Hemodynamic disorders - DONE

Question 1

Recent brain haemorrhage =

Answer 1

Focus haemorrhagicus cerebri rescens

Question 2

What does haemorrhage indicate?

Answer 2

haemorrhage generally indicates extravasation of blood due to vessel rupture

Question 3

Cerebral haemorrhages range from….

Answer 3

small perivascular extravasations to massive haemorrhages causing stroke

Question 4

What kind of cerebral haemorrhages does arterial hypertention cause?

Answer 4

massive haemorrhages causing stroke

Question 5

Which vessel is most commonly rupture in cerebral haemorrhage?

Answer 5

arteriae lenticulostriatae - small branches of middle cerebral artery (therefore internal capsule and adjacent basal ganglia are most frequent site of cerebral haemorrhages)

Question 6

What are most frequent site of cerebral haemorrhages?

Answer 6

internal capsule and adjacent basal ganglia

Question 7

Recent brain haemorrhage macroscopically?

Answer 7

cerebral hemisphere affected with massive haemorrhage is swollen, showing flattening of gyri.

On cut surface one can see a blood clot lacerating brain substance, surrounded by compressed oedematous, soft whiter matter, often with multiple small extravasations

Question 8

Recent brain haemorrhage histological examination:

Answer 8

reveals irregular mass of compactly arranged extravasated erythrocytes with trapped remnants of nervous cells.

This mass has ill defined borders and is surrounded by changed brain of numerous neurones and ganglia cells as well as oedema and vacuolization.

Question 9

Inveterated (old) brain haemorrhage =

Answer 9

haemorrhagic cerebri inveterata

Question 10

How is the situation of Inveterated (old) brain haemorrhage in the survived patient?

Answer 10

In cases of the survival of the patient the blood mixed with necrotic brain mass is removed by macrophages. These cells phagocytize:

• The red cells: their heme is transformed into brown hemosiderin
• cerebral lipids: the macrophages accumulate them into the cytoplasm which becomes foamy

Question 11

What happens with the red cells of the phagocytosed cells?

Answer 11

their heme is transformed into brown hemosiderin

Question 12

What happens with the cerebral lipids of the phagocytosed cells?

Answer 12

the macrophages accumulate them into the cytoplasm which becomes foamy

Question 13

What does the destroyed masses in Inveterated (old) brain haemorrhage form?

Answer 13

posapopletic cavern (lacuna postapopletics)

Question 14

What is posapopletic cavern (lacuna postapopletics)?

Answer 14

• formed by the destroyed masses in posapopletic cavern (lacuna postapopletics)
• fluid-filled PSEUDOCYST (pathologic cavity without epithelial lining) lined with astroglial cells with scattered haemosiderin-laden macrophages

Question 15

What is a pseudocyst?

Answer 15

pathologic cavity without epithelial lining

Question 16

Inveterated (old) brain haemorrhage (Microscopical):

Answer 16

the slide reveals the margin of haemorrhagic pseudocyst with haemosiderin-loaded macrophages and free haemosiderin granules derived from ingested erythrocytes

Question 17

nutmeg liver =

Answer 17

Chronic passive liver congestion

Question 18

The term „congestion”:

Answer 18

The term „congestion” designates increase in blood volume in dilated vessels.

Passive (venous) congestion results from the impairment of blood outflow from affected area.

Question 19

What is the passive congestion of the liver is most commonly subsequent to?

Answer 19

Passive congestion of the liver is most commonly subsequent to the right-sided heart failure, but in some cases to compression or obstruction of inferior vena cava as well as hepatic veins.

Question 20

What causes the morphological changes as the passive congestion prolongs?

Answer 20

As passive congestion prolongs, congested liver develops morphological changes.

They mostly arise from hypoxia of hepatocytes which is caused by decreased oxygen content of blood and reduction of hepatic blood flow.

Question 21

Chronic passive liver congestion (“nutmeg liver”) (Macroscopically):

Answer 21

MA:
liver is often diminished with characteristic two colored, mottled cut surface resembling a cut nutmeg (nutmeg liver).

Lobular pattern is accentuated:
there are dark-red centrilobular areas contrasting with pale, yellowish peripheral zones of lobules

Question 22

Chronic passive liver congestion (“nutmeg liver”) (Microscopically):

Answer 22

centrilobular congestion- the center of all hepatic lobules is highly engorged by blood;
centrilobular hepatocytes may become atrophic or even necrotic due to severe hypoxia of this region;
lobular periphery shows either normal parenchyma or its fatty degeneration hepatocytes filled with fat are round-shaped and appear empty, since lipids are dissolved during routine preparation of the specimen

Question 23

Pulmonary brown induration=

Answer 23

Induratio fusca pulmonum

Chronic passive congestion

Question 24

Wher is Pulmonary brown induration (Induratio fusca pulmonum) most commonly seen:

Answer 24

Chronic passive congestion (ch.p.c) of lungs is most commonly seen in case of long-standing, gradually developing left-sided heart failure or mitral stenosis.

Question 25

ch.p.c =

Answer 25

Chronic passive congestion

Question 26

What does Chronic passive congestion lead to?

Answer 26

Of unclear reasons ch.p.c. leads to fibrosis which is due to the stimulated formation of collagen in the stoma of involved organs. The latter become firmer

Question 27

Pulmonary brown induration (Macroscopically):

Induratio fusca pulmonum/Chronic passive congestion

Answer 27

lungs are brown and firm.

This appearance explains origin of designation „brown induration”

Question 28

What has „brown induration”?

Answer 28

Pulmonary brown induration:

Induratio fusca pulmonum/Chronic passive congestion

Question 29

Pulmonary brown induration (Microscopically):

Induratio fusca pulmonum/Chronic passive congestion

Answer 29

is considerable thickening of interalveolar septa, resulting from: distension of capillaries, which are packed with erythrocytes, from edema and fibrosis.

Numerous erythrocytes can be seen in alveolar spaces because of extravasations from congested capillarie and venules.

• There are also intra-alveolar macrophages containing brown hemosiderin granules („ heart failure cells” ).
• Hemosiderin originates from breakdown of haemoglobin derived from ingested red blood cells.
• Deposition of hemosiderin appears also in interstitial pulmonary tissue.

Question 30

What is “heart failure cells”?

Answer 30

There are also intra-alveolar macrophages containing brown hemosiderin granules („heart failure cells” ).

Question 31

Where does hemosiderin originate from?

Answer 31

Hemosiderin originates from breakdown of haemoglobin derived from ingested red blood cells.

Question 32

Pulmonary oedema def:

Answer 32

characterized by excessive accumulation of fluid within lungs.

Question 33

Pulmonary oedema results from:

Answer 33

• hemodynamic disturbances – hemodynamic edema
  
  1. increased hydrostatic pressure (pulmonary venous pressure)- COMMON
     ▪ acute left ventricular failure (left-sided heart failure)
     ▪ mitral stenosis, - pulmonary vein obstruction, -
     overhydration
  2. decreased oncotic pressure
     ▪ hypoalbuminemia, - liver and renal disease,
• direct increases in capillary permeability - edema due to microvascular injury (alveolar injury)
  ▪ infections: pneumonia
  ▪ inhaled gases: oxygen, smoke
  ▪ liquid aspiration: gastric contents
  ▪ drugs and chemicals, e.g. bleomycin, heroin

Question 34

Edema of undetermined origin:

Answer 34

e.g. neurogenic (central nervous system trauma)

Question 35

Pulmonary oedema (macroscopically):

Answer 35

lungs are enlarged, heavy and pit on pressure. Frothy, blood-tinged, watery fluid can be squeezed from the cut surface

Question 36

Pulmonary oedema (microscopically):

Answer 36

Alveolar septa show congested capillarie whereas alveolar spaces are filled with eosin staining material (transudate containing protein, precipituated during fixation).

Some scattered red blood cells, hemosiderin-laden macrophages can be seen in alveolar lumina.

Occasionaly, empty round spaces are present within intraalveolar fluid.

They represent air bubbles which reflect frothing of edema fluid which is evident grossly.