FLUID AND HEMODYNAMIC DERANGEMENTS
Ed Friedlander, M.D., Pathologist
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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

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More of Ed's Notes: Ed's Medical Terminology Page

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Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

LEARNING OBJECTIVES

Once again, this is absolutely essential material. Given any of the definitions, you should be able to supply the word. Given any of the processes, you must be able to explain "how", "when", "where", and "why".

Describe the processes that give rise to transudates, and those that give rise to exudates.

Describe edema as seen in inflammation, heart failure, liver failure, and kidney failure. Describe the special cases of cerebral edema and "angioedema". Explain how lymphedema develops.

Describe in general terms the causes and consequences of hemorrhages.

Cite Virchow's triad for the causes of thrombosis, and recognize and give examples in each category. Explain why turbulent flow promotes thrombosis, why damaged endothelium promotes thrombosis, and how blood can become hypercoagulable. Describe the possible fates, good and bad, of a thrombus.

Describe the nature, causes, and significance of disseminated intravascular coagulation, and give its synonyms.

Describe things that embolize. Briefly discuss classic pulmonary thromboemboli, paradoxical emboli, and systemic thromboemboli. Give an account of the causes and consequences of amniotic fluid, air, fat, atherosclerotic, marrow, tumor, and therapeutic emboli.

Give a full account of the various types of infarcts. Mention two factors contributing to "reperfusion injury".

Define shock, and mention its major causes. Describe how whole-body hypoperfusion causes problems. Discuss the physiology of shock, and describe its stages (compensated, progressive, and irreversible). Describe the anatomic pathology that results from fatal shock. Tell how prolonged compensated shock affects the whole person.

Use the following terms correctly, and produce the term given a definition or description:

anasarca
ascites
clot
congestion
ecchymosis
edema
effusion
elephantiasis
embolus
empyema
exudate
hemarthrosis
hematemesis
hematoma
hemopericardium
hemoptysis
hemorrhage
hemothorax
hydrocele
hydrocephalus
hydropericardium
hydrosalpinx
hydrothorax
hyperemia
infarct
loculation
melena
milk leg
mural thrombus
petechiae
propagation
purpura
pyemia
pyothorax
seroma
shock
recanalization
thrombus
transudate
Trousseau's sign
vegetation
Bringing out the Dead
Fluid and Hemodyamic
"Bringing Out the Dead"

Recognize the following gross items:

Be sure you can recognize the following under a microscope, with or without other pathologic lesions:

KCUMB Students
"Big Robbins" -- Hemodynamic
Lectures follow Textbook

QUIZBANK

* As he was dying of alcoholic liver disease, W.C. Fields was told he had excessive accumulation of water in his abdomen. He replied, "I knew that insipid, tasteless fluid would be the death of me!"

LEARN FIRST

Hemodynamic Disorders
Taiwanese pathology site
Good place to go to practice

Hemodynamic disorders
Iowa Virtual Microscopy
Have fun

Hemodynamic
First Section
Chaing Mi, Thailand

Hemodynamic
Second Section
Chaing Mi, Thailand

Hemodynamic
Third Section
Chaing Mi, Thailand

Hemodynamic
Fourth Section
Chaing Mi, Thailand

Fluid and Hemodynamic
Photos, explanations, and quiz
Indiana U.

EDEMA

Lymphatic vessels in edema
They are not themselves plugged,
but are dilated from carring away fluid.

Child with anasarca
Neonatal catastrophic illness
Personal website

{19381} ascites

Hydrothorax
WebPath Photo

Hydrothorax

WebPath Photo

{13394} hydrocephalus
{13395} hydrocephalus

Hydrocephalus, untreated
From a Saddam-era Iraqi
propaganda website (!)

{08295} elephantiasis of leg, filariasis patient
{08259} elephantiasis of scrotum, filariasis patient

Normal lymphatic vessels
in fat, with lymphocytes
KCUMB Team

Lymphatic spread
Lung pathology series
Dr. Warnock's Collection

Pitting edema

WebPath Photo

HYPEREMIA AND CONGESTION: The two possible reasons for increased blood volume in a particular part of the body.

{10967} heart failure cells in the lung

{00029} nutmeg liver
{31889} real nutmeg

Hyperemia I
From Chile
In Spanish

Hyperemia II
From Chile
In Spanish

Nutmeg liver

KU Collection

Congested liver, live cells in zone 1
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

Congested liver, dead cells in zone 3
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

HEMORRHAGE

    There's no need to review the basics of hemostasis here (though for your convenience, "Big Robbins" does). Some terms:

      HEMORRHAGE: Blood cells that have escaped from a vessel. Hemorrhages range from hickies to exsanguinating hemoptysis.

      HEMATOMAS: Enough blood in the tissues to create a palpable mass. (Don't think the suffix "-oma" means only "tumor" -- it also refers to other masses. More about this later.)

      HEMOTHORAX: Blood in a pleural cavity. HEMOPERICARDIUM: Blood in the pericardial cavity. HEMOPERITONEUM: Blood in the peritoneal cavity. HEMARTHROSIS: Bleeding into a joint.


Fight Club

{07554} petechiae on eye, strangulation victim
{14287} petechiae on legs
{08059} petechiae on heart, leukemia case
{21433} petechiae on oral mucosa

Hemorrhage in a corpus luteum
Plentiful red cells
David Barber MD -- KCUMB

Intrapulmonary hemorrhage
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

Hemopericardium
Broken aortic root
Utah Webpath

{07051} contusions, abuse

Hemorrhage
From Chile
In Spanish

Hemopericardium
Car wreck
WebPath Photo

Hemothorax
Urbana Atlas of Pathology

CPR contusion on epicardium
Blood in the fat pad
KCUMB Team

Hemothorax
Urbana Atlas of Pathology

{13104} hemorrhage into the pituitary; another really bad place to have a hemorrhage
{21233} petechiae in the mouth from a mouthguard. Not so troublesome.

      How much of your ~5 L of blood can you lose at once?

        10%... You donated a unit of blood. Thank you.

        20%... You will probably feel a little sick.

        40%... You will probably go into hypovolemic shock.

Bacon, Blood on the Floor
Painting, "Blood on the Floor", 1986

{06275} hemorrhage in the lung (blood in alveoli)
{06278} hemorrhage (blood in the stomach)

THROMBOSIS: The transformation of flowing blood from a liquid to a solid within the vessels or heart.

{11456} thrombi in the venous plexus around the prostate
{31952} thrombus in the superior saggital sinus
{11639} thrombus in the femoral vein

Thrombosis of intracerebral vein
Baby
Pittsburgh Pathology Cases

Vessel severed...

Plasma contacts Tissue Factor (TF)...

TF binds VII/VIIa...

VII/VIIa complex with TF activates IX and X...

And the rest happens like in your old textbooks.

{06299} thrombus on a venous catheter

{11039} lines of Zahn
{11132} lines of Zahn
{11451} lines of Zahn
{06530} lines of Zahn. The lines themselves are subtle. Thrombus in a coronary artery (left side). Cholesterol needles from a plaque that has ruptured into the bloodstream.

Fresh thrombus
Deep inside, lines of Zahn
ERF/KCUMB

Thrombosis
From Chile
In Spanish

Post-mortem thrombus
From a "pop" site that erroneously
called this a pulmonary embolus

{06317} atrial mural thrombus
{11600} old cardiac mural thrombus

Mural thrombus
After heart attack
Utah Webpath

{19454} thrombus on ruptured plaque in coronary artery. Fresh thrombus at bottom. Starting to scar up at top.
{24781} thrombus in the carotid artery

{06287} thrombus on a heart valve

{06293} organizing thrombus, leg vein
{06305} organizing thromboembolus, lung

Pulmonary thromboembolus
Autopsy photo
KU Collection

Pulmonary thromboembolus
Main pulmonary artery has been opened
Utah

Carotid Artery Thrombosis
Australian Pathology Museum
High-tech gross photos

{06533} recanalized thrombus

Organizing venous thrombus
Great labels
Romanian Pathology Atlas

Recanalized thrombus
Teaching photo
from Hopkins

Recanalized thrombus
Small pulmonary artery
UCSF

DISSEMINATED INTRAVASCULAR COAGULATION (the dreaded "DIC", "consumption coagulopathy", or "defibrination syndrome")

{12308} schistocytes

{21028} DIC: little thrombus in a glomerulus

DIC
Renal glomeruli with fibrin plugs
Taiwan

DIC from meningococcemia
Thrombocytopenia
but no schistocytes yet

DIC
Nice schistocytes
Lichtman's Atlas

DIC
Nice schistocytes
Lichtman's Atlas

DIC
Photomicrograph of skin
Belgian trauma site

THROMBOEMBOLI

Emboli
From Chile
In Spanish

{10682} embolus, celiac trunk

{03182} saddle embolus
{10799} saddle embolus
{10802} saddle embolus
{11133} saddle embolus
{06311} pulmonary emboli
{20221} small pulmonary embolus
{20992} pulmonary embolus

AMNIOTIC FLUID EMBOLI ("amniotic fluid infusion")

{11663} amniotic fluid embolus

Amniotic fluid embolus

WebPath

Amniotic fluid embolus

WebPath Photo

AIR EMBOLI ("gas emboli", etc.): Gas in the circulation. Bubbles coalesce and produce a mass of air that the pulse pressure just compresses, preventing the blood from being pushed. Recalls "vapor lock" in automobiles.

Air in jugular at autopsy
Prize photograph
Institute of Medical Illustrators

Fatal air embolus
Post-mortem scan & photo
Swiss "virtual autopsy" team

FAT EMBOLI

{29056} fat embolus in lung, oil red O stain
{29057} fat embolus in lung, oil red O stain

Fat Embolus
Lung
WebPath Photo

Fat Embolus
Oil red O
WebPath Photo

Fat Embolus
Kidney
WebPath Photo

Fat Embolus
Brain
WebPath Photo

Fat Embolus
Brain
WebPath Photo

Fat Embolus
Brain -- oil red O
WebPath Photo

Fat embolus

WebPath

OTHER EMBOLI

{10889} atherosclerotic embolus
{25651} atheroembolus
{25652} atheroembolus

Atheroembolization
Kidney
ERF/KCUMB

Bone Marrow Embolus
Tom Demark's Site

Bone Marrow Embolus
Slide from Andrea McCollum MD
Cuyahoga County Coroner's Office

Talc in the lung
Intravenous drug abuser
Utah Webpath

Crystals in the lungs of drug abusers
Lung pathology series
Dr. Warnock's Collection

Cancer embolus to pulmonary artery
AFIP
Wikimedia Commons

INFARCTION

Kidney infarct.

WebPath Photo

Coagulation necrosis.
Spleen infarct.
WebPath Photo

Infarcts
From Chile
In Spanish

{24501} infarct of hand following embolus to brachial artery

Infarcted bowel
Seen at surgery
U. of Pisa

Infarcted lung
Huge thromboembolus was present
Utah

Bowel infarct
Red
WebPath Photo

Bowel infarct
Urbana Atlas of Pathology

Bowel infarct
Urbana Atlas of Pathology

Red lung infarct
Urbana Atlas of Pathology

Red infarct of the colon
Neglected peritonitis with
vascular compromise

Myocardial Infarct
Australian Pathology Museum
High-tech gross photos

{17390} hemorrhagic lung infarct

{17384} schematic infarct
{17385} schematic infarct
{17388} Zahn infarct of liver
{46489} real necrotic infarcts of the liver

SHOCK ("circulatory collapse"): Widespread hypoperfusion of the tissues

{06359} shock lung
{06362} shock liver
{06365} shock liver; histology; note central necrosis

GENERAL REACTIONS TO SHOCK AND TRAUMA

* * * 

BIBLIOGRAPHY / FURTHER READING

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