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Patologia de hemorragias
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Universidad Autónoma de Nuevo LeónFacultad de Medicina Veterinaria y
Zootecnia
Patología GeneralRafael Ramírez Romero
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Hemorrhage, the escape of blood from the vascular system, is commonly due to trauma. Hemorrhage may be external or internal and in either case may deprive the animal of blood (exsanguination)
Hemorragia, la salida de sangre del sistema vascular, se debe comúnmente a trauma. La hemorragia puede ser externa o interna y en cualquier caso puede privar de sangre al animal (exanguinaciòn)
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When hemorrhage occurs as the result of rupture or tear in the blood vessel the hemorrhage is by rhexis. If there is not defect in the blood vessel and the red blood cells merely pass through the vascular structures it is by diapedesis
Cuando la hemorragia es el resultado de una ruptura o desgarre del vaso sanguíneo la hemorragia es por rexis. Si no hay defecto en el vaso sanguíneo y los glóbulos rojos simplemente atraviesan la estructura vascular esta es por diapédesis
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rhexis
diapedesis
hemorrhage
Microscopic image of an hemorrhage
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Accumulation of blood in the thoracic cavity, pericardial space, peritoneral space (abdominal cavity), and joints are called hemothorax, hemopericardium, hemoperitoneum, o hemarthrosis, respectively
La acumulación de sangre en la cavidad torácica, espacio pericárdico, espacio peritoneal (cavidad abdominal) y articulaciones se denomina, hemotórax, hemopericardio, hemoperitoneo, o hemartrosis, respectivamente
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Hemothorax sheep and Hemopericardium dog
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When blood escapes into tissue (rather than through broken surfaces), it accumulates as a blood-filled space called hematoma (hematocyst)
Cuando la sangre escapa hacia los tejidos (mas que a través de superficies rotas), se acumula como un espacio lleno de sangre y se llama hematoma (hematoquiste)
Tra
sto
rno
s C
ircu
lato
rio
s Horse
Subdural hematoma
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Subcutaneous hematoma
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Petechiae refers to very tiny hemorrhages into the skin, mucous membranes and serosal surfaces. Their presence indicates a generalized process with severe endothelial damage such as septicemia and viral infections
Petequias se refiere a hemorragias muy pequeñas en la piel, membranas mucosas y superficies serosas. Su presencia indica un proceso generalizado con daño endothelial severo como ocurre en septicemias e infecciones virales
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Petechiae
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Ecchymoses are larger hemorrhages (greater than 1 cm diameter). The term purpura is emloyed loosely to mean hemorrhages larger than petechiae or petechial and ecchymotic hemorrhages generalized
Equimosis son hemorragias mas grandes (mayores que 1 cm de diámetro). El termino púrpura se emplea de manera amplia para referirse a hemorragias mas grandes que petequias o hemorragias petequiales y equimoticas generalizadas
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Ecchymoses
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Pig, purpura associated to hemorrhagic dermatitis/nephritic syndrome
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Sheep, adult Paintbrush hemorrhages
Sufusiones Suffusions
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Horse, Hemomelasma ilei hemorrhagic lesions probably associated to parasites
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Guanaco, newborn
Hyphema
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Hemoptisis and Epistaxis
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Gastric ulcer in pigs provoking melena Melena in a puppy due to Ancylostoma caninum
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Causes of hemorrhage:
Trauma
Vascular lesions
Toxins
Coagulation disorders
Allergies
Agonal
Causas de hemorragia:
Trauma
Lesiones vasculares
Toxinas
Desórdenes de la Coagulación
Alergias
Agónicas
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Horse, fractured rib and traumatic hemorrhage
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Horse, aneurysm and thrombosis in mesenteric artery due to Strongylus vulgaris, also, aneurism in aorta due to abnormal migration of Spirocerca lupi
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Hemorrhages
Vit. K deficiency in cattle feeding lush sweet clover (containing dicumarol a compound related to warfarin)
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Cow, heart; agonal hemorrhages Pig, lung; blood bronchoaspiration during euthanasia
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Thrombus: Solid mass of coagulated blood formed within the circulation
Clot (blood): Blood coagulated outside the blood vessel or after death
Trombo: masa solida de sangre coagulada que se forma dentro de la circulación
Coágulo (sangre): sangre coagulada fuera de los vasos sanguíneos o después de la muerte
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Thrombosis (antemortem coagulated blood) versus chicken fat clots (post mortem coagulated blood)
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It is difficult to make a clear distinction between a thrombus and a blood clot because their obvious relationship based on blood coagulation. A thrombus is essentially a pathological type of blood clot formed intravascularly
Es difícil hacer una clara distinción entre un trombo y un coágulo de sangre debido a su obvia relación basada en la coagulación sanguínea. Un trombo es esencialmente un coágulo de sangre e tipo patológico formado intravascularmente
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Normal blood coagulation often takes place largely extravascularly, as in the arrest of an hemorrhage, and is often referred to as hemostasis to distinguish it from the pathological process of thrombosis, or thrombogenesis
La coagulación normal de la sangre se lleva a cabo mayormente fuera de los vasos sanguíneos, como en la detención de una hemorragia y se le llama comúnmente hemostasia para distinguirla del proceso patológico de trombosis o trombo génesis
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To understand the intrincacies of blood coagulation during the physiological or pathological processes of hemostasis and thrombosis, it would be appropiate to separate the components in: a) plasma proteins, b) blood platelets and c) endothelium
Para entender lo intrincado de la coagulación durante los procesos fisiológicos y patológicos de hemostasis y trombosis, puede ser apropiado separar los componentes en: a) proteínas plasmáticas, b) plaquetas y, c) endotelio
A After vascular injury, local neurohumoral factors induce a transient vasoconstriction
B Platelets adhere to exposed estracellular matrix via von Willebrand factor and become activated, that is, undergo a shape change and release secretory granules to recruit additional platelets
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C Tissue factor is exposed by endothelium resulting in fibrin polymerization and cementing of platelets into a definitive secondary hemostatic plug
D Counter-regulatory mechanisms includes release of tissue type plasminogen activator that promotes fibrinolysis and thrombomodulin that impedes coagulation cascade, to restrict the hemostatic process
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Factor Name
I Fibrinogen
II Prothrombin
III Tissue thromboplastin
IV Divalent calcium
V Proaccelerin
VII Proconvertin
VIII Antihemophilic factor
IX Christmas factor
X Stuart-Prower factor
XI Plasma thromboplastin antecedent
XII Hageman factor
XIII Fibrin stabilizing factor
Preallikrein (Fletcher factor)
High-molecular-weight-kininogen (Fitzgerald factor)
Endothelium modulates opposing aspects of blood coagulation: a) Normally possesses antiplatelet, anticoagulant, and fibrynolitic properties b) After injury or activation endothelium exerts procoagulant activities
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The fibrinolytic system illustrating the plasminogen activators and inhibitors: a) tPA activates plasminogen most effectively when bound to fibrin meshwork b) Free plasmin in circulation is rapidly bound and neutralized by 2-plasmin inhibitor, and tPA is blockd by PAI released by endothelium stimulated by thrombin
The balance is an overall procoagulant effect
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Arterial thrombus
Venous thrombus
Fate of Thrombi: Progression, extension of the primary thrombus Embolization, thrombi may disloge and travel to other sites Organization (re-canalization), invasion by connective tissue and formation of new blood vessels Dissolution, removed by fibrinolytic activity
Desarrollo de los trombos: Progresión, extensión del trombo primario Embolización, los trombos pueden desprenderse y viajar a otros sitios Organización (recanalización), invasión por tejido conectivo con formación de nuevos vasos sanguíneos Disolución, removidos por actividad fibrinolítica
Potential outcome of venous thrombosis
Organized and recanalized thrombus
Embolus is a mass carried in the bloodstream from its site of origin to a more distant site. The process is called embolism. Although most emboli originate from thrombi, there are other less common types of emboli including, tumor cell clumps, air bubbles, aggregates of bacteria, and fat or bone marrow emboli after fractures
Embolo es una masa llevada por el torrente circulatorio desde su sitio de origen hacia otras partes mas distantes. Al proceso se le llama embolismo. Aunque la mayoría de los émbolos se originan de trombos, hay otros tipos de émbolos menos comunes incluyendo, conglomerados de células tumorales, burbujas de aire, agregados de bacterias y grasa o medula ósea después de fracturas
As an embolus moves downstream, it eventually encounters a small blood vessel smaller than its diameter, provoking a partial or complete occlusion. The consequences could be ischaemia (an inadequate blood supply to an organ causing cell damage) or infarction (death of tissue “an infarct” due to insufficient blood supply).
Conforme un émbolo se mueve a favor de la corriente sanguínea, este encuentra eventualmente un vaso sanguíneo pequeño mas pequeño que el mismo, provocando una oclusión parcial o completa. Las consecuencias podrían ser isquemia (un aporte sanguíneo inadecuado a un órgano causando daño celular) o infarto (muerte del tejido “un infarto” debido a un aporte sanguíneo insuficiente).
pulmonary thromboembolism
Angiogram - Embolism Infarction Kidney
Pathology, macro and micro Embolism Infarction Kidney
Development of Coronary Atherosclerosis
Coronary Atheorsclerosis and Infarction
Coronary Thrombosis With
Infarction
myocardium infarct first day
myocardium normal
myocardium infarct first to second day
myocardium infarct with hemorrhage first to second day
myocardium infarct third to fourth day
myocardium infarct first to second week
Coronary Angioplasty
Embolic Pneumonia
Embolic Nephritis
Parasitic Emboli due to Dirofilaria immitis
Metastasis from oral cavity soft palate; Embolic Malignant Melanoma
DIC (disseminated intravascular coagulation)