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TISSUE REACTIONS TO INJURY

FLUID AND HEMODYNAMIC DISTURBANCES

Prepared by
Emmanuel R. de la Fuente, M.D.
Objectives
2. Recognize the essential morphology of
important fluid and hemodynamic
changes.
3. Identify and describe these morphologic
changes.
4. Briefly discuss the etiopathogenesis of
these lesions.
5. Correlate these changes with situational
events.
Situation No. 1
A 42 year old woman was suffering from
periodic abdominal pains. She was
diagnosed by ultrasound to have uterine
leiomyomas. A hysterectomy was
performed. The appendix was also removed.
The appendix
prior to its
removal is seen
at the left photo.
Do you see any
lesion?
Describe the
gross and
microscopic
lesions, if any.
Situation no. 2

A 12 year-old body complained of pain and


tenderness in the right iliac region. These
were accompanied by leukocytosis,
predominantly neutrophils, and fever. An
appendectomy was performed.
Appendectomy specimen. Indicate and
describe the lesion. Compare with the previous
appendix in Situation no. 1
Section of the appendix. Indicate and describe the lesions.
Right picture is a higher magnification. How should this
circulatory disturbance be classified? Give basis.
1. Correlate the gross and microscpic features.
2. Briefly discuss the etiopathogenesis of this type
of circulatory disturbance.
3. Correlate this lesion with the situational events.
4. Study the following glass slides and identify this
type of circulatory disturbance:
1) No. GIAP
2) GI – 008
3) GI – 009
Situation no. 3

A 57 year-old hypertensive man suffered a


massive myocardial infarction of the left
ventricle. This was accompanied by
dyspnea caused by acute congestive heart
failure. After a week the patient was in
chronic congestive heart failure.
Three lung lesions showing the different phases of the
expected circulatory disturbance. Indicate the lesions and
describe each. How should these lesions be categorized?

A B C
1. If all three lesions had occurred in the lungs of
the patient, arrange these lesions in chronological
order according to their appearance from the time
of myocardial infarction to that after a week.
Explain.

2. Briefly discuss the pathogenesis of these lesions.

5. Study the following glass slides and identify these


lesions:
1) LU – 010
2) LU – 001B
Situation no. 4

The same man in Situation No. 3 after a


week went into progressive hypotension.
This was accompanied by small amounts of
blood coming out of the nasogastric tube.
Fibrin split products were increased in the
blood. From thereon he went into shock.
Before he died he developed wide areas of
hemorrhage all over the skin.
Gross of skin lesion. Identify and describe. How
will you classify this circulatory disturbance?
Two lesions: A is from the intestine, and B is from the lung.
Indicate and describe the lesions, including the lesion
indicated by the arrow.

A B
Two lesions: A is from the lung, and B is from the kidney.
Identify and describe the lesions indicated by the arrows..

A B
1. How should these lesions be categorized?
2. Briefly discuss the etiopathogenesis of the
lesions, including the biomolecular aspects.
3. Correlate the lesions with the situational events.
4. Study the following glass slide and identify similar
lesions:
1) GI – 038.
Situation no. 5

The same man in situation no. 3 was


autopsied. The heart was markedly
enlarged with gross evidence of extensive
necrosis of the left myocardium.
Dissection of the coronary arteries
discloses severe atherosclerosis with
extensive dystrophic calcification. An
obstruction was noted at the left anterior
descending branch.
Gross heart with affected coronary artery exposed.
Identify and describe the lesions. Low and high
magnifications.
Gross appearance of other areas of affected
coronary artery cut serially. Identify and describe
the lesion.
Microscopic sections from two areas of the affected
coronary artery. Identify and describe the lesions.
1. How should the obstructive lesion be
categorized?
2. Briefly discuss the etiopathogenesis of the
obstructive lesion, including the
biomolecular aspects.
Situation no. 6
A 58 year old woman had been bed ridden
for the past month because of a chronic
illness. A week prior to death, she
experienced swelling of the left lower
extremity accompanied by pain and
tenderness. While going to the bathroom,
she suddenly became dyspneic and then
collapsed and died.
The event that happened to the
woman that caused her sudden
death is illustrated in the next slide.
Discuss this event as illustrated in
the previous slides along the
following areas:
1) Etiopathogenesis
2) Morphologic lesions
3) Correlate this event with the
sudden death of the woman.
Opened pulmonary artery with thromboembolus
saddling the right and left branches of the artery.
A vertical section through the hilus of the lung
showing the thromboembolus.
A section of the pulmonary artery showing the
thromboembolus. Identify and describe the features of
this lesion and why this is not a post-mortem clot. Higher
magnification of area within the square in the next slide.
The features seen indicate that this is a thrombus and not
a post-mortem clot. Identify and describe the features.
Discuss the pathogenesis.
THE END