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Circulatory Disorders

Oedema

Circulatory Disorders

Abnormal and excessive


accumulation of fluid in
intercellular
space(interstitial tissue) and
serous cavities

Circulatory Disorders

Edema:

Two major types


Inflammatory
Non inflammatory - changes in
haemodynamic forces

Normal
Microcirculation

Capillary
Arterial
Hydrostatic Pressure + 35
Oncotic Pressure
- 25
Net filtration Pressure + 10 mmHg
(leak-out)
Lymph vessels

Circulatory Disorders

Venous
+ 15
- 25
- 9 mm Hg
(Reabsorb)

Circulatory Disorders

Edema mechanism:

Leaky vessels (Increased


capillary permeability)
Increased capillary hydrostatic
pressure
Decreased Osmotic pressure
Lymphatic obstruction
Increased tissue oncotic pressure
Decreased tissue tension
Sodium and water retension

Circulatory Disorders

Oedema fluid

Exudate

Transudate

Circulatory Disorders

Sites of accumulation

Localized subcutaneous tissue or


a body cavity
eg ; plueral-hydrothorax
peritoneal cavity-ascites
pericardial cavity-pericardial
effusion
Generalized-Subcutaneous tissue and
body cavities

Circulatory Disorders

Increased hydrostatic
pressure

Arteriolar dilatation
Venous out flow impairment
Pitting oedema
Local- DVT of lower limb
Acute LVF
Ascites of liver desease (portal HPT)
Postural oedema
Generalized-CCF-dependant

Circulatory Disorders

Decreased oncotic
pressure

Increased loss of albumin


Decreased synthesis
Eg; protein loosing enteropathy
Nephrotic syndrome
Ascites of liver disease

Circulatory Disorders

Tissue factors
Increased vascular permeability
(increased tissue oncotic pressure)
Generalized-systemic infections
poisoning drugs chemicals
Anaphylactic reactions
Anoxia
localized -Inflammation
Loose tissues(tissue pressure)

Circulatory Disorders

Lymphatic obstruction

Localized
Eg; Filariasis
Breast carcinoma
Pressure on thoracic duct
Non pitting oedema

Circulatory Disorders

Sodium and water


retention

Oedema of cardiac failure


Oedema of renal disease
Ascites of liver disease

Circulatory Disorders

Congestive cardiac failure

CVP

COP

Chronic hypoxia

hypovolaemia
capillary permeability

Hydrostatic
pressure

extra renal

mechanisms

GFR

ADH

Renal retention of Na Water


cardiac oedema

Circulatory Disorders

Excercise

Pathogenesis of oedema in
cirrhosis

Circulatory Disorders

Shock:

A clinical statecharacterized by
generalized decrease in tissue
perfusion due to decrease in
effective cardiac output

Circulatory Disorders

Hypoperfusion of tissue
Reduced blood volume
Reduced cardiac out put
Redistribution of blood
Leading to inadequate effective
circulatory volume

Circulatory Disorders

Three major types

Cardiogenic shock
Hypovolaemic shock
Septic shock
Rare types
Neurogenic shock
Anaphylactic shock

Circulatory Disorders

Cardiogenic shock

Myocardial infarction
Rupture of heart
Rhythm diturbences
Out Flow obstruction-Pulmonary
embolism
Mechanism failure of myocardial
pump

Circulatory Disorders

Hypovolaemic shock

Haemorrhage
Fluid loss/vomiting,diarrhoea,burns

Inadequate blood/plasma volume

Circulatory Disorders

Septic shock

Overwelming bacterial infection


Gram (-)
Endotoxic shock
Gram (+)
Peripheral vasodilation
Pooling of
blood
Endothelial injury
DIC
Rare types-Neurojenic
,anaphylactic

Circulatory Disorders

Neurogenic shock
anaesthetic accidents
Spinal cord injuries
massive peripheral vasodilatation
Anaphylactic shock
Generalized type 1
hypersensitivity

Circulatory Disorders

Stages of shock

Non progressive
Progressive
-Reversible
-Irreversible

Circulatory Disorders

Non Progressive
-Compensatory mechanisms
-Vital organs
preserved
Eg: Blood loss-early shock
cardiac output & blood pressure
maintained
Heart brain not affected

Circulatory Disorders

Produces- pulse
-peripheral vasoconstriction-pale
,cool
-Fluid conservation-kidney

Rx

best response

Circulatory Disorders

Uncorrected -progressive

Vital organs

hypoxia

anaerobic
metabolism

Lactic acidosis
peripheral vasodialation

DIC

endothelial damage

Circulatory Disorders

Brain
Kidney

confused
UOP

Irreversible
Kidney
total anuria
Brain injury
Myocardial failure

Circulatory Disorders

Morphological changesCharacterized by hypoxic


failure of multiple organ
systems
Heart-Focal necrosis(Zonal
lesions)/subendocardial
haemorrhages

Circulatory Disorders

Brain Ischaemic enchephalopathy


boundary zone infarcts
Lungs-Shock lung
ARDS(Acute Respiratory
Distress
Syndrome)
Kidney- Acute tubular necrosis
GIT-Haemorrhages
Liver-fatty change,central
haemorrhagic necrosis
Adrenals-depletion of cortico lipids
haemorrhages/necrosis

Circulatory Disorders

Shock Featurs:

Hypotension
Tachycardia
Cold clammy skin
Rapid shallow respiration.
Drowsiness, confusion, irritability
Multi organ failure.

Circulatory Disorders

Exercise

Discuss the pathogenesis of septic


shock