Hemodynamic Disorders

Fluid Homeostasis

Homeostasis is maintained by the opposing effects of:

• Vascular Hydrostatic Pressure – and

• Plasma Colloid Osmotic Pressure

EdemaASCITES

Pitting EdemaPERIORBITAL (RENAL)

Pulmonary Edema

• The Lungs are typically 2-3 times normal weight

• Cross sectioning causes an outpouring of frothy, sometimes blood-tinged fluid

• It may interfere with pulmonary

function

Pulmonary Edema

the alveolar capillaries are engorged, and an intra-alveolar granular pink precipitate is seen

Brain Edema

The surface of the brain with cerebral edema demonstrates widened gyri with a flattened surface. The sulci are narrowed

Brain Edema

Clinical Correlation The big problem is: There is no place for the fluid to go!

• Herniation into the

foramen magnum will kill

Effects of Lipopolysaccharide

Septic Shock

LPS = lipopolysaccharide

TNF = tumor necrosis factor

IL = interleukin

NO = nitric oxide

PAF = platelet-activating factor

ARDS/diffuse alveolar damage in shock

Some of the alveoli are collapsed; others are distended. Many contain dense proteinaceous debris, desquamated cells, and hyaline membranes

MYOCARDIAL NECROSIS in Shock

lower field contains intact myocardium, while the upper field exhibits coagulation necrosis of myocardium. the hypoperfusion is greatest in the subendeocardium, which is perfused mainly in diastole.

ATN

ATN in shock , extensive tubular isghaemia , note relative sparing of the glomeruli.