Oedema
Circulatory Disorders
Circulatory Disorders
Edema:
Normal
Microcirculation
Capillary
Arterial
Hydrostatic Pressure + 35
Oncotic Pressure
- 25
Net filtration Pressure + 10 mmHg
(leak-out)
Lymph vessels
Circulatory Disorders
Venous
+ 15
- 25
- 9 mm Hg
(Reabsorb)
Circulatory Disorders
Edema mechanism:
Circulatory Disorders
Oedema fluid
Exudate
Transudate
Circulatory Disorders
Sites of accumulation
Circulatory Disorders
Increased hydrostatic
pressure
Arteriolar dilatation
Venous out flow impairment
Pitting oedema
Local- DVT of lower limb
Acute LVF
Ascites of liver desease (portal HPT)
Postural oedema
Generalized-CCF-dependant
Circulatory Disorders
Decreased oncotic
pressure
Circulatory Disorders
Tissue factors
Increased vascular permeability
(increased tissue oncotic pressure)
Generalized-systemic infections
poisoning drugs chemicals
Anaphylactic reactions
Anoxia
localized -Inflammation
Loose tissues(tissue pressure)
Circulatory Disorders
Lymphatic obstruction
Localized
Eg; Filariasis
Breast carcinoma
Pressure on thoracic duct
Non pitting oedema
Circulatory Disorders
Circulatory Disorders
CVP
COP
Chronic hypoxia
hypovolaemia
capillary permeability
Hydrostatic
pressure
extra renal
mechanisms
GFR
ADH
Circulatory Disorders
Excercise
Pathogenesis of oedema in
cirrhosis
Circulatory Disorders
Shock:
A clinical statecharacterized by
generalized decrease in tissue
perfusion due to decrease in
effective cardiac output
Circulatory Disorders
Hypoperfusion of tissue
Reduced blood volume
Reduced cardiac out put
Redistribution of blood
Leading to inadequate effective
circulatory volume
Circulatory Disorders
Cardiogenic shock
Hypovolaemic shock
Septic shock
Rare types
Neurogenic shock
Anaphylactic shock
Circulatory Disorders
Cardiogenic shock
Myocardial infarction
Rupture of heart
Rhythm diturbences
Out Flow obstruction-Pulmonary
embolism
Mechanism failure of myocardial
pump
Circulatory Disorders
Hypovolaemic shock
Haemorrhage
Fluid loss/vomiting,diarrhoea,burns
Circulatory Disorders
Septic shock
Circulatory Disorders
Neurogenic shock
anaesthetic accidents
Spinal cord injuries
massive peripheral vasodilatation
Anaphylactic shock
Generalized type 1
hypersensitivity
Circulatory Disorders
Stages of shock
Non progressive
Progressive
-Reversible
-Irreversible
Circulatory Disorders
Non Progressive
-Compensatory mechanisms
-Vital organs
preserved
Eg: Blood loss-early shock
cardiac output & blood pressure
maintained
Heart brain not affected
Circulatory Disorders
Produces- pulse
-peripheral vasoconstriction-pale
,cool
-Fluid conservation-kidney
Rx
best response
Circulatory Disorders
Uncorrected -progressive
Vital organs
hypoxia
anaerobic
metabolism
Lactic acidosis
peripheral vasodialation
DIC
endothelial damage
Circulatory Disorders
Brain
Kidney
confused
UOP
Irreversible
Kidney
total anuria
Brain injury
Myocardial failure
Circulatory Disorders
Circulatory Disorders
Circulatory Disorders
Shock Featurs:
Hypotension
Tachycardia
Cold clammy skin
Rapid shallow respiration.
Drowsiness, confusion, irritability
Multi organ failure.
Circulatory Disorders
Exercise