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HEMODYNAMIC DISORDERS, THROMBOSIS AND SHOCK. Edema. Fluid Balance Across Capillary Walls Factors Involved. Interstitial Fluid. Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7 th ed., Saunders, Philadelphia, 2003. Edema - Pathogenesis. Edema. Edema: Lymphatic Obstruction.

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fluid balance across capillary walls factors involved
Fluid Balance Across Capillary WallsFactors Involved

Interstitial Fluid

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.

slide26

Microscopically, the nutmeg pattern results from congestion around the central veins, as seen here. This is usually due to a "right sided" heart failure.

congested liver passive nutmeg liver right heart failure
Congested Liver (Passive) = Nutmeg LiverRight Heart Failure

Photo: Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.; Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.

slide31
Here are petechial hemorrhages seen on the epicardium of the heart. Petechiae (pinpoint hemorrhages) represent bleeding from small vessels and are classically found when a coagulopathy is due to a low platelet count. They can also appear following sudden hypoxia.
slide32
The blotchy areas of hemorrhage in the skin are called ecchymoses (singular ecchymosis), or also as areas of purpura. Ecchymoses are larger than petechiae. They can appear with coagulation disorders.
intracerebral hemorrhage
Intracerebral Hemorrhage

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.

thrombus morphology
Arterial

Arise in arteries

Grow in retrograde fashion (towards the heart- away from the direction of flow)

Forms at site of Endothelial injury (AS), turbulence (aneurysms)

Pale/ white

Lines of Zahn

Firmly adherent to vessel wall

From emboli  Cause infarctions (lower extremities – 75%, Brain, Kidney, spleen)

Venous

Arise in deep veins and superficial veins (popleteal  Femoral Iliac),

Antigrade (towards the heart- direction of flow)

At site of stasis (lower extremities)

Red / dark

No lines of Zahn

Loosely attached (easily embolize)

Emboli cause Pulmonary embolism ( silent in 50% of pts.)

Thrombus - Morphology
slide41
These are "lines of Zahn" which are the alternating pale pink bands of platelets with fibrin and red bands of RBC's forming a true thrombus.
thrombotic vegetations mitral valve
Thrombotic VegetationsMitral Valve

Photo: Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.

mural thrombus over myocardial infarction
Mural ThrombusOver Myocardial Infarction

Photo: Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.

thrombosis outcomes
ThrombosisOutcomes

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.

embolization embolus thromboembolism of pulmonary artery
Embolization (Embolus)Thromboembolism of Pulmonary Artery

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003; . Stevens A, Lowe J. Slide atlas of pathology. Mosby, London, 1995.

bone marrow embolus in pulmonary vessel
Bone Marrow EmbolusIn Pulmonary Vessel

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.

infarction infarct lung left spleen right
Infarction (Infarct)Lung (Left); Spleen (Right)

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.

kidney infarction replaced by fibrotic scar left
Kidney InfarctionReplaced by Fibrotic Scar (Left)

Photo: Kumar, Cotran, Robbins. Robbins Basic pathology, 7th ed., Saunders, Philadelphia, 2003.