Circulatory Disturbances

Prepared by
Dr. Nourhan Elfar, Ph.D
 1- Hyperaemia (Active Hyperaemia)
Definition: Increased blood flow to organ or tissue due to active vasodilatation of its
arterioles & capillaries
Types:
§ Physiological: muscular exercise.
§ Pathological: acute inflammation.
Morphology: The affected tissues appear red (erythema) owing to engorgement with
oxygenated blood

2- Congestion (passive process)

Definition: Decreased blood flow from an organ, resulting in increased blood content. This
happens when something is interfering with the organ's venous drainage.
Types of congestion:
1- Local: acute or chronic.
2- Generalized : acute or chronic.
 3-Thrombosis
Definition: A thrombus is a compact mass formed of blood elements, inside blood vessel or
heart during life.
Causes :
1. Damage to the vascular endothelium (Endothelial injury).
2. Slowing of blood stream (Stasis).
3. Disorders of blood stream (Turbulence).
4. Changes in blood composition (Hypercoagulability of blood).

Mode of thrombus formation and types:

§ Pale thrombus: the initial thrombus is formed of platelets only.

§ Mixed thrombus: stasis allows deposition of RBCs and fibrin.

§ Propagating thrombus: when a thrombus occludes a vein completely, the proximal column
of blood clots till the next tributary. Opposite the tributary another thrombus is formed [the
blood is moving] and when it occludes the lumen completely it results in the formation of
another clot proximal to it. The process may be repeated several times [resulting in
alternating thrombi and clots] and may even reach the heart [fatal].
Sites of thrombus formation:
1-Thrombosis in veins:
more common because veins are thin-walled, superficial [easily injured] and blood flow is slow.
Venous thrombi cause congestion. They are of 2 types:
§ Thrombophlebitis: thrombosis initiated by inflammation. It may be septic [in veins draining
areas of acute suppuration] or aseptic [in veins exposed to trauma or radiation].
§ Phlebothrombosis: thrombosis initiated by factors other than inflammation such as stasis

2-Thrombosis in arteries:
less common because arteries are thick-walled, deep [less easily injured] and blood flow is rapid.
3-Thrombosis in the heart:
more common on the left side. Several types are known:
§ Mural [thrombus on rough endocardium, usually at site of myocardial infarction]
§ Vegetations [pale thrombus on the valve due to rheumatic and bacterial endocarditis]
4- Thrombosis in capillaries:
Rare, may be seen in acute inflammation or severe cold.
Fate and complications of thrombosis
A- Septic thrombus: may be fragmented by the proteolytic enzymes into septic emboli à
pyaemic abscesses.
B- Aseptic thrombus:
§ If it’s small --> Lysis, fragmentation.
§ If it’s large -->
1. Organization by Fibrosis.
2. Recanalization.
3. Dystrophic calcification.
4. Propagation.
5. Arterial occlusion (ischemia)
4- Embolism
Definition: Embolus is an insoluble material circulating in the blood. Embolism is
the impaction of an embolus in a narrow blood vessel.
Types of emboli :
§ Emboli of thrombotic origin (thrombo-embolism)
§ Air embolism
§ Fat embolism.
§ Amniotic fluid embolism
§ Tumor embolism.
§ Parasitic embolism.
§ Bacterial embolism.
Pulmonary Embolism
Sources of the embolus: the embolus may originate from:
• Thrombi in veins of lower limbs: after prolonged bed rest.
• Thrombi in iliac or pelvic veins: after labor or pelvic operation.
• Thrombi in the right side of the heart: right sided heart failure.
Effects:
• Big embolus: occluding the pulmonary trunk or one of its main branches à release of
excessive amounts of serotonin à bilateral pulmonary artery vasoconstriction à sudden
death due to acute right sided heart failure. No infarction [no time].
• Medium-sized embolus in healthy lung à no effect because the lung has double blood
supply [bronchial and pulmonary].
• Medium-sized embolus in lung suffering from chronic venous congestion à
haemorrhagic lung infarct.

• Small-sized embolus à no effect.

5- Ischemia
Definition: Decrease blood supply to tissue or organ due to occlusion of its arterial supply.
Types :
1- Sudden or Acute (Complete) Ischemia:
Causes :
• Thrombosis or embolism.
• Ligature of an artery.
2- Gradual or Chronic (Incomplete) Ischemia:
Causes :
• Atherosclerosis.
• Pressure from outside by enlarged lymph nodes, tumor mass

6- Infarction
Definition: An area of coagulative necrosis caused by sudden ischemia. It is liquefactive in
the brain.
Etiology: Mainly thrombosis or embolism causing complete arterial occlusion.
Fate : Fibrosis with dystrophic calcification
7- Gangrene
Definition: Massive tissue necrosis with superimposed putrefaction.

Causes :
1. Necrosis: usually caused by sudden ischemia

2. Putrefaction: caused by saprophytic bacteria which breaks down proteins and

produces H2S [bad odour]. The latter reacts with iron of haemoglobin forming iron
sulphide [black in colour].

Types:
§ Dry gangrene: senile gangrene
§ Moist gangrene
Dry gangrene
It usually affects limbs with poor collaterals when a main artery is occluded by:
1.Thrombosis usually on top of atherosclerosis.
2.Embolism.
3.Arterial spasm
4.Surgical ligature of artery.

Senile gangrene:
§ Usually affects old aged males, with atherosclerosis, weak cardiac action and low
body resistance.
§ It usually shows line of demarcation and line of separation.
Pathogenesis:
§ Dry gangrene of limbs is due to arterial occlusion, while veins are patent.
§ Gangrene in such cases is dry because:
ü Limbs are not rich in tissue fluids due to surface evaporation.
ü Since veins are patent, the present tissue fluid will be drained into the veins as
normal.
 Moist gangrene
§ It usually affects internal organs (intestine) due to sudden occlusion of both
arterial & venous blood supply.
§ There is no evaporation & no drainage by veins or lymphatics, so the tissue
remain moist.

Moist Gangrene Dry Gangrene

of the Intestine
Comparison between Dry & Moist gangrene

Dry Gangrene Moist Gangrene

Gradual arterial occlusion, by Sudden arterial & venous occlusion, by crush
atherosclerosis or arterial spasms. injuries, or bed sores.

Affects exposed parts (limbs) Affects internal organs (intestine).

Slow putrefaction & spread. Rapid putrefaction & spread.

Tissue dryness Tissue edema.

Line of demarcation & self separation Poor line of demarcation & no self separation.

Mild toxemia Severe toxemia.

 7- Edema
Definition: Pathological accumulation of excess fluids in the interstitial tissue spaces, serous
sacs and body cavities.

Types of edema: may by localized or generalized.

A- Localized: Edema
- Allergic edema - Inflammatory edema
- Venous obstruction - Lymphatic obstruction
B- Generalized edema :
- Cardiac edema, Renal edema, Nutritional edema
Type according to nature:
Pitting oedema.
Nonpitting oedema

Pitting Edema
 7- Hemorrage
Definition: Escape of the blood outside vessels or heart.

Causes :
q Traumatic
q Spontaneous:
a- Degenerative conditions of vessel wall: atheroma & aneurysm.
b- Destruction of vessel wall by tumor or peptic ulcer.
c- Hemorrhagic blood diseases : hemophilia & leukemia.
d- Vitamin C or vitamin K deficiency .
7- Hemorrage
Types of hemorrhage :

1- External hemorrhage :
§ Epistaxis: Bleeding from the nose.
§ Hemoptysis: Coughing blood.
§ Hematemesis: Vomiting blood
§ Melena: Presence of dark digested blood in stool.
§ Bleeding per rectum: Passage of fresh blood with stool.
§ Hematuria: Blood in urine.
§ Menorrhagia: Abnormal uterine bleeding
7- Hemorrage
Types of hemorrhage :

2-Internal hemorrhage:
§ Hemothorax: Bleeding into the pleural sac.
§ Hemopericardium: Bleeding into the pericardial sac.
§ Hemoperitoneum: Bleeding into the peritoneal sac.
§ Hemo-arthrosis: Bleeding into the joint cavity.
7- Hemorrage
Types of hemorrhage :

3- Interstitial hemorrhage :
§ Petechiae: Escape f small amount of blood → small spots of hemorrhage.

§ Ecchymosis: Escape of moderate amount of blood → bigger patch of hemorrhage

more than 1 cm.

§ Hematoma: Escape of large amount of blood → swelling bigger than ecchymosis.

7- Shock
Definition: Depression of vital functions due to decrease in cardiac output or acute
circulatory failure.
Types and Causes of Shock :

qHypovolemic shock:

oLoss of blood: Hemorrhage

oLoss od plasma: Burn

oLoss of fluid and electrolytes: Vomiting/Diarrhea

qCardiogenic shock: Myocardial infarction, heart failure.
qSeptic (Endotoxic) shock: Severe toxemia and septicemia.

qNeurogenic shock: Severe pain.

qAnaphylactic shock: Severe allergic conditions