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HEMORRHAGE - University of Prince Edward · PDF fileDiapedesis HEMORRHAGE . HEMORRHAGE •Bleeding from a small defect Hemorrhage by Diapedesis • RBCs passing through a wall in inflammation

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Text of HEMORRHAGE - University of Prince Edward · PDF fileDiapedesis HEMORRHAGE . HEMORRHAGE...

  • Learning Objectives

    Recognize and describe hemorrhage as to its size and location using proper terminology

    Outline the pathogenesis of hemorrhage

    Describe the outcome of hemorrhagic lesions

    HEMORRHAGE

  • Circulatory Disturbances 4: Hemorrhage

    Shannon Martinson, Feb 2017

    http://people.upei.ca/smartinson/ VPM 152 General Pathology

  • Edema

    Hyperemia and congestion

    Shock

    Hemorrhage

    Thrombosis and embolism

    Infarction

    CIRCULATORY DISTURBANCES

    Altered hemostasis

    Altered Blood flow

  • Escape of blood from the cardiovascular system Hemorrhage

    Internal External

    HEMORRHAGE

  • Causes

    Trauma

    Sepsis, viruses, or toxins

    Abdominal neoplasia

    Coagulation disorders

    Platelet disorders

    Congestion (capillary hemorrhage)

    HEMORRHAGE

  • Causes

    Trauma

    Sepsis, viruses, or toxins

    Abdominal neoplasia

    Coagulation disorders

    Platelet disorders

    Congestion (capillary hemorrhage)

    HEMORRHAGE

  • Causes

    Trauma

    Sepsis, viruses, or toxins

    Abdominal neoplasia

    Coagulation disorders

    Platelet disorders

    Congestion (capillary hemorrhage)

    HEMORRHAGE

  • Causes

    Trauma

    Sepsis, viruses, or toxins

    Abdominal neoplasia

    Coagulation disorders

    Platelet disorders

    Congestion (capillary hemorrhage)

    HEMORRHAGE

  • www.merckvetmanual.com

    Causes

    Trauma

    Sepsis, viruses, or toxins

    Abdominal neoplasia

    Coagulation disorders

    Platelet disorders

    Congestion (capillary hemorrhage)

    HEMORRHAGE

  • Causes

    Trauma

    Sepsis, viruses, or toxins

    Abdominal neoplasia

    Coagulation disorders

    Platelet disorders

    Congestion (capillary hemorrhage)

    HEMORRHAGE

  • Significance

    HEMORRHAGE

    Location:

    Brain

    Pericardium

    Volume and rate:

    worse -

    Hemorrhagic shock

  • Blood accumulation beneath / above the dura Subdural / Epidural

    hemorrhage

    Compresses the brain

    HEMORRHAGE

  • Heart failure due to massive accumulation of fluid/blood in the pericardial sac

    Cardiac Tamponade

    HEMORRHAGE

    Compresses the atria and ventricles - restricts diastolic cardiac filling

  • Hemorrhage from a tear in blood vessel or heart Hemorrhage by

    Rhexis

    HEMORRHAGE

  • HEMORRHAGE

    Hemorrhage from a tear in blood vessel or heart Hemorrhage by

    Rhexis

  • Results in moderate to marked hemorrhage

    HEMORRHAGE

    Hemorrhage from a tear in blood vessel or heart Hemorrhage by

    Rhexis

  • Bleeding from a small defect Hemorrhage by

    Diapedesis

    HEMORRHAGE

  • HEMORRHAGE

    Bleeding from a small defect Hemorrhage by

    Diapedesis

  • RBCs passing through a wall in inflammation or vasculitis

    RBCs entering alveoli with lung congestion

    HEMORRHAGE

    Bleeding from a small defect Hemorrhage by

    Diapedesis

  • Increased tendency to hemorrhage from usually insignificant injuries

    Hemorrhagic Diathesis

    HEMORRHAGE

    Seen in a wide variety of clinical disorders: Platelet disorders and Coagulation deficiency

  • Extravascular 3D blood clot

    Hemorrhage enclosed within a tissue Hematoma

    HEMORRHAGE

    Splenic hematoma

  • Photos: Dr R Lofstedt, AVC

    HEMORRHAGE

    Extravascular 3D blood clot

    Hemorrhage enclosed within a tissue Hematoma

    Ovarian hematoma

  • Blood in the pericardial sac Hemopericardium

    Can lead to cardiac tamponade

    HEMORRHAGE

  • Blood in the thorax (pleural cavity) Hemothorax

    HEMORRHAGE

  • Blood in the abdomen (peritoneal cavity) Hemoabdomen

    (Hemoperitoneum)

    HEMORRHAGE

  • Blood in the joint spaces Hemarthrosis

    HEMORRHAGE

  • Coughing blood from the lungs or airways Hemoptysis

    HEMORRHAGE

  • Bleeding from the nose Epistaxis

    HEMORRHAGE

  • Vomiting up blood Hematemesis

    HEMORRHAGE

    Presence of fresh blood in the stool Hematochezia

    Presence of tarry blood in the stool Melena

  • Pinpoint (~1-2 mm) hemorrhages

    Most common in the skin, mucosa, serosa Petechia(e)

    HEMORRHAGE

  • 3 mm 1 cm hemorrhages

    Most common in the skin, mucosa, serosa Purpura

    HEMORRHAGE

  • Hemorrhages larger than 1 cm

    Often blotchy and irregular

    Ecchymosis

    (Ecchymoses)

    HEMORRHAGE

  • Hemorrhage which looks like red paint was applied with a brush

    Paint brush hemorrhage

    HEMORRHAGE

  • HEMORRHAGE

    Areas of hemorrhage larger than ecchymoses and contiguous

    Suffusive hemorrhage

  • Areas of hemorrhage larger than ecchymoses and contiguous

    Suffusive hemorrhage

    HEMORRHAGE

  • Refer to petechiae and ecchymoses that are associated with the death struggle (terminal hypoxia)

    Agonal hemorrhage

    HEMORRHAGE

  • Arrest of hemorrhage occurs as a result of hemostasis

    Resolution depends on the amount of hemorrhage

    Resolution of Hemorrhage

    A small amount can be resorbed

    1. Resorption

    Larger amounts require breakdown and removal of RBCs by macrophages

    Hemoglobin pigment broken down sequentially

    Connective tissue organization occurs in large hematomas

    2. Organization

    HEMORRHAGE

  • Hemoglobin Bilirubin Hemosiderin

    Resolution of Hemorrhage

    HEMORRHAGE

    Blue-Green Yellow-Brown Red - Blue

  • Center contains fibrin and RBCs that are phagocytosed by macrophages

    Outside is composed of vascularized fibrous tissue

    Organizing hematoma

    HEMORRHAGE

    Aural hematoma http://criticalcaredvm.com

  • REVIEW

    Coelomic cavity of male turkey with ruptured aorta which term is correct for this lesion?

    Hemorrhage by diapedesis

    Hemorrhage by rhexis

    Hemarthrosis

    Petechiae

    Hemoptysis

  • REVIEW

    What is your diagnosis?

    Hemothorax

    Hydrothorax

    Chylothorax

    Hemopericardium

    Hydropericardium

  • Morphologic Diagnosis and Speculate on cause...

    Hydroperitoneum - Ruptured small intestine

    Ascites - Left Heart Failure

    Hydroperitoneum - Liver Failure

    Ascites - Right heart failure

    Morphologic Diagnosis and Speculate on cause... REVIEW

  • REVIEW

    What type of hemorrhage is this?

    Ecchymoses

    Paintbrush hemorrhage

    Purpura

    Petechiae

    Suffusive hemorrhage

  • This aortic rupture could have resulted in which of the following?

    Hemothorax

    Cardiac tamponade

    Cor pulmonale

    Hemoptysis

    Hemopericardium

    REVIEW

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