DISORDERS OF CIRCULATION, BODY FLUID AND BASIC ACID

By Taufik Rahman, M.D

Body Fluid
Human body 60%, water

40 %, intracellular

20 %, extracellular

5 %, interstitial

15 %, intravascular

Electrolyt
Intracellular
Extracellular

Na + K+ Ca ++ Mg ++ Cl HCO3 -

142 mEq/L 4 mEq/L 2,4 mEq/L 1,2 mEq/L 103 mEq/L 28 mEq/L

Na + K+ Ca ++ Mg ++ Cl HCO3 -

10 mEq/L 140 mEq/L 0,0001 mEq/L 58 mEq/L 4 mEq/L 10 mEq/L

Classification of circulation disorders

Disorders of body fluid and electrolyt Edema, dehydration, electrolyt deficiensi and electrolyt excess 2. Disorders of volume Hiperemia, bleeding and shock 3. Obstructions Trombosis, emboli, ischemia, infarc and other obstruction
1.

Oedema
Collected of body fluid in interstitial or body cavity. Oedema : - transudat (BJ < 1,15) - exudat (BJ > 1,20) Oedema : - local - general Oedema in serous cavity : hidrothorac, hidropericard, hidroperitoneum ( acites ).

Cont
Causes of oedema Noninflamation oedema : 1. Increase of hidrostatic pressure 2. Decrease of osmotic pressure 3. Obstruction of limphatic canal Inflamation oedema : Increase of vascular permeubelity Other causes : disorder of natrium exchange or electrolyt balance

Change of morphology as consequence of oedema

Pulmonary oedema increase of weight fluid around septum capiler fluid that content edema fluid, air, and erytrocyt. disorders of gas exchange that cause asfixia or anoxia. Brain oedema constriction of sulcus dilation of gyrus substansia alba being soft like gelatin dilation of substantia grisea

Hyperemia and congestion

Hyperemia ( active hyperemia ) Dilatation of arteriol and artery causes increase of blood flow to capiler tissue with opening inactive capilers. Dilatation of vascular caused by vasoactive agent. Example : fever shy

Cont
Congestion ( pasive hyperemia ) Blood flow to vena have a disorders. Vena blood flow decrease in spesific area and dilatation of vena and capiler.

Change of morphology as consequence of hyperemia

Wet apperanace and full of erytrocyt Pulmo : full of erytrocyt in alveoli capiler

Shock
Syndrome that caused by circulation failure Inbalance of volume and vascular space. Shock primer : Vascular space increase, but the body fluid volume constant Shock secunder : Vascular space constant, but the body fluid decrease

Cont
Shock ( characteristic ) : - Reversible - Irreversible Shock ( cause ) : - Anaphylactic - Cardiogenic - Septic - Neurogenic

Cont
Sign and symptom : Paleness and weak Cold extremity Pulseness weak and quick Very low blood pressure Oliguria Decrease of consciousness

Dehydration
Deficiency of fluid Inbalance of input and output Causes : - water loss - natrium loss - combination of both

Cont
Water loss : Long comatosa Hydrophobia Exercise Consequnce of dehydration Release of ADH by Hypopise, and then oliguria

Cont
Sign and symptom of dehydration (water loss) : - thirsty - decrease of saliva secret - dry throat - oliguria - weakness - consciousness disorders

Cont
Natrium Loss : Proggresive vomiting Progressive diarrhea Sign and symptom of dehydration ( natrium loss ) : - Nausea - Weakness - Cephalgia - Vomiting - seizure

Bleeding
Release of blood from vascular Internal bleeding Blood release to interstitial, serous cavity, or body organ. External bleeding Blood release to out of body

Cont
Inner body bleeding Skin and mucous : petiche, echimosis, purpura, hematoma. Body cavity : hemothorac, hemoperitoneum hematopericardium Uterus, vagina and tuba : hematometrium hematokolpos, hematosalphink Testis : hematochele Articulatio cavity : hemarthrosis

Cont
Outter body bleeding Respiratory tract : Epistaksis, Hemoptisis, Gastrointestinal tract : Hematemesis, Hematokezia, Melena Uterus : Menorargia, Metrorargia

Cont
Local effect of bleeding Brain : increase of ICP Pulmo : decrease of pulmonary volume Heart : tamponade fibrosis

Cont
Systemic effect of bleeding Anemia Circulation colaps Death

Trombosis
Solidfication of blood that content blood element in vascular of human life. Factors that contibute to make trombus : 1. Change of vascular wall 2. Change of blood flow 3. Change of blood composition

Cont
Trombus ( form ) : - Occlution trombus - Propagating trombus - Saddle or riding trombus - Mural or parietal trombus - Pedunculated trombus - Ball trombus Trombus ( colour ) : - Red trombus - White trombus - Mixed trombus

Cont
Trombus ( making time ) : - Fresh trombus - Old trombus Trombus ( bacteria ) : - Septic trombus - Sterile trombus Trombus ( site ) : - Vena trombus - Arteria trombus - Car trombus

Cont
Effect of trombus : - Ischemia - Necrosis - Infarction - Gangren

Embolus
Foreign bodies that follow blood flow from their sites and can trapp in other sites causes obstruction. Embolus ( substance ) : - Fatty emboly - Air emboly - Tumor cell emboly - Aterom emboly Embolus ( sites) : - Arteria emboly - Vena emboly

Vascular disorders
Ischemia : Decrease or loss of blood supply to part of body. Effect of ischemia : - degeneration - Loss of parenchym cell - Cell death

Cont
Infarc : vascular obstruction by specific material (trombus), that causes ischemia and anoxia necrosis of tissue in distal of obstruction. Infarc : - Hemorargic infarc - Paleness infarc

Cont
Gangren : death of tissue that caused by loss of blood supply and followed saprophyt bacteria invasive. Gangren : Wet gangren : - body organ that content lots of fluid - places that no evaporation Dry gangren : - Body organ that content few of fluid - Places that evaporation - Places that good drainage

Basic acid Balance

Human body inclined acid, caused : - carbon dioxide production in aerobic respiration - lactat acid in glikolisis - Fatty acid in lipolisis pH level : - Artery : 7,4 - Interstitial fluid : 7,35 - Intracellular fluid : 7,0

Cont
Henderson-Hasselbach pH = pK + log HCO3 H2CO3

pK = 6,1

Mechanism
Renal mechanism Balancing hidrogen ion and bicarbonat

H2CO3

H + + HCO3 -

Cont
Pulmonary mechanism

H20 + CO2

H2CO3

Cont
Acidosis : decreasing pH level Acidosis : - respiratoric - metabolic Alcalosis : increasing pH level Alkalosis : - respiratoric - metabolic

Any question ? Please!!!