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DISORDERS OF
CIRCULATION, BODYFLUID AND
BASIC ACIDBy
Taufik Rahman, M.D
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Body Fluid
Human body
60%, water
40 %, intracellular 20 %, extracellular
5 %, interstitial 15 %, intravascular
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Electrolyt
Intracellular
Na + 142 mEq/L
K + 4 mEq/L
Ca ++ 2,4 mEq/L
Mg ++ 1,2 mEq/L
Cl - 103 mEq/LHCO3 - 28 mEq/L
Extracellular
Na + 10 mEq/L
K + 140 mEq/L
Ca ++ 0,0001 mEq/L
Mg ++ 58 mEq/L
Cl - 4 mEq/LHCO3 - 10 mEq/L
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Classification of circulation
disorders
1. Disorders of body fluid and electrolyt
Edema, dehydration, electrolytdeficiensi and electrolyt excess
2. Disorders of volume
Hiperemia, bleeding and shock
3. ObstructionsTrombosis, emboli, ischemia, infarc andother obstruction
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Oedema
Collected of body fluid in interstitial orbody cavity.
Oedema : - transudat (BJ < 1,15)
- exudat (BJ > 1,20)
Oedema : - local
- generalOedema in serous cavity : hidrothorac,hidropericard, hidroperitoneum ( acites ).
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Cont
Causes of oedema
Noninflamation oedema :
1. Increase of hidrostatic pressure
2. Decrease of osmotic pressure3. Obstruction of limphatic canal
Inflamation oedema :
Increase of vascular permeubelityOther causes : disorder of natrium exchange orelectrolyt balance
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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
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Hyperemia and congestion
Hyperemia ( active hyperemia )
Dilatation of arteriol and artery causesincrease of blood flow to capiler tissuewith opening inactive capilers.
Dilatation of vascular caused by vasoactiveagent.
Example : fever
shy
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Cont
Congestion ( pasive hyperemia )
Blood flow to vena have a disorders.
Vena blood flow decrease in spesific areaand dilatation of vena and capiler.
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Change of morphology as
consequence of hyperemia
Wet apperanace and full of erytrocyt
Pulmo : full of erytrocyt in alveoli capiler
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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
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Cont
Shock ( characteristic ) :
- Reversible
- Irreversible
Shock ( cause ) :
- Anaphylactic
- Cardiogenic
- Septic
- Neurogenic
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Cont
Sign and symptom :
Paleness and weak
Cold extremity Pulseness weak and quick
Very low blood pressure
Oliguria Decrease of consciousness
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Dehydration
Deficiency of fluid
Inbalance of input and output
Causes :- water loss
- natrium loss
- combination of both
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Cont
Water loss :
Long comatosa
Hydrophobia Exercise
Consequnce of dehydration
Release of ADH by Hypopise, and thenoliguria
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Cont
Sign and symptom of dehydration (waterloss) :
- thirsty
- decrease of saliva secret
- dry throat
- oliguria
- weakness
- consciousness disorders
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Cont
Natrium Loss : Proggresive vomiting Progressive diarrhea
Sign and symptom of dehydration ( natrium loss ):- Nausea- Weakness
- Cephalgia- Vomiting- seizure
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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
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Cont
Inner body bleeding
Skin and mucous : petiche, echimosis, purpura,hematoma.
Body cavity : hemothorac, hemoperitoneumhematopericardium
Uterus, vagina and tuba : hematometrium
hematokolpos, hematosalphink
Testis : hematochele
Articulatio cavity : hemarthrosis
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Cont
Outter body bleeding
Respiratory tract : Epistaksis, Hemoptisis,
Gastrointestinal tract : Hematemesis,Hematokezia, Melena
Uterus : Menorargia, Metrorargia
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Cont
Local effect of bleeding
Brain : increase of ICP
Pulmo : decrease of pulmonary volume Heart : tamponade
fibrosis
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Systemic effect of bleeding
Anemia
Circulation colaps Death
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Trombosis
Solidfication of blood that content bloodelement 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
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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
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Cont
Trombus ( making time ) :- Fresh trombus- Old trombus
Trombus ( bacteria ) :- Septic trombus- Sterile trombusTrombus ( site ) :
- Vena trombus- Arteria trombus- Car trombus
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Cont
Effect of trombus :
- Ischemia
- Necrosis- Infarction
- Gangren
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Embolus
Foreign bodies that follow blood flow from theirsites and can trapp in other sites causesobstruction.
Embolus ( substance ) :
- Fatty emboly- Air emboly
- Tumor cell emboly
- Aterom emboly
Embolus ( sites) :- Arteria emboly
- Vena emboly
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Vascular disorders
Ischemia : Decrease or loss of blood supplyto part of body.
Effect of ischemia :
- degeneration
- Loss of parenchym cell
- Cell death
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Cont
Infarc : vascular obstruction by specificmaterial (trombus), that causes ischemiaand anoxia necrosis of tissue in distal of
obstruction.
Infarc :
- Hemorargic infarc
- Paleness infarc
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Cont
Gangren : death of tissue that caused by loss ofblood supply and followed saprophyt bacteriainvasive.
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
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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
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Cont
Henderson-Hasselbach
pH = pK + log HCO3 -H2CO3
pK = 6,1
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Mechanism
Renal mechanism
Balancing hidrogen ion and bicarbonat
H2CO3 H + + HCO3 -
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Cont
Pulmonary mechanism
H20 + CO2 H2CO3
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Cont
Acidosis : decreasing pH level
Acidosis : - respiratoric
- metabolicAlcalosis : increasing pH level
Alkalosis : - respiratoric
- metabolic
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Any question ?
Please!!!