive) causes. Congestion is the accumulation of blood in tissues due to impaired venous outflow , resulting in swelling and discoloration. Causes of edema include increased hydrostatic pressure, decreased oncotic pressure, and lymphatic obstruction.

52. Effusions result from imbalances in pressures, inflammation, or malignancy. Active hyperemia occurs during exercise or inflammation, while passive hyperemia arises from conditions like heart failure. Congestion can be pulmonary (leading to edema), hepatic (causing nutmeg liver), or peripheral (swelling in extremities).