prezentacja programu powerpoint · •polyps or cancer (e.g. adenocarcinoma) 1. terminology of...
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LECTURE 6
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HEMORRHAGE
• It is a blood escaping from the circulatory
system
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HEMORRHAGE
HAEMORRHAGIA EXTERNA
DIRECT INDIRECT
(VULNUS) (ESOPHAGEAL VARICES)
INTERNAL HEMORRHAGE
(FROM HEART) -
HEMOPERICARDIUM
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VARICES
• Dilated tortuous vessels, usually
submucosal, that develop due to portal
hypertension (prolonged or severe),
which induces formation of collaterals
between portal and caval systems
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VARICES
• Collaterals in lower esophagus divert
flow from portal vein, through coronary
veins of stomach, into esophageal veins,
then azygous veins, then into vena cava
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VARICES
in the lower esophagus (which has been turned inside out at
autopsy) are linear dark blue submucosal dilated veins known
as varices: in patients with portal hypertension
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ORIGIN OF HEMORRHAGES
HEMORRHAGE FROM HEART
ARTERIAL HEMORRHAGE
VENOUS HEMORRHAGE-varices
PARENCHYMATOUS HEMORRHAGE
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MECHANISMS OF HEMORRHAGES
HEMORRHAGIA PER RHEXIN -
RUPTURE
HEMORRHAGIA PER DIABROSIN
- ARROSION
HEMORRHAGIA PER DIAPEDESIN
- DIAPEDESIS
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CLASSIFICATION OF HEMORRHAGES
WITH REGARD TO THE MECHANISM
• 1. TRAUMATIC HEMORRHAGES
• 2. SPONTANEOUS HEMORRHAGES
• A. PER RHEXIN (RUPTURE)
• B. PER DIABROSIN (ARROSION)
• C. PER DIAPEDESIN (DIAPEDESIS)
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TYPES OF HEMORRHAGIC CHANGES
A.
B.
D.
C.
A. PETECHIA (SKIN)
C. PETECHIA (BRAIN)
B. and D.
PURPURA
SIZE
1-5 mm
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HEMORRHAGIC SUGGILLATIONS
EPICARDIAL
BRUISE
BRUISE UNDER
EPICARDIUM –
OFTEN AS A
RESULT OF A
DAMAGE OF
BRAIN STEM
SKIN BRUISE
A BRUISE IS THE
EXTRAVASATION OF BLOOD TO
SURROUNDING INTACT TISSUES
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ECCHYMOSIS
Ecchymosis is the medical
term for a bruise that
measures over one
centimeter in diameter
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HEMATOMA
A. B.
C.
A. CEREBRAL HEMATOMA
B. EPIDURAL HEMATOMA
C. HEMATOMA (MICROSCOPY)
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INTRACEREBRAL HEMORRHAGE
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INTRACEREBRAL HEMORRHAGE
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MOST IMPORTANT
TYPES OF
HEMORRHAGE
Metrorrhagia –
pathological
Menorrhagia –
pathological
(profuse menses)
Menorrhea = Menses –
physiological
Hematochezia – fresh
blood in stool
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HEMATOCHEZIA• Possible causes of blood in stool include:
• Diverticular disease
• Anal fissures
• Colitis
• Angiodysplasia: condition in which fragile,
abnormal blood vessels lead to bleeding
• Non-cancer ulcers
• Polyps or cancer (e.g. adenocarcinoma)
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1. TERMINOLOGY OF HEMORRHAGES
A HEMORRHAGE WITHIN ORGAN = ORGAN NAME + ENDING
„RRHAGIA” (ENGLISH: „RRHAGE”)
PNEUMORRHAGIA
BRONCHORRHAGIA
GASTRORRHAGIA
ENTERORRHAGIA
COLORRHAGIA
METRORRHAGIA
MENORRHAGIA
UROCYSTORRHAGIA
ESOPHAGORRHAGIA
IEIUNORRHAGIA
ILEORRHAGIA
DUODENORRHAGIA
PYELORRHAGIA
URETERORRHAGIA
ETC
BLEEDING FROM THE NOSE - EPISTAXIS
MENSTRUAL BLEEDING - MENORRHEA
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2. TERMINOLOGY
HEMO/HEMATO AND THE NAME OF AN ORGAN
HEMOCEPHALUS
HEMOTHORAX
HEMOPERICARDIUM
HEMASCOS
HEMATOSALPINX
HEMATOMETRA
HEMATOCOLPOS
HEMATURIA
HEMOPTOE
MELENA (SEDES CRUENTES)
HEMATEMESIS
MENORRHEA
PURPURA
EPISTAXISHEMOTHORAX HEMOPERICARDIUM
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WHAT IS EDEMA ?
• abnormal accumulation of fluid in the
interstitium, located beneath the skin
and/or in the cavities of the body
• Latin: oedema
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PATHOMECHANISM OF EDEMA
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VENOSTATIC EDEMA
ANASARCA (SUBCUTANEOUS
TISSUE)
ASCITES
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HAEMORRHAGIA EX CORDE
RENAL EDEMA
EDEMA BEFORE AND AFTER TREATMENT
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HUNGER EDEMA (MARANTIC EDEMA)
EDEMA CAUSED BY DEFICIENCY IN PROTEINS BECAUSE OF THE LACK OF FOOD OR
IN CANCER PATIENTS
HEPATIC EDEMA CAUSED BY DEFICIENCY IN ALBUMIN IN CASE
OF LIVER DAMAGE
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edema occurring in diseases characterized
by wasting and hypoproteinemia; due to
low plasma oncotic pressure.
HUNGER EDEMA (MARANTIC EDEMA,
CACHECTIC EDEMA)
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TOXIC EDEMA
RESULT OF WAR GASES: CHLORINE, MUSTARD GAS, ETC.
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ANGIONEUROTIC EDEMA
BEFORE AND AFTER ADMINISTRATION OF ANTIHISTAMINE
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Angioneurotic edema, hereditary: A genetic form of
angioedema which is also referred to as Quinke's disease.
Persons with it are born lacking an inhibitor protein (called
C1 esterase inhibitor) that normally prevents activation of
a cascade of proteins leading to the swelling of
angioedema.
Patients can develop recurrent attacks of swollen tissues,
pain in the abdomen, and swelling of the voice box
(larynx) which can compromise breathing → death.
The diagnosis is suspected with a history of recurrent
angioedema.
It is confirmed by finding abnormally low levels of C1
esterase inhibitor in the blood. Treatment options include
antihistamines and male steroids (androgens) that can also
prevent the recurrent attacks.
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MOST IMPORTANT
CLINICAL FORMS OF
EDEMA
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EDEMA
THE LARYNX IN A CHILD DIFFERS
FROM LARYNX IN ADULT
PERSON – IT EASILY BECOMES
SWOLLEN
1. IT IS SLIMMER
2. EPIGLOTTIS IS NARROW
3. IT CONTAINS A SIGNIFICANTLY
LARGER AMOUNTS OF
FIBROUS TISSUE, WHICH
EASILY AND QUICKLY
INCREASES ITS VOLUME
4. ELASTIC STRUCTURE.
CONNECTIONS BETWEEN
CARTILAGES ARE ALSO
ELASTIC
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BRAIN EDEMA
COLLATERAL EDEMACEREBELLAR TONSILS
HERNIATION
HERNIATION occurs when brain tissue, blood, and
cerebrospinal fluid (CSF) shifts from their normal
position inside the skull
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There are three main types of brain herniation
subfalcine: brain moves underneath the falx cerebri in the middle
of the brain. Brain tissue ends up being pushed across to the other
side. The most common type of brain herniation.
transtentorial herniation, two types:
1. descending transtentorial or uncal. The uncus, part of the
temporal lobe, is shifted downward into an area known as the
posterior fossa. This is the second most common type of brain
herniation.
2. ascending transtentorial herniation. The cerebellum and the
brainstem move upward through a notch in a membrane called
the tentorium cerebelli.
cerebellar tonsillar: tonsils move downward through the foramen
magnum, where the spinal cord connects to the brain.
A brain herniation can also occur through a hole that was created
previously during surgery.
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PULMONARY EDEMA
FOAMY DISCHARGE SEEN
DURING AUTOPSYTRANSUDATE IN LUMEN OF
VESICLES
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LYMPHEDEMA - LYMPHATIC EDEMA
ELEPHANTIASIS: DURING FILARIASIS –
OBSTRUCTION OF LYMPH
NODES/VESSELS BY PARASITES
LYMPHEDEMA – AFTER A
RADICAL OPERATION ON
BREAST WITH REMOVAL OF
LYMPH NODES
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SHOCK
TYPE OF SHOCK CLINICAL EXAMPLES MAIN MECHANISMS
CARDIOGENIC
MYOCARDIAL
INFARCTION
DISRUPTURE OF
HEART, DISTURBANCE
IN THE HEART
RHYTHM, PULMONARY
EMBOLISM, OTHERS
DAMAGE OF „HEART
PUMP”
HYPOVOLEMIC
HEMORRHAGE, LOSS
OF FLUIDS (BURNS,
VOMITTING,
DIARRHEA, TRAUMA)
LOWERING OF BLOOD
OR PLASMA
DENSITY/AMOUNT
SEPTIC
BACTERIAL
INFECTIONS (GRAM -) –
ENDOTOXIC SHOCK
(GRAM+) - SEPSIS
DILATION OF
PERIPHERAL VESSELS,
STASIS, ACTIVATION OF
LEUKOCYTES
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Sudden Cardiac Death can occur with:
Coronary artery occlusion: atherosclerotic plaque, thrombus, platelet
aggregates, embolus
Coronary artery aneurysm / rupture: associated with Kawasaki
disease, vasculitis, connective tissue disease
Coronary artery dissection: often young females, multifocal, and
associated with increased eosinophils
Arteritis: Multiple vasculitides, rheumatic conditions, connective tissue
disorders and drugs (eg, cocaine)
Coronary artery spasm
Congenital anomalies of coronary vessels: abnormal origin and course,
osteal malformations, hypoplasia, coronary artery tunneling
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Cardiomegaly (220 g) and symmetric left ventricular hypertrophy
from the autopsy of a 6-year-old boy who suddenly collapsed while on
a walk with his family. These findings are consistent with symmetric
hypertrophic
cardiomyopathy.
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SHOCK - CHANGES IN KIDNEYS
PALE PART OF
CORTEX AND
MANY
HEMORRHAGES
A. B.
A. DILATION OF VESSELS IN MEDULLA
B. NECROSIS OF CANALICULAR
EPITHELIUM, EDEMA OF STROMA
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THE END
Thank you
THANK YOU