Hemodynamic disorders - DONE Flashcards
Recent brain haemorrhage =
Focus haemorrhagicus cerebri rescens
What does haemorrhage indicate?
haemorrhage generally indicates extravasation of blood due to vessel rupture
Cerebral haemorrhages range from….
small perivascular extravasations to massive haemorrhages causing stroke
What kind of cerebral haemorrhages does arterial hypertention cause?
massive haemorrhages causing stroke
Which vessel is most commonly rupture in cerebral haemorrhage?
arteriae lenticulostriatae - small branches of middle cerebral artery (therefore internal capsule and adjacent basal ganglia are most frequent site of cerebral haemorrhages)
What are most frequent site of cerebral haemorrhages?
internal capsule and adjacent basal ganglia
Recent brain haemorrhage macroscopically?
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
Recent brain haemorrhage histological examination:
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.
Inveterated (old) brain haemorrhage =
haemorrhagic cerebri inveterata
How is the situation of Inveterated (old) brain haemorrhage in the survived patient?
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
What happens with the red cells of the phagocytosed cells?
their heme is transformed into brown hemosiderin
What happens with the cerebral lipids of the phagocytosed cells?
the macrophages accumulate them into the cytoplasm which becomes foamy
What does the destroyed masses in Inveterated (old) brain haemorrhage form?
posapopletic cavern (lacuna postapopletics)
What is posapopletic cavern (lacuna postapopletics)?
- 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
What is a pseudocyst?
pathologic cavity without epithelial lining
Inveterated (old) brain haemorrhage (Microscopical):
the slide reveals the margin of haemorrhagic pseudocyst with haemosiderin-loaded macrophages and free haemosiderin granules derived from ingested erythrocytes
nutmeg liver =
Chronic passive liver congestion
The term „congestion”:
The term „congestion” designates increase in blood volume in dilated vessels.
Passive (venous) congestion results from the impairment of blood outflow from affected area.
What is the passive congestion of the liver is most commonly subsequent to?
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.
What causes the morphological changes as the passive congestion prolongs?
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.
Chronic passive liver congestion (“nutmeg liver”) (Macroscopically):
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
Chronic passive liver congestion (“nutmeg liver”) (Microscopically):
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
Pulmonary brown induration=
Induratio fusca pulmonum
Chronic passive congestion
Wher is Pulmonary brown induration (Induratio fusca pulmonum) most commonly seen:
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.
ch.p.c =
Chronic passive congestion
What does Chronic passive congestion lead to?
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
Pulmonary brown induration (Macroscopically):
Induratio fusca pulmonum/Chronic passive congestion
lungs are brown and firm.
This appearance explains origin of designation „brown induration”
What has „brown induration”?
Pulmonary brown induration:
Induratio fusca pulmonum/Chronic passive congestion
Pulmonary brown induration (Microscopically):
Induratio fusca pulmonum/Chronic passive congestion
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.
What is “heart failure cells”?
There are also intra-alveolar macrophages containing brown hemosiderin granules („heart failure cells” ).
Where does hemosiderin originate from?
Hemosiderin originates from breakdown of haemoglobin derived from ingested red blood cells.
Pulmonary oedema def:
characterized by excessive accumulation of fluid within lungs.
Pulmonary oedema results from:
- hemodynamic disturbances – hemodynamic edema
- increased hydrostatic pressure (pulmonary venous pressure)- COMMON
▪ acute left ventricular failure (left-sided heart failure)
▪ mitral stenosis, - pulmonary vein obstruction, -
overhydration - decreased oncotic pressure
▪ hypoalbuminemia, - liver and renal disease,
- increased hydrostatic pressure (pulmonary venous pressure)- COMMON
- 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
Edema of undetermined origin:
e.g. neurogenic (central nervous system trauma)
Pulmonary oedema (macroscopically):
lungs are enlarged, heavy and pit on pressure. Frothy, blood-tinged, watery fluid can be squeezed from the cut surface
Pulmonary oedema (microscopically):
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.
