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HEMORRHAGE

HEMORRHAGE. It is the escape or loss of blood from the cardiovascular system Causes of hemorrhage Local causes of haemorrhage : Traumatic injury of vessel: accidents, surgery. Destruction of the vascular wall as on case of tuberculosis, malignant tumours , and peptic ulcers.

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HEMORRHAGE

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  1. HEMORRHAGE • It is the escape or loss of blood from the cardiovascular system • Causes of hemorrhage • Local causes of haemorrhage: • Traumatic injury of vessel: accidents, surgery. • Destruction of the vascular wall as on case of tuberculosis, malignant tumours, and peptic ulcers. • Inflammations due to bacterial infection as in case of dysentery or bronchitis. • Local venous congestion e.g. oesophagus varicose. • General causes of haemorrhage: • Hypertension and general venous congestion. • Blood disease as haemophilia. • Vitamin C or vitamin K deficiency.

  2. Types of hemorrhage • 1- External Hemorrhage • From skin • From respiratory tract - Epistaxis: Bleeding from the nose. - Haemoptysis: Coughing blood. • From alimentary tract - Haematemesis: Vomiting of blood. - Melena: Passage of dark digested blood in stools. • From urinary tract: haematuria • From female genitalia: - Menorrhagia: excessive or prolonged menses. - Metrorrhagia: Irregular uterine bleeding. • 2- Internal hemorrhage: • i-Hemo thorax: bleeding in pleura. • ii- Hemo pericardium: bleeding the pericardium. • iii- hemo peritoneum: bleeding in the peritoneum. • iiii-Haemarthrosis: haemorrhage into a joint cavity 3- Interstitial Hemorrhage: • Petechia, Echymosis, Hematoma

  3. Natural arrest of hemorrhage • 1- Contraction and retraction of the blood vessel to narrow their lumen. • 2- Formation of blood clot to seal the blood vessel. • 3- Decrease in blood pressure and activation of vasomotor center. • 4- Vascular constriction by serotonin released from platelets at the site of vascular leakage. Signs of hemorrhage 1- Cold skin. 2- Thirst. 3- Hypoxia in vital organs. 4- Decreased blood pressure. 5- Faintness. 6- Severe hemorrhage results in shock and may be death.

  4. SHOCK= cardiovascularcollapse” • is the sudden systemic hypoperfusion caused by reduction either in cardiac output or in the effective circulating blood volume. Shock is sudden depression of vital functions due to decreased circulating blood volume • Signs: Pale face, cold skin, rapid pulse, sweating, shallow respiration and low blood pressure, the urine volume is decreased

  5. TYPES OF SHOCK: • Hypovolemic shock: results from loss of blood or plasma volume. This may be caused by haemorrhage, fluid loss (dehydration) from severe burns or trauma. • Cardiogenic shock: results from myocardial pump failure and hence decrease in cardiac output. This may be caused by myocardial infarction, or outflow obstruction (e.g. pulmonary embolism).

  6. Septic shock: - Causes: Systemic gram-negative bacterial infection (endotoxic shock). - Pathogenesis: - Dilatation of the capillaries and venules by chemical mediators as histamine, kinins…etc results in pooling of the blood in the peripheral vessels and reduction in the effective circulating blood volume. - Endotoxins stimulate the release of chemical mediators, which lead to increase vascular permeability. • Endotoxins activate the clotting system resulting in disseminated intravascular coagulation, DIC

  7. Rare types are neurogenic and anaphylactic shock: • Neurogenic shock: may occur in anesthesia or spinal cord injury, resulting in neurogenic mediated vasodilatation and fall of blood pressure. • Anaphylactic shock: is a type I hypersensitivity response, which may follow penicillin injection…etc. It is associated with systemic vasodilatation and increased vascular permeability. • Inthese instances, widespread vasodilatation causes a sudden increase in the capacity of vascular bed, which is not adequately filled by the normal circulating blood volume. Thus, hypotension, tissue hypoperfusion, and cellular anoxia results.

  8. DISEASES OF THE BLOOD VESSEL • Arteriosclerosis: thickening and hardening of the arterial wall 1- Atherosclerosis (atheroma): characterized by lipid deposition in the connective tissue followed by fibrosis. Effects and complications: • Incomplete or complete ischemia, which may lead to arteriosclerotic heart disease, myocardial, or cerebral infarction or dry gangrene. In large arteries thrombosis may develop which my be complicated by systemic embolism leading to infarcts in different organs. • Aneurysms due to stretch of atrophic media, which may be complicated by rupture and haemorrhage.

  9. Atherosclerosis

  10. Medial calcification Senile degenerative change affecting the media of the medium sized muscular arteries especially those of the limbs. It is characterized by fatty and hyaline degeneration of the media followed by patchy calcium deposition (dystrophic calcification). • Arteriosclerosis or hypertensive disease of the arterioles: is a degenerative change of small arteries and arterioles caused by persistent hypertension.

  11. HYPERTENSION • persistent elevation of the systolic and diastolic blood pressure above 140/90 mm of mercury due to increased peripheral resistance in the arterioles • Types of systemic hypertension: • 1- Primary or essential hypertension: Common (90%) • Causes: • Genetic factors • Sodium intake • Neurogenic factors: stress & emotional stimuli increase the sympathetic tone. - Humoralvasoconstrictive factors: In renal hypertension, the ischaemic kidney releases rinin, which acts on plasma hypertensinogen to form hypertensin. Hypertensin causes constriction in the peripheral arterioles

  12. A- Benign essential hypertension: common disease that occurs above theage of 40 years. It is characterized by a slowly progressive rise in blood pressure Pathological changes: • - Vascular lesions (arteriosclerosis): occur in the vessels of kidney, brain and retina. • It shows hyaline thickening and or decreased elastic tissues • - Heart: Left ventricular hypertrophy. • - Brain: Micro-aneurysms in the cerebral arteries, which may rupture causing cerebral haemorrhage. • - Retinal lesions leading to retinal haemorrhage. • - Kidney lesions (nephrosclerosis): Kidneys are small, contracted and firm. • B-Malignant essential hypertension: is a rare disease affecting mainly the young adults. It is characterized by a rapid progressive rise in the blood pressure. • 2- Secondary hypertension (10%):Occur secondary to pre-existing diseases such as: • Renal diseases e.g. glomerulonephritis, renal vascular atheroma, thrombosis. • Endocrine diseases e.g. hyperthyroidism and pituitary tumours or steroid therapy • Cardiovascular diseases e.g. coarctation of the aorta and polycythaemiavera. • .

  13. Aneurysm ANEURYSM:is a localized dilatation in the wall of an artery due to weakness in the media of the artery. Hypertension helps in the dilatation.

  14. DISEASES OF VEINS: • VARICOSE VEINS: Is the dilatation, elongation, thickening and tortuosity of the veins. • Sites: Veins of lower limbs, oesophagus, lower end of the rectum (haemorrhoids). • Predispoing factors: 1. Weakness of the venous wall either congenital or caused by obesity and senility. 2. Incompetence or rupture of the valves in the veins. 3. Increased pressure inside the veins due to prolonged standing, venous obstruction by thrombosis, venous compression in pregnancy and by uterine, ovarian and rectal tumours. 4. Congenital defect in the venous muscular coat

  15. Varicose veins

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