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

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