局部血液循环障碍

皮下出血 脑出血
硬膜下血肿
心脏破裂及心包积血
hemorrhages
petechia 淤点
ecchymosis 淤斑
Thrombosis 血栓形成
The formation of a clotted mass of blood in the noninterrupted cardiovascular system is known as thrombosis, and the mass itself is termed a thrombus.
Chronic pulmonary congestion
Brown duration （肺褐色硬化）
Congestion 淤血
---肝淤血 Liver congestion
Right-sided heart failure Acute hepatic congestion:
Gross: dusky red, tense, slightly heavy; LM: central vein and sinusoids are distended with blood
Interstitial hyperplasia: fibrosis, congestive sclerosis
间质纤维组织增生
Congestion 淤血
Morphology
Dilatation of local venules and capillaries
✓Parenchyma cell: atrophy, reversible injury and necrosis ✓Interstitial hyperplasia: fibrosis, congestive sclerosis
Local hemodynamic disorders
Water extravasati
Hyperemia充血 Congestion /淤血 Ischemia 缺血
Abnormal substances
Thrombus 血栓
Embolism 栓塞 --- Infarction 梗死
congestion of liver
Congestion 淤血
congestion of liver
Centrilobular necrosis with hemorrhage and hemosiderin
Congestion 淤血
congestion of liver
Centrilobular necrosis
血液从血管或心腔逸出,称出血.
破裂性出血
漏出性出血
出血 (Hemorrhage)
外出血-- 鼻出血，咯血，呕血，血便，血尿
- 淤点，紫癜，淤斑
内出血 - 体腔积血: (心包腔,胸腔,腹腔,关节腔) - 软组织血肿: (硬脑膜下血肿，腹膜后血肿，皮下血肿)
petechia 淤点(1-2mm) purpura 紫癜(3-5mm), ecchymosis 淤斑(大于1-2cm) hematoma 血肿
vascular injury Hemorrhage 出血
Section 1 Hyperemia or congestion
A local increased volume of blood in a particular tissue
局部组织血管内血液含量的增多
Hyperemia 动脉性充血
An active process resulting from augmented blood flow due to arteriolar dilation
Local hemodynamic disorders
局部血液循环障碍
A clinical case
病例摘要
死者熊卓为，49岁，北大医院心血管研究所研究员。2006年初， 因腰腿疼痛，到北大医院门诊接受保守治疗。1月18日，其X光检 查结果显示：腰椎骨关节病、腰4-5椎间盘病变、腰4Ⅰ度滑脱伴 峡部裂。于2006年1月23日入住北大医院。次日，熊接受了“L4/5 椎管减压，椎弓根钉内固定，后外侧植骨融合术”手术。术后第 六天，即1月30日，熊在下地行走时忽感头晕，摔倒于地，恶心呕 吐，血压、脉搏测不出。经抢救无效，于31日死亡。
sclerosis
出血 (Hemorrhage)
Loss of blood from the vascular compartment, usually as a result of trauma or disease of the vessel wall. This can involve large vessels, e.g, aorta or small vessels, e.g., capillaries.
局部静脉和毛细血管扩张
Congestive edema
淤血性水肿
Congestive hemorrhage，hemosiderin–laden macrophage
淤血性出血
Parenchyma cell: atrophy, reversible injury, necrosis
实质细胞萎缩、变性、坏死
There may be central hepatocyte necrosis
Chronic hepatic congestion: Gross: nutmeg liver LM: centrilobular necrosis and peri-lobular fatty change;
hemorrhage; atrophy long standing congestion—hepatic fibrosis
✓状告北京大学第一医院(以下简称北大医院)“非法行医” ✓3年多后，2009年11月3日，经由央视《经济半小时》报道 ✓ 2010年4月28日，对于熊卓为的丈夫王建国状告北大医院 “非法行医” 一案，北京市高级人民法院作出终审(二审)判决。
1、该患者的死亡原因是什么？
2、其死因是否与之前的骨科手术有关？
Intact Circulation ---
Proper function of Heart and lung Integrity of the vasculature maintenance of balance between the coagulation and fibrinolytic systems stability of normal fluid homeostasis
Congestion 淤血
Chronic congestion of the liver
fibrosis
Congestion 淤血
淤血性肝硬变(Congestive cirrhosis)
Morphology and Consequences of congestion
✓ Dilatation of local venules and capillaries ✓ Congestive edema ✓ Congestive hemorrhage ✓ Parenchyma cell: atrophy,degeneration, necrosis ✓ Interstitial hyperplasia: fibrosis, congestive
Congestion 淤血
A passive process resulting from impaired venous return from a tissue
器官或组织静脉血流回流受阻，血液淤积于小静脉 和毛细血管内，称淤血
Congestion 淤血
Causes
Systemically, in cardiac failure Local--venous obstruction
Congestion 淤血
Lung congestion 肺淤血
Left heart failure
Acute pulmonary congestion
Chronic pulmonary congestion
Congestion 淤血
Acute pulmonary congestion
Congestion 淤血
器官或组织因动脉输入血量的增多而发生的充血
Hyperemia 动脉性充血
Types: Physiologic， Pathologic (inflammation)
Morphology:
组织器官体积轻度增大 ，颜色鲜红，温度增高 细动脉和毛细血管扩张充血
Consequence:
Hyperemia 动脉性充血
Chronic pulmonary congestion
The septa become thickened and fibrotic The alveolar spaces contain hemosiderin–laden macrophages
Heart failure cells
Congestion 淤血
Acute pulmonary congestion
✓ Alveolar capillaries engorged with blood ✓ Alveolar septal edema ✓ Intra-alveolar edema fluid and hemorrhage
Congestion 淤血
uncongested tan.
在慢性肝淤血时，肝小叶 中央区因严重淤血呈暗红 色，两个或多个肝小叶中 央淤血区可相连，而肝小 叶周边部肝细胞则因脂肪 变性呈黄色，致使在肝的 切面上出现红（淤血区） 黄（肝脂肪变区）相间的 状似槟榔切面的条纹，称 为槟榔肝
Congestion 淤血
Chronic hepatic congestion
-- venous compressed
Congestion 淤血
Morphology and Consequences
Swollen, cyanosis (Blue-red color), low temperature
肿胀，发绀(蓝紫色），体表温度下降
Dilatation of local venules and capillaries
Chronic pulmonary congestion
The septa become thickened and fibrotic The alveolar spaces contain hemosiderin–laden macrophages
normal lung
Congestion 淤血
nutmeg liver
---肝淤血 Liver congestion
central vein and sinusoids are distended with blood centrilobular necrosis, peri-lobular fatty change
Congestion 淤血
常见类型： 生理性充血Physiologic ： 病理性充血Pathologic：炎症反应的早期 减压后充血：受压的组织或器官→突然解除压力→细动脉反 射性扩张充血,如一次性大量抽取胸水或腹水→血压下降
肉眼：组织器官体积轻度肿胀，颜色鲜红，温度升高，代谢 功能亢进
镜下：动脉和毛细血管扩张、充满血液
后果：暂时性变化，去除原因即可恢复正常，因而影响小 但血管本身有病变时，充血可以是血管破裂的诱因
Congestion 淤血
Chronic hepatic congestion
nutmeg liver —in chronic hepatic congestion, the central
regions of the hepatic lobules are grossly red-brown, accentuated against the surrounding zones of
在活体的心脏和血管内，血液发生凝固或血液中某些有形成 分凝集形成固体质块的过程称为血栓形成(thrombosis)。 所形成的固体质块称为血栓(thrombus)
Thrombosis 血栓形成
Pathogenesis of thrombosis
Three important elements in thrombosis virchow triad: