HEMODYNAMICS Brain – Cerebral edema (can occur in severe trauma,

infections like viral encephalitis)

- How blood flows thru arteries & veins and the
forces that affect blood flow o Vasogenic – extracellular
o Cytotoxic – intracellular
EDEMA
NORMAL HEMOSTASIS
- Accumulation of fluid in tissues resulting from
a net movement of water into extra-vascular - Primary hemostatis: formation of platelet plug
spaces caused by: o Disruption of enothelium -> exposes
- Increased hydrostatic pressure (caused by subendothelial von Willebrand Factor
disorders that impair venous return) (vWF) and collagen -> promote platelet
- Reduced plasma oncotic/osmotic pressure adherence and activation -> activation
(caused by inadequate synthesis or increased of platelets - > dramatic shape change -
loss of albumin – accounts for almost half of the > form primary hemostatic plug
total plasma protein) - Secondary hemostatis: deposition of fibrin
o Osmotic pressure is the force that drives o Vascular injury exposes tissue factor
the movement of water molecules from (membrane bound procoagulant
a region of low solute concentration to glycoprotein) at site of injury-> tissue
a high solute concentration, factor binds and activates factor VII ->
o while oncotic pressure is the force cascade of reactions -> thrombin
exerted by proteins in the blood that generation -> thrombin cleaves
draws water into the blood vessels. circulating fibrinogen into insoluble
o Balanced lang dapat tong dalawa so pag fibrin -> create fibrin meshwork ->
nagging unbalanced = edema activates other platelets - > additional
- Sodium & water retention platelet at injury
- Lymphatic obstruction (Trauma, fibrosis, - Clot stabilization and resorption
invasive tumors, and infectious agents can all o Polymerized fibrin and platelet
disrupt lymphatic vessels and impair the aggregates undergo contraction to form
clearance of interstitial fluid, resulting in a solid, permanent plug that prevents
lymphedema in the affected part of the body) further hemorrhage ->
counterregulatory mechanisms set into
! inflammatory edema = exudate;
motion that limit clotting to site of
noninflammatory = transudate
injury -> clot resorption & tissue repair
! sa tissues lang ang edema, effusions na sa body
cavities

PITTING EDEMA

GRADE SYSTEM

- Grade 1 – 2mm; goes back immediately

- Grade 2 – 4mm; 15 seconds
- Grade 3 – 6mm; 60 seconds
- Grade 4 – 8mm; 2-3 mins.

Eyes – Preorbital edema

Lungs – Pulmonary edema (fluid fills alveoli - can cause

life-threatening hypoxia)
 very low platelet counts (thrombocytopenia) is
intracerebral hemorrhage, which may be fatal

- ECCHYMOSIS
o Some of blood Leaking of blood from
blood vessels into subcutaneous tissue
that underlies the skin
o bruise
o Common cause is trauma
o Internal bleeding
o 1-2 cm
o Some blood has left the blood vessels
causing purple-colored area on skin
o Bigger than purpura smaller than
hematoma
- HEMATOMA
o LEAKING blood from vessels, collected,
HEMORRHAGE DISORDERS and clotted in an area it shouldn’t be
o Both purpura and ecchymoses may be
- Characterized by excessive bleeding, hemostatic
large enough to be a hematoma
mechanism are either blunted or insufficient to
prevent abnormal blood loss HYPEREMIA
- Bleeding; an escape of blood from the blood
- Active process in w/c arteriolar dilation (e.g at
vessels because of trauma, inflammation,
sites of inflammation or in skeletal muscle
neoplasia, or abnormal hemostasis
during exercise) leads to increased blood flow
- a discharge of blood from the vascular
- Defined as an excess amount of blood in an
compartment to the exterior of the body or into
organ bc of increased supply of blood from
nonvascular body spaces
arterial system (active) or by impediment to the
- PURPURA
exit of blood through venous pathways (passive
o More or = than 3mm
hyperemia/congestion)
o Small dots
o Collection of small blood pools beneath ! affected tissues turn red (erythema) bc of increased
the skin deliv of oxygenated blood
o Occur when blood vessels burst near
! congestion – turn blue-red color (cyanosis) from
the skin’s surface
accumulation of Deoxygenated blood
o Larger than petechiae
- PETECHIAE TYPES OF HYPEREMIA
o 1-2mm
- Reactive – high blood flow after something
o Smaller than purpura
limited your blood flow
o Areas of hemorrhage in the dermis
- Active – high blood flow to meet active muscles’
! believed that the capillaries of the mucosa and skin increased need for oxygen
are particularly prone to rupture following minor - Functional – high blood flow going to active
trauma and that under normal circumstances platelets neurons in your brain
seal these defects virtually immediately - Conjuctival – high blood flow from
inflammation in eye
! emostasis may also take the form of epistaxis
(nosebleeds), gastrointestinal bleeding, or excessive
menstruation (menorrhagia). A feared complication of
CONGESTION
 - Increase in volume of blood in a particular
tissue
- Passive hyperemia
- CYANOSIS (turning blue-red)

THROMBOEMBOLISM

- A circulating blood clot that gets stuck and

causes an obstruction
- Blood Clotting/Coagulation – an important
process that prevents excessive bleeding when
a blood vessel is injured ri
o consists of platelets and proteins
- Thrombosis – formation of a clot in an
artery/vein that reduces blood flow (arterial
thrombosis is usually caused by fatty deposits
(atherosclerosis))
o Diseases caused by thrombosis –
stroke, heart attack, peripheral vascular
disease, Deep Vein Thrombosis (DVT)

- Embolism – happens when an embolus, blood

VIRCHOW TRIAD
clot or air bubble severely blocks the flow of
blood
o Pulmonary embolism – blood clot gets
stuck in an artery in the lung
o Happens to most ppl who have risk
factors for blood clot formation, such as
smoking and heart disease
o Most Pes originate as thrombi in the
deep veins of the lower extremities
 o Flank or lower back pain, decreased
urine output, blood in urine, and
2 categories of thromboembolism
swelling of the lower limbs
- Venous thromboembolism
o Occurs in veins
o When a blood clot breaks off and blocks ARTERIAL THROMBOEMBOLISM (ATE) – occurs in
a vein arteries
o risk of developing VTE: highest after
o When a blood clot breaks off and blocks
major surgery, major injury, or during
an artery
periods of infection and inflammation
o Linked to ischemia (restriction of blood
o originates as small fibrin deposits in
flow and oxygen due to obstruction)
these areas of low flow
o When an artery is damaged by
 often starts in legs (DVT)
atherosclerosis
 if the clot breaks off and lodges
in a lung ! risk factors for blood lot in artery: eating a high-fat
 less common sites: arms, liver, diet
kidneys, and brain
- Thrombosis over atherosclerotic plaques is
Deep Vein thromboembolism DVT(E) (leg) – occurs ether due to superficial or to deep injury
when a blood clot forms in a deep vein - Strokes and transient ischemic attacks (TIA’s)
are the most important clinical manifestations
o throbbing, cramps, swelling, warmth,
of arterial emboli
pain, hardened veins, and redness or
darkened skin in one leg

Pulmonary Embolism PE (lungs) – occurs when a part of Limb infarction

the DVT clot breaks off and travels to the lungs
- An area of tissue death of an arm/leg.
o blocked artery in lungs - May cause skeletal muscle infarction, avascular
o sudden shortness of breath, rapid necrosis of bones, or necrosis of a part of an
breathing, chest pain, coughing up entire limb
blood, and bluish discoloration of the - Limb coldness, numbness, tingling, pain, muscle
lips or finger weakness, muscle spasms, pale skin, and
decreased pulse in the affected arm/leg
Cerebral Venous Thrombosis CVST (brain) – occurs
when a blood clot forms in the brain’s venous sinuses Heart attack

o headaches, facial dropping, limb - Occurs when an artery that sends blood and
weakness, difficulty speaking, and in oxygen to the heart is blocked
some cases, seizures - Fatty, cholesterol-containing deposits build up
over time, forming plaques in the heart’s
Portal Vein Thrombosis PVT (liver) –
arteries.
narrowing/blockage of the portal vein by a blood clot
- Chest pains, shortness of breath, profuse
o PVT is mainly due to inherited or sweating, weakness, lightheadedness, nausea,
acquired pro-thrombotic states vomiting, and heart palpitations
(thrombophilia) Stroke
o Upper abdominal pain, nausea,
abdominal swelling, and persistent - “brain attack”
fever - Occurs when something blocks blood supply to
part of the brain or when a blood vessel in the
Renal Vein Thrombosis RVT (kidney) – blood clot that brain bursts.
develops in the vein that drains blood from the kidney
 - In either case, parts of the brain become
damaged or die
SHOCK
o sudden difficulty walking, speaking, and
understanding, as well as paralysis or - a state of circulatory failure that impairs tissue
numbness of the face, arm, or leg perfusion and leads to cellular hypoxia
 Ischemic stroke - cellular injury is reversible; however, prolonged
 Transient ischemic attack (TIA) – shock eventually leads to irreversible tissue
mini stroke injury and can be fatal.
 Hemorrhagic stroke

CARDIOGENIC SHOCK

- Occurs when heart is unable to pump blood

effectively
- Can result in: heart attack, severe arrythmias,
other heart related problems
- Heart’s inability to pump blood adequately =
reduced oxygen deliver to vital organs

HYPOVOLEMIC SHOCK

- Occurs when there is a significant loss of

blood/other bodily fluids
- Can happen bc of: severe bleeding from trauma,
Ischemic – when blood supply to part of the brain is surgery or dehydration
interrupted or reduced, preventing brain tissue from - With reduced blood volume, there’s inadequate
getting oxygen and nutrients blood flow to vital organs causing shock
Hemorrhagic stroke - due to bleeding into the brain by ANAPHYLACTIC SHOCK
the rupture of a blood vessel
- Severe allergic reaction that can happen rapidly
Transient ischemic attack - a stroke that lasts only a few after exposure to an allergen
minutes. It occurs when the blood supply to part of the - Involves widespread of chemicals like histamine,
brain is briefly interrupted. TIA symptoms, which usually leading to sudden drop in BP, swelling, and
occur suddenly, are similar to those of stroke but do not difficulty breathing.
last as long - w/o immediate treatment, it can be life-
threatening

SEPTIC SHOCK

- result of a severe infection that spreads

throughout the body
- occurs when chemicals released into the
bloodstream to fight an infection trigger
inflammatory responses throughout body
- when body’s immune response to an infection
becomes uncontrolled, it can lead to
widespread inflammation and blood vessel
dilation
 - causes drop in BP, impairing organ function

NEUROGENIC SHOCK

- occurs when there’s damage to the nervous

system, particularly spinal cord
- this damage can disrupt the normal regulation
of blood vessel tone, causing blood vessels to
dilate and BP to drop
- often associated w spinal cord injuries / certain
medical conditions