General Pathology

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General Pathology

• Circulation
• Disorders - II
• Manifestations Causes of Local Circulatory
  Disturbances

Jaroslava Dušková Inst. Pathol. ,1st Med.
Faculty, Charles Univ. Prague
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Manifestations of Local Circulatory Disturbances

• local hyperemia
• local anemia
• LOCAL ISCHEMIA

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Manifestations of Local Circulatory Disturbances

• local hyperemia
• active arterial (fluxe)
  
• capillary
  (peristatic)
• passive venous (stasis)

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Manifestations of Local Circulatory Disturbances

• local anemia
• slow development vascular atrophy
• fast development dystrophy , necrosis
  
• 
  

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Ischemia stratification of changes

• complete necrosis - central part
• myomalacia
• hyperemia
• interstitial leucocyte infiltration vital
  reaction
• dystrophic steatosis ( glycogenosis)
• healthy

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Causes of Local Circulatory Disturbances

• local anemia
• stenosis to occlusion of artery
• lumen embolism
• wall atherosclerosis, thrombosis
• (spasmus, depositions,
  inflammations, tumours)
• combination of previous
• neighbourhood compression
  

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Causes of Local Circulatory Disturbances

• local hyperemia
• active
• function
• inflammatory vasodilation
• passive (outflow blocade)
• lumen
• wall
• neighbourhood

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Thrombosis

• Def.
• intravital intravascular
• blood clotting
• Range
• parietal
• obturative

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Haemostasis

• Endothelium damage vWF secretion
• Thrombocytes adhesion aggregation
• Thrombocytes secretion
• serotonin, PDGF, thromboxan A2
  vasoconstriction
• fibronectin, vWF, fibrinogen aggregation
• Plasma factors - proteins synthesized in hct,
  (vit. K dependence) cascade activation

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Coagulum x Thrombus

• postmortem
• autolysis protein activation
• thrombin liberation
• no platelet thrombus
• fibrinogen - fibrin
• non adherent
• elastic

• intravital
• platelet based
• adherent to the vessel wall
• friable /crumbly

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Types of Thrombi

• red stagnation
• white fluxe
• mixed
• hyaline

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Thrombosis - causes

• blood stagnation
• endothelium damage
• blood composition changes

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Thrombosis - causes

• blood stagnation
• heart failure
• vein insufficiency
• local factors (compression)

laminar flow disturbance
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Thrombosis - causes

• endothelium damage
• atherosclerosis
• inflammation
• injury
• hemodynamic stress
• high cholesterol levels

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Thrombosis - causes

• blood composition changes
• increased platelet number (over 400 000/mm3)
• thromboplastin liberation (e.g. following
  pancreas and lung surgery)
• endotoxin - DIC
• amniotic fluid embolism
• contraceptives

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Hypercoagulation

• inborn
• mutations
• with increased levels of thrombocytes or lack of
  anticoag. proteins

• acquired
• pregnancy
• contraceptives
• disseminated neoplasms
• atrial flutter
• arteficial valves
• surgery.

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Thrombus development

• no
• lysis
• organisation (decoloration,
  recanalization, hyalinization, dystrophic
  calcification - phlebolith)
• lysis organisation
• embolism
• puriform softening
• infection

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Natural Anticoagulant Systems

1. Antithrombins e.g.antithrombin III
   inhibits fcts IXa,Xa,XIa,XIIa
2. Proteins C, S (vit K dependent) inh. fcts
   Va, VIIIa
3. Plasminogene plasmin system fibrin
   breakdown

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Embolism

• Def.
• transport of a compact particle in circulation
  with stopping in the place of anatomic narrowing

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Emboli Types

• thrombotic
• fat
• air
• amniotic fluid
• cellular (neoplastic, bacterial
  trophoblastic)
• foreign body

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Embolism Fate

• THROMBOTIC
• no
• organisation
• lysis , resorption
• progression
• fat
• air
• amniotic fluid

life threatening
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Embolism Fate

• CELLULAR
• lysis trophoblastic
• progression
• neoplastic METASTASES
• bacterial metastatic sepsis

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Caisson Disease (Decompression thickness gas
microembolism)
life threatening

• divers
• underwater construction workers
• unpressurized aircraft in high altitudes

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Factors Influencing Vessel Occlusion Result

• anatomy
• time
• tissue/organ sensitivity to hypoxy
• functional status
• general circulation status
• MEDICAL INTERVENTION

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Haemorrhagia

• Def.
• blood extravasation
• (and the presence of blood in the tissue)

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Hemorrhage Classification

• Source
• arterial
• capillary
• venous

• Localisation
• external
• internal

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Hemorrhage - pathogenesis

• Haemorrhagia
• per rhexin (trauma tear of the vessel
  wall)
• per diabrosin (arosion ulcus,
  neoplasm)
• per diapedesin (increased vessel
  permeability- leakage)

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Haemostasis

• Endothelium damage vWF secretion
• Thrombocytes adhesion aggregation
• Th secretion
• serotonin, PDGF, thromboxan A2
  vasoconstriction
• fibronectin, vWF, fibrinogen aggregation
• Plasma factors - proteins synthesized in hct,
  (vit. K dependence) cascade activation

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Hemorrhagic Statuses

• Thrombocytopaties
• thrombocytopenia, thrombasthenia
• Coagulopaties
• hemofilia, hypoprothrombinemia,
  afibrinogenemia,
• Vasculopaties
• scurvy, m. Osler,
• m. Schönlein Henoch