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Author(s): Gerald Abrams, M.D., 2009

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Circulatory Derangements I

            M1 – Cardiovascular/Respiratory
                      Sequence
                  Gerald Abrams, MD

Fall 2008
Circulatory Derangements
•  I -Congestion, Edema
•  II -Hemorrhage
•  III-Thrombosis
•  IV-Embolism, Ischemia, Infarction
•  V –Atherosclerosis, Ischemic Ht. Disease
CONGESTION
   Too much blood in an area

Within the cardiovascular system
    (unlike hemorrhage)

Vessels engorged with blood
ACTIVE CONGESTION (hyperemia)
  Increased flow into the area
          -erythema-



PASSIVE CONGESTION
 Decreased outflow from area
       -cyanosis-
Source Undetermined
Normal Lung




Department of Pathology, University of Michigan
Congested Lung




Department of Pathology, University of Michigan
Normal Lung




G.D. Abrams, University of Michigan Medical School
Congested Lung




G.D. Abrams, University of Michigan Medical School
Congested Lung
        Hemorrhage by Diapedesis




G.D. Abrams, University of Michigan Medical School
Congestion
                  erythrophagocytosis




G.D. Abrams, University of Michigan Medical School
Early CPC




G.D. Abrams, University of Michigan Medical School
Advanced CPC




G.D. Abrams, University of Michigan Medical School
Normal liver




G.D. Abrams, University of Michigan Medical School
Liver – Outflow Obstruction




G.D. Abrams, University of Michigan Medical School
Liver – Outflow Obstruction




G.D. Abrams, University of Michigan Medical School
Liver – Outflow Obstruction




G.D. Abrams, University of Michigan Medical School
Liver
  Central Hemorrhagic Necrosis




G.D. Abrams, University of Michigan Medical School
Liver
 Central Hemorrhagic Necrosis




G.D. Abrams, University of Michigan Medical School
Liver
                                Cardiac Failure




Department of Pathology, University of Michigan
Nutmeg                         Liver




Department of Pathology, University of Michigan
Esophageal Varices




 Samir (Wikimedia Commons)
Portal Circulation




      Gray’s Anatomy




   Original image here: http://1.bp.blogspot.com/
   _DJHKI52rMWA/SfaTtEF0jqI/AAAAAAAAADw/
   6X0s8peMvOo/s320/shared_7303_HM-06.jpg
Liver - Cirrhosis




Department of Pathology, University of Michigan
Esophageal Varices




Department of Pathology, University of Michigan
Esophageal Varices




Department of Pathology, University of Michigan
EDEMA


Accumulation of excess fluid in the
 interstitial spaces / body cavities
Effusion

Fluid accumulation in a body cavity
       Pleural Effusion
       Pericardial Effusion
       Peritoneal Effusion = Ascites
Anasarca – Generalized edema,
             a water-logged body
Source Undetermined
Fluid Collections


•  Inflammatory collection = Exudate

•  Non-inflammatory collection = Transudate
Edematous Connective Tissue




G.D. Abrams, University of Michigan Medical School
Peripheral Edema




   miss pupik, (flickr)
Pitting Edema (1)




Department of Pathology, University of Michigan
Pitting Edema (2)




Department of Pathology, University of Michigan
Pitting Edema (3)




Department of Pathology, University of Michigan
Chronic Lymphedema




Source Undetermined
Pulmonary Edema




G.D. Abrams, University of Michigan Medical School
Pulmonary Edema




Department of Pathology, University of Michigan
Pulmonary Edema




Department of Pathology, University of Michigan
Laryngeal Edema




Department of Pathology, University of Michigan
Cerebral Edema




Department of Pathology, University of Michigan
Additional Source Information
                           for more information see: http://open.umich.edu/wiki/CitationPolicy


Slide 7: Source Undetermined
Slide 8: Department of Pathology, University of Michigan
Slide 9: Department of Pathology, University of Michigan
Slide 10: G.D. Abrams, University of Michigan Medical School
Slide 11: G.D. Abrams, University of Michigan Medical School
Slide 12: G.D. Abrams, University of Michigan Medical School
Slide 13: G.D. Abrams, University of Michigan Medical School
Slide 14: G.D. Abrams, University of Michigan Medical School
Slide 15: G.D. Abrams, University of Michigan Medical School
Slide 16: G.D. Abrams, University of Michigan Medical School
Slide 17: G.D. Abrams, University of Michigan Medical School
Slide 18: G.D. Abrams, University of Michigan Medical School
Slide 19: G.D. Abrams, University of Michigan Medical School
Slide 20: G.D. Abrams, University of Michigan Medical School
Slide 21: G.D. Abrams, University of Michigan Medical School
Slide 22: Department of Pathology, University of Michigan
Slide 23: Department of Pathology, University of Michigan
Slide 24: Samir, Wikimedia Commons, http://en.wikipedia.org/wiki/File:Esophageal_varices_-_wale.jpg

Slide 25: Gray’s Anatomy
Slide 26: Department of Pathology, University of Michigan
Slide 27: Department of Pathology, University of Michigan
Slide 28: Department of Pathology, University of Michigan
Slide 31: Source Undetermined
Slide 33: G.D. Abrams, University of Michigan Medical School
Slide 34: miss pupik, flickr, http://www.flickr.com/photos/miss_pupik/2418359498; CC:BY 2.0,
    http://creativecommons.org/licenses/by/2.0/deed.en
Slide 35: Department of Pathology, University of Michigan
Slide 36: Department of Pathology, University of Michigan
Slide 37: Department of Pathology, University of Michigan
Slide 38: G.D. Abrams, University of Michigan Medical School
Slide 39: G.D. Abrams, University of Michigan Medical School
Slide 40: Department of Pathology, University of Michigan
Slide 41: Department of Pathology, University of Michigan
Slide 42: Department of Pathology, University of Michigan
Slide 43: Department of Pathology, University of Michigan

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11.10.08(c): Circulatory Derangements I

  • 1. Author(s): Gerald Abrams, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution-Non-commercial-Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
  • 2. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (USC 17 § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (USC 17 § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (USC 17 § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  • 3. Circulatory Derangements I M1 – Cardiovascular/Respiratory Sequence Gerald Abrams, MD Fall 2008
  • 4. Circulatory Derangements •  I -Congestion, Edema •  II -Hemorrhage •  III-Thrombosis •  IV-Embolism, Ischemia, Infarction •  V –Atherosclerosis, Ischemic Ht. Disease
  • 5. CONGESTION Too much blood in an area Within the cardiovascular system (unlike hemorrhage) Vessels engorged with blood
  • 6. ACTIVE CONGESTION (hyperemia) Increased flow into the area -erythema- PASSIVE CONGESTION Decreased outflow from area -cyanosis-
  • 8. Normal Lung Department of Pathology, University of Michigan
  • 9. Congested Lung Department of Pathology, University of Michigan
  • 10. Normal Lung G.D. Abrams, University of Michigan Medical School
  • 11. Congested Lung G.D. Abrams, University of Michigan Medical School
  • 12. Congested Lung Hemorrhage by Diapedesis G.D. Abrams, University of Michigan Medical School
  • 13. Congestion erythrophagocytosis G.D. Abrams, University of Michigan Medical School
  • 14. Early CPC G.D. Abrams, University of Michigan Medical School
  • 15. Advanced CPC G.D. Abrams, University of Michigan Medical School
  • 16. Normal liver G.D. Abrams, University of Michigan Medical School
  • 17. Liver – Outflow Obstruction G.D. Abrams, University of Michigan Medical School
  • 18. Liver – Outflow Obstruction G.D. Abrams, University of Michigan Medical School
  • 19. Liver – Outflow Obstruction G.D. Abrams, University of Michigan Medical School
  • 20. Liver Central Hemorrhagic Necrosis G.D. Abrams, University of Michigan Medical School
  • 21. Liver Central Hemorrhagic Necrosis G.D. Abrams, University of Michigan Medical School
  • 22. Liver Cardiac Failure Department of Pathology, University of Michigan
  • 23. Nutmeg Liver Department of Pathology, University of Michigan
  • 24. Esophageal Varices Samir (Wikimedia Commons)
  • 25. Portal Circulation Gray’s Anatomy Original image here: http://1.bp.blogspot.com/ _DJHKI52rMWA/SfaTtEF0jqI/AAAAAAAAADw/ 6X0s8peMvOo/s320/shared_7303_HM-06.jpg
  • 26. Liver - Cirrhosis Department of Pathology, University of Michigan
  • 27. Esophageal Varices Department of Pathology, University of Michigan
  • 28. Esophageal Varices Department of Pathology, University of Michigan
  • 29. EDEMA Accumulation of excess fluid in the interstitial spaces / body cavities
  • 30. Effusion Fluid accumulation in a body cavity Pleural Effusion Pericardial Effusion Peritoneal Effusion = Ascites Anasarca – Generalized edema, a water-logged body
  • 32. Fluid Collections •  Inflammatory collection = Exudate •  Non-inflammatory collection = Transudate
  • 33. Edematous Connective Tissue G.D. Abrams, University of Michigan Medical School
  • 34. Peripheral Edema miss pupik, (flickr)
  • 35. Pitting Edema (1) Department of Pathology, University of Michigan
  • 36. Pitting Edema (2) Department of Pathology, University of Michigan
  • 37. Pitting Edema (3) Department of Pathology, University of Michigan
  • 39. Pulmonary Edema G.D. Abrams, University of Michigan Medical School
  • 40. Pulmonary Edema Department of Pathology, University of Michigan
  • 41. Pulmonary Edema Department of Pathology, University of Michigan
  • 42. Laryngeal Edema Department of Pathology, University of Michigan
  • 43. Cerebral Edema Department of Pathology, University of Michigan
  • 44. Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicy Slide 7: Source Undetermined Slide 8: Department of Pathology, University of Michigan Slide 9: Department of Pathology, University of Michigan Slide 10: G.D. Abrams, University of Michigan Medical School Slide 11: G.D. Abrams, University of Michigan Medical School Slide 12: G.D. Abrams, University of Michigan Medical School Slide 13: G.D. Abrams, University of Michigan Medical School Slide 14: G.D. Abrams, University of Michigan Medical School Slide 15: G.D. Abrams, University of Michigan Medical School Slide 16: G.D. Abrams, University of Michigan Medical School Slide 17: G.D. Abrams, University of Michigan Medical School Slide 18: G.D. Abrams, University of Michigan Medical School Slide 19: G.D. Abrams, University of Michigan Medical School Slide 20: G.D. Abrams, University of Michigan Medical School Slide 21: G.D. Abrams, University of Michigan Medical School Slide 22: Department of Pathology, University of Michigan Slide 23: Department of Pathology, University of Michigan Slide 24: Samir, Wikimedia Commons, http://en.wikipedia.org/wiki/File:Esophageal_varices_-_wale.jpg
 Slide 25: Gray’s Anatomy Slide 26: Department of Pathology, University of Michigan Slide 27: Department of Pathology, University of Michigan Slide 28: Department of Pathology, University of Michigan Slide 31: Source Undetermined Slide 33: G.D. Abrams, University of Michigan Medical School Slide 34: miss pupik, flickr, http://www.flickr.com/photos/miss_pupik/2418359498; CC:BY 2.0, http://creativecommons.org/licenses/by/2.0/deed.en Slide 35: Department of Pathology, University of Michigan Slide 36: Department of Pathology, University of Michigan Slide 37: Department of Pathology, University of Michigan Slide 38: G.D. Abrams, University of Michigan Medical School Slide 39: G.D. Abrams, University of Michigan Medical School Slide 40: Department of Pathology, University of Michigan Slide 41: Department of Pathology, University of Michigan Slide 42: Department of Pathology, University of Michigan Slide 43: Department of Pathology, University of Michigan