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General Pathology

General Pathology. Circulation Disorders - II Manifestations & Causes of Local Circulatory Disturbances. Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague. Manifestations of Local Circulatory Disturbances. local hyperemia local anemia LOCAL ISCHEMIA.

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General Pathology

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  1. General Pathology Circulation Disorders - II Manifestations & Causes of Local Circulatory Disturbances Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

  2. Manifestations of Local Circulatory Disturbances • local hyperemia • local anemia LOCAL ISCHEMIA

  3. Manifestations of Local Circulatory Disturbances • local hyperemia • active arterial (fluxe) capillary (peristatic) • passive venous (stasis)

  4. Manifestations of Local Circulatory Disturbances • local anemia • slow development – vascular atrophy • fast development – dystrophy , necrosis

  5. Ischemia – stratification of changes • complete necrosis - central part • myomalacia • hyperemia • interstitial leucocyte infiltration – vital reaction • dystrophic steatosis (& glycogenosis) • healthy

  6. Causes of Local Circulatory Disturbances • local anemia stenosis to occlusion of artery • lumen embolism • wall atherosclerosis,thrombosis (spasmus, depositions, inflammations, tumours) • combination of previous • neighbourhood compression

  7. Causes of Local Circulatory Disturbances • local hyperemia active • function • inflammatory vasodilation passive (outflow blocade) • lumen • wall • neighbourhood

  8. Thrombosis Def.: intravital intravascular blood clotting Range: parietal obturative

  9. Haemostasis • Endotheliumdamage – vWF secretion • Thrombocytesadhesion & aggregation • Thrombocytes secretion • serotonin, PDGF, thromboxan A2vasoconstriction • fibronectin, vWF, fibrinogen aggregation • Plasma factors - proteins synthesized in hct, (vit. K dependence) cascade activation

  10. postmortem autolysis protein activation thrombin liberation no platelet thrombus fibrinogen - fibrin non adherent elastic intravital platelet based adherent to the vessel wall friable /crumbly Coagulum x Thrombus

  11. Types of Thrombi • red stagnation • white fluxe • mixed • hyaline

  12. Thrombosis - causes • blood stagnation • endothelium damage • blood composition changes

  13. Thrombosis - causes • blood stagnation • heart failure • vein insufficiency • local factors (compression) laminar flow disturbance

  14. Thrombosis - causes • endothelium damage • atherosclerosis • inflammation • injury • hemodynamic stress • high cholesterol levels

  15. Thrombosis - causes • blood composition changes • increased platelet number (over 400 000/mm3) • thromboplastin liberation (e.g. following pancreas and lung surgery) • endotoxin - DIC • amniotic fluid embolism • contraceptives……

  16. inborn mutations with increased levels of thrombocytes or lack of anticoag. proteins acquired pregnancy contraceptives disseminated neoplasms atrial flutter arteficial valves surgery……. Hypercoagulation

  17. Thrombus development • no • lysis • organisation(decoloration, recanalization, hyalinization, dystrophic calcification - phlebolith) • lysis + organisation • embolism • puriform softening • infection

  18. Natural Anticoagulant Systems • Antithrombins– e.g.antithrombin III inhibits fcts IXa,Xa,XIa,XIIa • Proteins C, S (vit K dependent) – inh. fcts Va, VIIIa • Plasminogene – plasmin system fibrin breakdown

  19. Embolism Def.: transport of a compact particle in circulation with stopping in the place of anatomic narrowing

  20. Emboli – Types • thrombotic • fat • air • amniotic fluid • cellular (neoplastic, bacterial trophoblastic) • foreign body

  21. Embolism – Fate THROMBOTIC • no • organisation • lysis , resorption • progression • fat • air • amniotic fluid life threatening

  22. Embolism – Fate CELLULAR • lysis trophoblastic • progression neoplastic METASTASES bacterial metastatic sepsis

  23. Caisson Disease (Decompression thickness – gas microembolism) • divers • underwater construction workers • unpressurized aircraft in high altitudes life threatening

  24. Factors Influencing Vessel Occlusion Result • anatomy • time • tissue/organ sensitivity to hypoxy • functional status • general circulation status • MEDICAL INTERVENTION

  25. Haemorrhagia Def.: blood extravasation (and the presence of blood in the tissue)

  26. Localisation: external internal Source: arterial capillary venous Hemorrhage – Classification

  27. Haemorrhagia per rhexin (trauma – tear of the vessel wall) per diabrosin (arosion – ulcus, neoplasm) per diapedesin (increased vessel permeability- leakage) Hemorrhage - pathogenesis

  28. Haemostasis • Endotheliumdamage – vWF secretion • Thrombocytesadhesion & aggregation • Thsecretion • serotonin, PDGF, thromboxan A2vasoconstriction • fibronectin, vWF, fibrinogen aggregation • Plasma factors - proteins synthesized in hct, (vit. K dependence) cascade activation

  29. Hemorrhagic Statuses Thrombocytopaties thrombocytopenia, thrombasthenia Coagulopaties hemofilia, hypoprothrombinemia, afibrinogenemia, Vasculopaties scurvy, m. Osler, m. Schönlein – Henoch

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