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MindMap Gallery Pathology Chapter 3 Local Blood Circulation Disorders
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Pathology Chapter 3 Local Blood Circulation Disorders
#人伟九版#pathology#Chapter 3#Local blood circulation disorder, including overview, Congestion and congestion, embolism, infarction, hemorrhage, thrombosis, etc.
Edited at 2024-03-11 20:18:36
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Pathology Chapter 3 Local Blood Circulation Disorders
- bacteria
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- Outline
Chapter 3: Local Blood Circulation Disorders
Overview
Symptoms of local blood circulation disorder
Intravascular components spill out of blood vessels
Edema
Water increases in tissue spaces
effusion
Accumulation of water in body cavities
Bleeding
red blood cells spilling out of blood vessels
Abnormal blood content in local tissue blood vessels
Increased blood volume
congestion
increased arterial blood volume
congestion
Increased venous blood volume
Reduced blood volume
ischemia
Abnormal substances present in the blood
thrombosis
Blood is formed or coagulated
embolism
Air, lipid droplets, amniotic fluid and other abnormal substances appear in blood vessels to block local blood vessels.
infarction
Tissue necrosis due to ischemia, embolism
congestion and congestion
Overview
Increased blood content in local tissue blood vessels
congestion
Overview
definition
Increased arterial blood input to organs or tissues → arterial congestion
Performance
Dilation of arterioles and capillaries in local tissues or organs, and increased blood input
Common types
Physiological congestion
Pathological congestion
inflammatory hyperemia
decompression hyperemia
Pathological changes and consequences
naked eye
big
Heavy
red
hot
under the mirror
localized arterioles, telangiectasia
congestion
Overview
definition
The venous return of local tissues or organs is blocked, and blood accumulates in small veins and capillaries → blood volume increases
reason
venous compression
venous lumen obstruction
heart failure
Pathological changes and consequences
Variety
naked eye
big
Heavy
purple
cold
under the mirror
Localized venules and telangiectasia
as a result of
chronic congestion
definition
prolonged bleeding
Due to local tissue hypoxia, insufficient supply of nutrients and accumulation and stimulation of metabolic intermediates → parenchymal cells atrophy, degeneration and even death; fibrous connective tissue hyperplasia, reticular fiber collagenization in the tissue, and organ hardening → congestive cirrhosis
Congestion of vital organs
pulmonary congestion
reason
Left heart failure → increased pressure in the left cardiac chamber → obstruction of venous return → pulmonary congestion
Classification
acute pulmonary congestion
Variety
naked eye
The lung volume increases, dark red, and foamy red bloody fluid (red blood cells + air) flows out from the cut surface
under the mirror
Pulmonary septal capillary dilatation, congestion, and edema
Thickening of lung septa
Part of the alveolar cavity is filled with edema fluid and red blood cells
Severe pulmonary edema occurs
chronic pulmonary congestion
Variety
under the mirror
Alveolar wall capillary dilation and congestion are more obvious
Alveolar septal thickening and fibrosis
Alveolar space: edema fluid, blood, heart failure cells
Heart failure cells: macrophages engulfing hemosiderin particles are called heart failure cells
Brown sclerosis of the lung: long-term chronic pulmonary congestion → lung tissue ischemia and hypoxia → fibroplasia of the lung tissue → brown sclerosis of the lung
clinical manifestations
Shortness of breath, cyanosis
Liver congestion
reason
Right heart failure →Hepatic venous return to the heart is blocked
type
acute liver congestion
Variety
naked eye
The liver increases in size and turns dark red
under the mirror
Central lobular veins and hepatic sinusoids are dilated and congested
In severe cases, central lobular liver cell atrophy and necrosis
Perilobular hepatocytes: fatty change
chronic liver congestion
naked eye view
Severe congestion in the central area of the liver lobules turns dark red
red and yellow stripes → betel nut liver
Looking under the mirror
The liver sinusoids in the center of the liver lobules are highly dilated and congested, and the liver cells atrophy and disappear.
Perilobular hepatocyte steatosis
Congestive cirrhosis
Long-term severe liver congestion → increased interstitial fibrous tissue throughout the liver
Bleeding
Overview
definition
Overflow of blood from blood vessels or heart chambers
reason
Chronic congestion → capillary bleeding
Vascular trauma/inflammation or tumor erosion of the vessel wall → rupture bleeding from large arteries/large veins
type
by nature
Physiological bleeding
pathological bleeding
According to the blood overflow mechanism
rupture hemorrhage
spillover bleeding
Press the bleeding site
internal bleeding
Blood spilling into a body cavity or tissue
external bleeding
blood flowing out of body
Causes and pathogenesis of bleeding
rupture hemorrhage
Mechanical damage to blood vessels
Blood vessel wall or heart disease
Lesion erosion around blood vessel walls
Vein rupture
ruptured capillaries
leakage bleeding
definition
The permeability of the capillaries and post-capillary veins of the microcirculation increases → blood leaks out of the blood vessels through the enlarged endothelial space and damaged basement membrane.
Common causes
damage to blood vessel walls
Thrombocytopenia or dysfunction
coagulation factor deficiency
Pathological changes of bleeding
internal bleeding
body cavity bleeding
Hemopericardium, hemopleural effusion, hemoperitoneum, hemoarticular hemorrhage
hematoma
definition
Localized massive bleeding within tissues
Example
Intradural hematoma, subcutaneous hematoma, retroperitoneal hematoma
microscope
A small amount of red blood cells/hemosiderin may be seen in small amounts of bleeding
external bleeding
Nosebleeds
Hemoptysis
Vomiting blood
Blood in the stool
blood in urine
petechiae
Purpura
ecchymosis
Consequences of bleeding
small amount of bleeding
Stop on its own
Minor local tissue bleeding/body cavity hemorrhage
elimination by absorption or organization
hemorrhagic shock
Serious consequences for important organs
hemopericardium
acute cardiac insufficiency
Brain stem hemorrhage
Nerve center compression and death
Internal capsule hemorrhage
Contralateral hemiplegia
retinal hemorrhage
Vision loss or blindness
thrombosis
Overview
thrombosis
Coagulation of blood in the heart and blood vessels of a living body/the process in which certain formed components in the blood agglomerate to form a solid mass
thrombus
solid mass formed
Coagulation system and anticoagulation system (fibrinolytic system)
It ensures the potential coagulability of blood and ensures the fluid state of blood.
Conditions and mechanisms of thrombosis
Overview
Thrombosis is a condition in which blood is in a flowing state, causing blood to coagulate due to the activation of platelets and coagulation factors.
Damage to cardiovascular endothelial cells (the most important and common cause of thrombosis)
Anticoagulant mechanism of endothelial cells
barrier effect
Anti-platelet adhesion effect
Prostacyclin/NO synthesized by endothelial cells → inhibits platelet adhesion
Secrete ADPase → degrade AOP/inhibit platelet aggregation
Synthetic antithrombin or coagulation factors
Promote fibrinolysis
Endothelial cell procoagulant mechanism
Activates the extrinsic coagulation pathway
Assist platelet adhesion
Inhibit fibrinolysis
Normal situation: Mainly inhibits platelet adhesion and anticoagulation:
Endothelial cell damage, exposure of subendothelial collagen fibers
Release tissue factor → activate coagulation factor 7 → initiate exogenous coagulation process
Activate platelets and coagulation factor 12 → initiate the intrinsic coagulation pathway
In the coagulation process, the most important thing is: activation of platelets
activation of platelets
adhesion reaction
VWF factor required
release reaction
Calcium ions: involved in the chain reaction of blood coagulation
ADP: a powerful mediator of platelet-to-platelet adhesion
sticky reaction
Calcium ions, ADP, and thromboxane A2 produced by platelets → platelets continue to adhere and release ADP and thromboxane A2 at the same time
Thrombin: fibrinogen → fibrin; is the core component of thrombosis
Abnormalities in blood flow status
normal distribution
Red blood cells and white blood cells are in the central axis of blood flow (axial flow), and outside of them are platelets
Outermost layer: plasma (side flow)
abnormal situation
Slowing of blood flow/creating whirlpools
Platelets enter the side stream → increase the chance of contact with the intima and the possibility of adhesion to the intima
Activated coagulation factors and thrombin locally reach the concentration required for coagulation
Variety
Electron microscope: The endothelial cell cytoplasm appears vacuoles or even dissolves, and subendothelial collagen is exposed
increased blood coagulability
definition
Increased platelets/coagulation factors in the blood, or reduced activity of the fibrinolytic system → hypercoagulable state of the blood
Classification
hereditary hypercoagulable state
The most common is low factor five gene mutation
acquired hypercoagulable state
The process of thrombosis and the morphology of thrombus
Formation process
Types and forms
White thrombus (platelet thrombus, precipitate thrombus)
Predisposed areas
Rapid blood flow in heart valves, heart chambers, and arteries
In venous thrombosis, the head of the white continuous thrombus
Features
naked eye
Small gray-white nodules/vegetation-like, rough, solid, tightly adherent to the blood vessel wall
Not easy to fall off
under the mirror
Platelets (mainly) + fibrin (a small amount)
mixed thrombus
Predisposed areas
body of venous thrombosis
mural thrombus
Mixed thrombi occurring within the cardiac chambers, atherosclerotic ulcers/aneurysms
ball thrombus
Thrombus that occurs in the left atrium, due to the contraction and relaxation of the atrium → mixed thrombus appears in a spherical shape
Features
naked eye
Rough, dry, cylindrical, adherent to blood vessel walls
Alternating gray-white (platelet trabeculae) and reddish-brown (fibrin) lamellar structure
Not easy to fall off
under the mirror
Light red unstructured branch-like/irregular coral-like platelet trabeculae (gray white) + red blood cells
There are neutrophils attached to the edges of platelets
Red thrombus (coagulable thrombus)
Predisposed areas
vein
For the tail of persistent thrombus
Features
naked eye
Dark red, moist and elastic when fresh, without adhesion to the blood vessel wall
After a certain period of time, the water in the thrombus is absorbed and becomes dry, inelastic, brittle and can fall off to form an embolism.
under the mirror
Fibrin mesh filled with blood cells
Mostly red blood cells
few white blood cells
Hyaline thrombus (microthrombus) (fibrous thrombus)
Predisposed areas
In the blood vessels of microcirculation, mainly capillaries
composition
Eosinophilic homogeneous, composed of fibrin
Common: DIC (disseminated intravascular coagulation)
outcome of thrombosis
Soften, dissolve and absorb
mechanization and recanalization
Calcification
The impact of thrombosis on the body (disadvantages > benefits)
block blood vessels
embolism
Heart valve deformation
extensive bleeding
infarction
Overview
definition
Necrosis of organs or local tissues due to blood vessel obstruction and stagnation of blood flow leading to hypoxia
Causes and conditions of infarction
Causes of infarction
thrombosis
most common reasons
myocardial infarction
Coronary arteriosclerosis combined with thrombosis
cerebral infarction
Cerebral atherosclerosis combined with thrombosis
foot infarction
dorsalis pedis artery obliterans vasculitis
arterial embolism
arterial spasm
blood vessel compression and occlusion
Factors affecting infarction formation
Organ blood supply characteristics
dual blood supply
lung
liver
forearm, hand
Difficult to establish collateral circulation
kidney
subtopic
brain
Sensitivity of local tissue to ischemia
Skeletal muscle cells, fibrous connective tissue>cardiac cells>brain cells
Lesions and types of infarction
Morphological features of infarction
The shape of the infarct
Depends on the vascularity pattern of the organ in which the infarction occurred
The texture of the infarct
Depends on the type of necrosis
The color of the infarct
Depends on the blood content in the lesion
Type of infarction
anemic infarction
hemorrhagic infarction
septic infarction
embolism
Overview
definition
A phenomenon in which abnormal substances that are insoluble in blood and appear in the circulating blood block the lumen of blood vessels as they travel with the blood.
embolus
definition
abnormal substance that blocks the lumen of blood vessels
type
solid, liquid, gas
Most common: dislodged thrombus or segments
other
Fat droplets, air, amniotic fluid, tumor cells
The path of travel of emboli
Venous system and right ventricular emboli
Entering the pulmonary artery and its branches → pulmonary embolism
The released emboli can flow back into the left heart through the capillaries of the alveolar wall → enter the systemic circulation system → block the small branches of the arteries.
Aortic system and left ventricular emboli
Block the small arteries of various organs
common
Brain, spleen, kidneys, limbs
Portal system emboli
liver
Cross embolism (paradoxical embolism)
Congenital atrial (ventricular) septal defect
retrograde embolism
Thrombus in the inferior vena cava, sudden increase in chest or abdominal pressure (coughing or deep breathing)
Retrograde flow into liver, kidney, iliac vein
Types of embolism and effects on the body
Thromboembolism
fat embolism
gas embolism
air embolism
decompression sickness