Mechanisms of Disease Module Session 6 Hemodynamic disorders PDF

Mechanisms of Disease Module Session 6 Hemodynamic disorders Small groups Dr Adnan Anwer M.B.ch.B. – F.I.B.M.S. (Haematopath.)  Case 1 These photomicrographs show: A) a normal coronary artery and B) a coronary artery from a 60 year ol...

Mechanisms of Disease Module Session 6 Hemodynamic disorders Small groups Dr Adnan Anwer M.B.ch.B. – F.I.B.M.S. (Haematopath.)  Case 1 These photomicrographs show: A) a normal coronary artery and B) a coronary artery from a 60 year old man who died after suffering severe chest pain. C) transverse section from a heart complicated by coronary artery obstruction. 1. What is present in the lumen (B)? Thrombus (bloodClot 2. Name the causes of the luminal deposition to form? 2-Atherosclerosis 3. What are the effects on the heart? 4. How can this heart condition be treated? 3 Angina - myocardial , infarction (ischemia 4- a) Anti-Platelet drugs (AsPirin) b) Angioplast] 1) Thrombectomy A Normal artery lumen B Coronary atheroschlerosis C Myocardial infarction  Case No; 2 Difficult breathing 68 year old man, Known with Y hypertension, Presents with dyspnea, Pleural effusion clinically (Hemothorax). " Excess fluid (blood) Present between lumds and chest wall 1 What are the special investigations required? 2 What is the important of pleural fluid features? 1-X-ray Ultrasounds , Thoracentesis (Pleural Fluid analysis) 2-Helps us identify the underlying cause of Pleural effusion and the type (transudate/exudate) and guide us to treatment ,  When the result of the pleural fluid are: Pleural fluid biochemistry: Protein: 2 gm/dL Protein Poor Few cellularity Negative for Gram stain and TB Non-inflammatory Transudate The type is ---------------- What are the causes of this type pleural fluid? Imbalances in hydrodynamic Pressure Increased Capillar] Pressure Case No; 3 32 year old woman, Presents with fever, - pleuritic chest pain and dyspnea, Pleural effusion clinically was detected and confirmed by Chest X Ray (CXR). - And the pleural fluid was aspirated. What is the important of the pleural fluid for diagnosis? ↑ same as we mentioned before  Colour of the fluid: Turbid yellow in colour Pleural fluid biochemistry: Protein: 6 gm/dL - Protein rich Many cellularity (Mostly Neutrophills) Positive culture growth of Bacteria Exudative The type of fluid is ----------- inflammatory · Increased Vascular permeability · Lymphatic obstruction Nza ? Case No; 4 64 year old male, Previous hip surgery 20 days ago, sudden dyspnae, Pleuritic chest pain, Hypoxic, Clinically DVT. - 1. What are the differential diagnosis? 2. Does the patient have risk factors for pulmonary embolism (PE). Yes 3. Mention the sequence of events that led top this problem? immobility after hiP surgery DUT ? > - 4. What would you do to confirm the diagnosis? 5. Which treatments is important to be used? How you Interpret the case? CXR: Duplex doppler of legs: ECG :Exclude other differential diagnoses like? Most common ECG changes in PE : Arterial blood gas; D- dimer : CT pulmonary angiography : What is blocking the pulmonary arteries? Case 5 A 70 year old man suffered from severe abdominal pain and rapidly developed shock (low blood pressure and rapid pulse). He was admitted to hospital but, unfortunately, despite emergency surgery he died. This is the appearance of his intestine. What process has occurred to cause these clinical symptoms? Red infarction (Intestine dual supply Why might congestion have happened? 3 What do you think would happen if this intestine is not removed promptly? Congestion (hemorhagic infarction) Complicated (hemorhagic infarction with septic shock  What type of shock is this? Types of shock A 55 years male with history of hypertention, diabetes mellitus – Hypovolemic - presents with “~ crushing“ substernal chest pain, – Cardiogenic Cold diaphoresis,- hypotention, – Septic X extremeties - -- tachycardia and cool, clammy –X Anaphylactic I extremities. - – X Neurogenic -Tachycardia NO ! so – Obstructive  What type of shock is this? Types of shock An 81 years female resident of nursing home present to –X Hypovolemic -warm extremeties the emergency with altered mental status. She is febrile –X Cardiogenic S 6 - to 39.0 ºC, hypotensive with - – Septic widened pulse pressure, tachcardia, with warm - – Anaphylactic - exterimities - – X Neurogenic -Tachcardia –Y Obstructive  What type of shock is this? Types of shock A 38 years male present with - severe gastrointestinal upset - – Hypovolemic (diarrhea and vomiting), use – Cardiogenic The patient is hypotensive, – Septic - - tachycardia, a febrile, with - cool but dry skin. - – Anaphylactic – Neurogenic – Obstructive  What type of shock is this? Types of shock A 41 years male admitted to emergency unit after road - – Hypovolemic traffic accident, - He complained of decreased – Cardiogenic – Septic - sensation below his waist - On examination he was hypotensive, -bradycardic , with – Anaphylactic - - - - warm extremities. – Neurogenic Damage to – Obstructive spinal card probably