Haemodynamic Disorders PDF

6 ‫انسجة نظري‬ Haemodynamic Disorders Haemodynamic ‫ح‬ٕٚ‫ح انذٔسج انذي‬ٛ‫ك‬ٛ‫ُاي‬ٚ‫د‬ OVERVIEW: In general terms, the topic of h...

6 ‫انسجة نظري‬ Haemodynamic Disorders Haemodynamic ‫ح‬ٕٚ‫ح انذٔسج انذي‬ٛ‫ك‬ٛ‫ُاي‬ٚ‫د‬ OVERVIEW: In general terms, the topic of hemodynamics deals with flow and distribution of blood and fluids within the body. To maintain the correct amount of intravascular and extravascular volumes, the body must maintain both hydrostatic pressure and osmotic pressure. An imbalance in either of these two pressures results in an abnormal distribution of fluid in the cells or interstitial tissues (Figure 1). The term used to describe excessive amounts of fluid within the interstitial tissues or within cells is edema. ،‫ح ٔخاسخٓا‬ٛ‫سح يٍ األزداو داخم األٔػ‬ٛ‫ح انصس‬ًٛ‫ نهسفاظ ػهٗ انك‬.‫غ انذو ٔانسٕائم داخم اندسى‬ٚ‫كا انذو ذذفك ٔذٕص‬ٛ‫ُاي‬ٚ‫رُأل يٕظٕع د‬ٚ ،‫ تشكم ػاو‬:‫َظشج ػايح‬ ٙ‫ نهسٕائم ف‬ٙ‫ؼ‬ٛ‫ش غث‬ٛ‫غ غ‬ٚ‫ٍ إنٗ ذٕص‬ٛ‫ٍ انعغط‬ٚ‫ أ٘ يٍ ْز‬ٙ‫ؤد٘ ػذو انرٕاصٌ ف‬ٚ.٘‫ ٔانعغػ األسًٕص‬ٙ‫ك‬ٛ‫ذسٔسراذ‬ٛٓ‫سافع اندسى ػهٗ كم يٍ انعغػ ان‬ٚ ٌ‫دة أ‬ٚ.‫ا ْٕ انٕسو‬ٚ‫ح أٔ داخم انخال‬ٛ‫اخ انضائذج يٍ انسٕائم داخم األَسدح انخالن‬ًٛ‫ انًصطهر انًسرخذو نٕصف انك‬.)1 ‫ح (انشكم‬ٛ‫ا أٔ األَسدح انخالن‬ٚ‫انخال‬ The process of coagulation serves to maintain the integrity of the vasculature in the event of disruption of the vascular wall. Inappropriate coagulation can have deleterious consequences, however. For example, abnormal coagulation can result in vessel occlusion; thus the process must be closely controlled. An adequate supply of blood to the tissues is vital because it provides oxygen and nutrients to the cells and removes toxic metabolites from the cells. An inadequate amount of blood flow to an organ is termed ischemia. ‫ش انًُاسة ػٕالة‬ٛ‫كٌٕ نهرخثش غ‬ٚ ٌ‫ًكٍ أ‬ٚ ،‫ ٔيغ رنك‬.‫ح‬ٕٚ‫ح انذي‬ٛ‫ خذاس األٔػ‬ٙ‫ زانح زذٔز خهم ف‬ٙ‫ح ف‬ٕٚ‫ح انذي‬ٛ‫ح انرخثش ػهٗ انسفاظ ػهٗ ساليح األٔػ‬ٛ‫ذؼًم ػًه‬ ‫ نألَسدح‬ٙ‫ش انذو انكاف‬ٛ‫ؼذ ذٕف‬ٚ.‫ح ػٍ كثة‬ٛ‫دة يشالثح انؼًه‬ٚ ٙ‫ ٔتانران‬.‫ح‬ٕٚ‫ح انذي‬ٛ‫ إنٗ اَسذاد األٔػ‬ٙ‫ؼ‬ٛ‫ش انطث‬ٛ‫ؤد٘ انرخثش غ‬ٚ ٌ‫ًكٍ أ‬ٚ ،‫م انًثال‬ٛ‫ ػهٗ سث‬.‫ًح‬ٛ‫ٔخ‬.‫ح‬ٚٔ‫ح يٍ ذذفك انذو إنٗ انؼعٕ َم انرش‬ٛ‫ش كاف‬ٛ‫ح غ‬ًٛ‫طهك ػهٗ ك‬ٚٔ.‫ا‬ٚ‫م انًسرمهثاخ انسايح يٍ انخال‬ٚ‫ض‬ٚٔ ‫ا‬ٚ‫ح نهخال‬ٚ‫ٍ ٔانًٕاد انًغز‬ٛ‫ٕفش األكسد‬ٚ َّ‫ًا أل‬ٕٚٛ‫أيشا ز‬ ً In vessels, hydrostatic pressure refers to the pressure pushing fluid out into the interstitial tissue. In interstitial tissue, hydrostatic pressure pushes fluid into the vessels. Osmotic pressure, which is imparted by thepresence of dissolved solutes, pulls fluid into the vessels and into the interstitial tissue. ٗ‫ انسائم إن‬ٙ‫ك‬ٛ‫ذسٔسراذ‬ٛٓ‫ذفغ انعغػ ان‬ٚ ،‫ح‬ٛ‫ األَسدح انخالن‬ٙ‫ ف‬.ٙ‫ح انخالن‬ٛ‫ذفغ انسائم إنٗ داخم انُس‬ٚ ٘‫ إنٗ انعغػ انز‬ٙ‫ك‬ٛ‫ذسٔسراذ‬ٛٓ‫ش انعغػ ان‬ٛ‫ش‬ٚ ،‫ح‬ٛ‫ األٔػ‬ٙ‫ف‬.‫ح‬ٛ‫ح ٔإنٗ األَسدح انخالن‬ٕٚ‫ح انذي‬ٛ‫ تسسة انسٕائم إنٗ األٔػ‬،‫ انُاذح ػٍ ٔخٕد انًٕاد انًزاتح‬،٘‫مٕو انعغػ األسًٕص‬ٚ.‫ح‬ٛ‫داخم األٔػ‬. Ischemia is an important cause of cellular dysfunction and, if severe, often leads to cell death..‫ا‬ٚ‫ؤد٘ إنٗ يٕخ انخال‬ٚ ‫ غانثا يا‬،‫ذا‬ٚ‫ ٔإرا كاٌ شذ‬،ٕ٘‫ح ْٕ سثة يٓى نهخهم انخه‬ٚٔ‫انرش‬ ‫ َم‬. Shock can result from a decreased amount of blood (i.e., hypovolemic shock), failure of the heart to effectively pump the blood (i.e., cardiogenic shock), or generalized dilation of the vasculature system secondary to infection (i.e., septic shock). ‫ح‬ٛ‫ َظاو األٔػ‬ٙ‫ أٔ ذٕسغ ػاو ف‬،)‫ح‬ٛ‫ ظخ انذو تشكم فؼال (أ٘ صذيح لهث‬ٙ‫ أٔ فشم انمهة ف‬،)‫زدى انذو‬ ‫ح انذو (أ٘ صذيح َم‬ًٛ‫ًكٍ أٌ ذُدى انصذيح ػٍ اَخفاض ك‬ٚ.)‫ح‬َٛ‫ح انثإَ٘ تسثة انؼذٖٔ (أ٘ صذيح إَرا‬ٕٚ‫انذي‬ Figure 1. interstitial tissues. 1  EDEMA Basic description: Accumulation of fluid within the cells, interstitial tissue, and body cavities..‫ف اندسى‬ٕٚ‫ح ٔذد‬ٛ‫ا ٔاألَسدح انخالن‬ٚ‫ ذشاكى انسٕائم داخم انخال‬:ٙ‫انٕصف األساس‬ Mechanisms of edema formation: Include increased vascular hydrostatic pressure, decreased plasma osmotic pressure, lymphatic obstruction, and inflammation. Increased vascular hydrostatic pressure is usually due to impaired venous return or arteriolar dilation. ‫ادج انعغػ‬ٚ‫ ص‬.‫ ٔاالنرٓاب‬،٘ٔ‫ ٔاالَسذاد انهًفا‬،‫ ٔاَخفاض انعغػ االسًٕص٘ نهثالصيا‬،ٙ‫ انٕػائ‬ٙ‫ك‬ٛ‫ذسٔسراذ‬ٛٓ‫ادج انعغػ ان‬ٚ‫ ذشًم ص‬:‫ٍ انٕريح‬ٕٚ‫اخ ذك‬ٛ‫آن‬.ٍٛٚ‫ذ٘ أٔ ذًذد انششا‬ٚ‫كٌٕ تسثة ظؼف انؼٕد انٕس‬ٚ ‫ ػادج يا‬ٙ‫ انٕػائ‬ٙ‫ك‬ٛ‫ذسٔسراذ‬ٛٓ‫ان‬ Causes of increased vascular hydrostatic pressure: :ٙ‫ انٕػائ‬ٙ‫ك‬ٛ‫ذسٔسراذ‬ٛٓ‫ادج انعغػ ان‬ٚ‫أسثاب ص‬ Heart failure: The heart is not pumping blood as effectively as it should, so there is a back up of blood into the veins..‫ األٔسدج‬ٙ‫رشاكى انذو ف‬ٚ ‫ نزنك‬،ٙ‫ُثغ‬ٚ ‫عخ انمهة انذو تشكم فؼال كًا‬ٚ ‫ ال‬:‫ فشم انمهة‬ Cirrhosis: Fibrous scarring of the liver that impairs return of blood through the portal vein, thereby increasing venous pressure in portal vein tributaries and causing fluid to leakinto the peritoneal cavity. ٙ‫ذ انثات‬ٚ‫ سٔافذ انٕس‬ٙ‫ذ٘ ف‬ٚ‫ادج انعغػ انٕس‬ٚ‫ؤد٘ إنٗ ص‬ٚ ‫ يًا‬،ٙ‫ذ انثات‬ٚ‫ك ػٕدج انذو ػثش انٕس‬ٛ‫ؼ‬ٚ ‫ انكثذ‬ٙ‫ ف‬ٙ‫ف‬ٛ‫ ذُذب ن‬:‫ف انكثذ‬ٛ‫ ذه‬.َٕٙ‫ر‬ٚ‫ف انثش‬ٕٚ‫ ذسشب انسٕائم إنٗ انرد‬ٙ‫رسثة ف‬ٚٔ. Venous obstruction: For example, a tumor pushing on a vein will cause back up of blood, eventually with leakage of fluid into the interstitium..ٙ‫ح انخالن‬ٛ‫رسشب انسائم إنٗ انُس‬ٚ ‫ح‬ٚ‫ انُٓا‬ٙ‫ ٔف‬،‫ذ إنٗ سخٕع انذو‬ٚ‫ؤد٘ ظغػ انٕسو ػهٗ انٕس‬ٚ ،‫م انًثال‬ٛ‫ ػهٗ سث‬:٘‫ذ‬ٚ‫ االَسذاد انٕس‬. Causes of decreased plasma osmotic pressure: :‫أسثاب اَخفاض انعغػ االسًٕص٘ نهثالصيا‬ Decreased production of albumin by the liver: A decreased level of albumin results in edemathrough decreased plasma osmotic pressure..‫ٍ إنٗ انٕريح يٍ خالل اَخفاض انعغػ األسًٕص٘ نهثالصيا‬ٛ‫ؤد٘ اَخفاض يسرٕٖ األنثٕي‬ٚ :‫ٍ تٕاسطح انكثذ‬ٛ‫ اَخفاض إَراج األنثٕي‬ Increased loss of protein by the kidney (e.g., certain glomerular diseases) or in the gut (e.g.,protein-losing gastroenteropathy). ‫ اػرالل‬،‫م انًثال‬ٛ‫ح (ػهٗ سث‬ًٛ‫ انمُاج انٓع‬ٙ‫ثاخ) أٔ ف‬ٛ‫ تؼط أيشاض انكث‬،‫م انًثال‬ٛ‫ك انكهٗ (ػهٗ سث‬ٚ‫ٍ ػٍ غش‬ٛ‫ادج فمذاٌ انثشٔذ‬ٚ‫ ص‬.)ٍٛ‫انًؼذج ٔاأليؼاء انُاخى ػٍ فمذاٌ انثشٔذ‬ ‫ح‬ٚ‫ سٕء انرغز‬ Malnutrition Causes of lymphatic obstruction: :‫ح‬ٚٔ‫ًفا‬ٛ‫أسثاب اَسذاد انغذد انه‬ Lymphoma compressing the thoracic duct or lymphatic channels;certain parasitic infestations, such as elephantiasis..‫م‬ٛ‫ يثم داء انف‬،‫ح‬ٛ‫ه‬ٛ‫ تؼط اإلصاتاخ انطف‬-.‫ح‬ٚٔ‫ح أٔ انمُٕاخ انهًفا‬ٚ‫عغػ ػهٗ انمُاج انصذس‬ٚ ‫ح‬ٚٔ‫ًفا‬ٛ‫سشغاٌ انغذد انه‬ 2  Causes of Inflammation: :‫أسثاب االنرٓاب‬ An important component of acute inflammation is increased vascular permeability, which causes edema..‫سثة انرٕسو‬ٚ ‫ يًا‬،‫ح‬ٕٚ‫ح انذي‬ٛ‫ح األٔػ‬ٚ‫ادج َفار‬ٚ‫أزذ انؼُاصش انًًٓح نالنرٓاب انساد ْٕ ص‬ Effects of edema depend upon organ involved ُٙ‫ذؼرًذ آثاس انٕسو ػهٗ انؼعٕ انًؼ‬ In soft tissues of the extremities: Edema usually produces no clinically significant damage. Over time, edema can cause changes in skin, but these are usually only cosmetic. ٌٕ‫ ٔنكٍ ْزِ ػادج يا ذك‬،‫ اندهذ‬ٙ‫شاخ ف‬ٛ‫ًكٍ أٌ ذسثة انرٕسياخ ذغ‬ٚ ،‫ يغ يشٔس انٕلد‬.‫ًا‬ٚ‫ش‬ٚ‫ش سش‬ٛ‫ ال ذُرح انٕريح ػادج ً أ٘ ظشس كث‬:‫ األغشاف‬ٙ‫ األَسدح انشخٕج ف‬ٙ‫ف‬.‫ح فمػ‬ٛ‫ه‬ًٛ‫ذد‬ In the lungs: Edema fluid fills the alveoli and pleural cavities, impairing the ability of the lung to oxygenate the red blood cells(Figure 2 A and B)..)‫ أ ٔ ب‬2 ‫ٍ (انشكم‬ٛ‫ا انذو انسًشاء تاألكسد‬ٚ‫عؼف لذسج انشئح ػهٗ إيذاد خال‬ٚ ‫ يًا‬،ٙ‫ف اندُث‬ٕٚ‫ح ٔانرد‬ٛ‫صالخ انٕٓائ‬ٕٚ‫ًأل سائم انٕريح انس‬ٚ :ٍٛ‫ انشئر‬ٙ‫ ف‬ In the brain: The brain is in a rigid compartment; edema causes the brain to swell, producing increased intracranial pressure (Figure 3). When the brain swells, there are only a few places into which it can expand. These expansions of the brain through available spaces are called herniations. ٖٕ‫ٕخذ س‬ٚ ‫ ال‬،‫رعخى انذياؽ‬ٚ ‫ ػُذيا‬.)3 ‫ادج انعغػ داخم اندًدًح (انشكم‬ٚ‫ؤد٘ إنٗ ص‬ٚ ‫ يًا‬،‫ زدشج صهثح؛ ذؤد٘ انٕريح إنٗ ذعخى انذياؽ‬ٙ‫ انذياؽ ف‬:‫ انذياؽ‬ٙ‫ ف‬.‫ انذياؽ يٍ خالل انًسازاخ انًرازح تانفرك‬ٙ‫ ٔذسًٗ ْزِ انرٕسؼاخ ف‬.‫ٓا‬ٛ‫رٕسغ ف‬ٚ ٌ‫ًكٍ أ‬ٚ ٙ‫م يٍ األياكٍ انر‬ٛ‫ػذد له‬ Important concepts and terms ‫ى ٔيصطهساخ يًٓح‬ْٛ‫يفا‬ Transudate: Protein and cell-poor fluid.Cardiac failure or decreased protein levels cause a transudate..‫ٍ إنٗ زذٔز االسذشاذ‬ٛ‫اخ انثشٔذ‬ٕٚ‫ؤد٘ فشم انمهة أٔ اَخفاض يسر‬ٚ :‫ االسذشاذ‬ Exudate: Protein and cell-rich fluid. Inflammation causes an exudate..‫سثة االفشاصاخ‬ٚ ‫ االنرٓاب‬.‫ا‬ٚ‫ح تانخال‬ُٛ‫ٍ ٔانسٕائم انغ‬ٛ‫ انثشٔذ‬:‫ اإلفشاصاخ‬ Dependent edema: Occurs in the extremities and areas of the body where accumulation of fluid is dependent upon gravity. Dependent edema is most commonly associated with heart failure..‫اٌ تمصٕس انمهة‬ٛ‫ أغهة األز‬ٙ‫ ذشذثػ انٕريح انراتؼح ف‬.‫ح‬ٛ‫ٓا ػهٗ اندارت‬ٛ‫ؼرًذ ذشاكى انسٕائم ف‬ٚ ٙ‫ األغشاف ٔيُاغك اندسى انر‬ٙ‫ ذسذز ف‬:‫ انٕريح انراتؼح‬ Pitting edema: When the skin and underlying soft tissues of a leg with edema are compressed with fingers, the impressions remain. This type of edema is most commonly associated with heart failure and is usually a transudate (Figure 4 A and B). ٙ‫شذثػ ْزا انُٕع يٍ انٕريح ف‬ٚ.‫ ذظم االَطثاػاخ لائًح‬،‫ انساق انًصاتح تانٕريح تاألصاتغ‬ٙ‫رى ظغػ اندهذ ٔاألَسدح انشخٕج انكايُح ف‬ٚ ‫ ػُذيا‬:‫ انٕريح انًُُمشج‬.)‫ أ ٔ ب‬4 ‫كٌٕ اسذشا ًزا (انشكم‬ٚ ‫اٌ تفشم انمهة ٔػادج ً يا‬ٛ‫أغهة األز‬ Anasarca: Generalized edema of the entire body that is most commonly associated with glomerular protein loss by the kidneys..ٗ‫ك انكه‬ٚ‫ ػٍ غش‬ٙ‫ث‬ٛ‫ٍ انكث‬ٛ‫اٌ تفمذ انثشٔذ‬ٛ‫ أغهة األز‬ٙ‫ اندسى تأكًهّ ذشذثػ ف‬ٙ‫ ٔريح ػايح ف‬:‫ أَساسكا‬ 3  Figure 2. Pleural effusion with pulmonary edema. A, Figure 3. Cerebral edema. This patient had a Accumulation of fluid in the pleural cavities. B, neoplasm on the left side of the brain. The Microscopic section from a patient with pulmonary edema of the brain was confined to the left edema. The edema fluid (arrows) stains light pink. cerebralhemisphere (the site of the tumor). SHOCK Basic description: Generalized hypoperfusion of the body (i.e., not enough blood is being circulated to supply the organs with the oxygen they require). The three main types of shock are cardiogenic,hypovolemic, and septic. ‫ح‬ٛ‫س‬ٛ‫ األَٕاع انثالثح انشئ‬.)ّ‫ٍ انز٘ ذسراخ‬ٛ‫ذ األػعاء تاألكسد‬ٚٔ‫ يٍ انذو نرض‬ٙ‫كف‬ٚ ‫رى ذذأل يا‬ٚ ‫ اندسى (أ٘ أَّ ال‬ٙ‫ َم ذذفك انذو تشكم ػاو ف‬:ٙ‫انٕصف األساس‬.‫ ذؼفٍ انذو‬،‫ َٔم زدى انذو‬،‫ح‬ٛ‫ انصذياخ انمهث‬ْٙ ‫نهصذياخ‬ CARDIOGENIC SHOCK ‫ح‬ٛ‫صذيح لهث‬ Basic description: Failure of the heart as a pump..‫ فشم انمهة كًعخح‬:ٙ‫انٕصف األساس‬ HYPOVOLEMIC SHOCK ‫زدى انذو‬ ‫صذيح َم‬ Basic description: Lack of enough blood (due to loss) to properly perfuse the body— most commonly due to trauma. 0.‫ػا تسثة انصذيح‬ ً ٕٛ‫ ْٕٔ األكثش ش‬- ‫ر‬ٛ‫ح اندسى تشكم صس‬ٚٔ‫ (تسثة فمذاَّ) نرش‬ٙ‫انذو انكاف‬ ‫ َم‬:ٙ‫انٕصف األساس‬ SEPTIC SHOCK Basic description: Generalized vascular dilation caused by an infectious organism, usually due to lipopolysaccharides (LPS) in the cell wall of gram-negative bacterial organisms such as Escherichia coli , Pseudomonas, and Klebsiella. Blood pools in the venous system and peripheral vasculature and not enough returns to the heart to be pumped out. ‫ح سانثح‬ٚ‫ش‬ٛ‫ح نهكائُاخ انثكر‬ٛ‫ خذاس انخه‬ٙ‫) ف‬LPS( ‫ح‬ُْٛ‫ذ انذ‬ٚ‫ذاخ انسكاس‬ٚ‫ ػادج تسثة ػذ‬،٘‫ح انًؼًى انُاخى ػٍ كائٍ يؼذ‬ٕٚ‫ح انذي‬ٛ‫ ذًذد األٔػ‬:ٙ‫انٕصف األساس‬.ّ‫رى ظخ‬ٛ‫ إنٗ انمهة ن‬ٙ‫كف‬ٚ ‫ؼٕد يا‬ٚ ‫ح ٔال‬ٛ‫ح انطشف‬ٕٚ‫ح انذي‬ٛ‫ذ٘ ٔاألٔػ‬ٚ‫ اندٓاص انٕس‬ٙ‫ردًغ انذو ف‬ٚ.‫ال‬ٛ‫ح ٔانضائفح ٔانكهثس‬َٕٛ‫ح انمٕن‬ٛ‫ك‬ٚ‫اندشاو يثم اإلشش‬ Figure 4. Pitting edema. Compression of the tissue with fingertips (A) leads to temporary impressions (B). This form of edema is com monly associated with left- sided congestive heart failure and occurs most often in the lower extremities. 4