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PRINCIPLESOFHEMODYNAMICSPRINCIPLESOF1PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件2EndothelialInjury(IntrinsicPathway)XIIXIIaXIXIaIXIXaXXaVIIIPF-3Ca++TissueInjury(ExtrinsicPathway)VIIaVIIVProthrombin(II)THROMBIN(IIa)FibrinogenFibrinCross-LinkedMonomerFibrinXIIIXIIIaPF-3Ca++HEMOSTASISCOAGULATION/THROMBUSSTABILIZATIONEndothelialInjuryXII3PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件4PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件5PREDISPOSINGFACTORS(VIRCHOW’STRIAD)THROMBOSISAlterationofthevascularendotheliumAlterationofbloodflowAlterationofthebloodcomponentsPREDISPOSINGFACTORSTHROMBOSIS6CardiovascularstatusTissuesensitivitytoanoxiaRapidityofvascularocclusionVascularanatomyoftissueMODIFYINGFACTORSINFARCTIONCardiovascularstatusMODIFYING7TISSUESWITHSINGLEBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEBLOODSUPP8TISSUESWITHSINGLEBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEBLOODSUPP9TISSUESWITHSINGLEANASTOMOSINGBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEANASTOMOSI10TISSUESWITHSINGLEANASTOMOSINGBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEANASTOMOSI11TISSUESWITHDUALBLOODSUPPLYINFARCTIONTISSUESWITHDUALBLOODSUPPLY12TISSUESWITHDUALBLOODSUPPLYINFARCTIONTISSUESWITHDUALBLOODSUPPLY13TISSUESWITHPARALLELBLOODSUPPLYINFARCTIONTISSUESWITHPARALLELBLOODSU14TISSUESWITHPARALLELBLOODSUPPLYINFARCTIONTISSUESWITHPARALLELBLOODSU15DISSEMINATEDINTRAVASCULARCOAGULATIONDISSEMINATED16DISSEMINATEDINTRAVASCULARCOAGULATIONDISSEMINATEDINTRAVASCULARCOA17DISSEMINATEDINTRAVASCULARCOAGULATIONDISSEMINATEDINTRAVASCULARCOA18EMBOLIZATIONEMBOLIZATION19Arterial(systemic)emboliVenous(pulmonary)emboliEMBOLIZATIONArterial(systemic)emboliEMBO20ARTERIALEMBOLIARTERIALEMBOLI21ARTERIALEMBOLIARTERIALEMBOLI22ARTERIALEMBOLIARTERIALEMBOLI23ARTERIALEMBOLIARTERIALEMBOLI24ARTERIALEMBOLIARTERIALEMBOLI25ARTERIALEMBOLIARTERIALEMBOLI26ARTERIALEMBOLIARTERIALEMBOLI27VENOUSEMBOLIVENOUSEMBOLI28VENOUSTHROMBOSISVENOUSTHROMBOSIS29VENOUSEMBOLIVENOUSEMBOLI30VENOUSEMBOLIVENOUSEMBOLI31FatAirBonemarrowTumorAmnioticfluidForeignbodyEMBOLIZATIONNON-THROMBOTICFatEMBOLIZATIONNON-THROMBOTIC32FATEMBOLIZATION/WebPathFATEMBOLIZATIONhttp://www-medl33FATEMBOLIZATION/WebPathFATEMBOLIZATIONhttp://www-medl34FATEMBOLIZATION/WebPathFATEMBOLIZATIONhttp://www-medl35AMNIOTICFLUIDEMBOLIZATIONAMNIOTICFLUIDEMBOLIZATION36SHOCKSHOCK37HypovolemicCardiogenicVascularNeurogenicSepticAnaphylacticDECREASEDPERFUSIONOFBODYTISSUESSHOCKHypovolemicDECREASEDPERFUSION38SHOCKSHOCK39ReducedbloodvolumeDecreasedbloodreturntotheheartDecreasedcardiacoutputDecreasedbloodflowTissuehypoxiaLacticacidosisVasodilationandIncreasedvascularpermeabilityPeripheralpoolingandfluidlossintotissuesSHOCKReducedbloodvolumeDecreased40CerebralneuronalnecrosisAcuterenaltubularnecrosis(ATN)CentrilobularhepaticnecrosisGastrointestinalmucosalnecrosisDiffusealveolardamageEFFECTSONTISSUESHOCKCerebralneuronalnecrosisEFF41CLINICALSEQUELAESHOCKTachycardiaIneffectivebloodvolumeCool,clammyskinWarm,moistskinOliguriaMetabolicacidosisCLINICALSEQUELAESHOCKTachycar42PRINCIPLESOFHOSTDEFENSEPRINCIPLESOF43PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件44IntensityTimeNeutrophilsLymphocytesMacrophagesFibroblastsFibrosisAcuteChronicScarHOSTDEFENSEINJURYREPAIRIntensityTimeNeutrophilsLympho45HOSTDEFENSEHOSTDEFENSE46HOSTDEFENSEHOSTDEFENSE47HOSTDEFENSEPOLYMORPHONUCLEARLEUKOCYTESNeutrophilsEosinophilsBasophilsCELLULARPARTICIPANTSHOSTDEFENSEPOLYMORPHONUCLEAR48POLYMORPHONUCLEARLEUKOCYTESNeutrophilEosinophilBasophilPOLYMORPHONUCLEARLEUKOCYTESNe49MASTCELLSMASTCELLS50HOSTDEFENSEMONONUCLEARLEUKOCYTESLymphocytesMonocytesCELLULARPARTICIPANTSHOSTDEFENSEMONONUCLEARLEUKO51MONONUCLEARLEUKOCYTESLYMPHOCYTESMONONUCLEARLEUKOCYTESLYMPHOCY52MONONUCLEARLEUKOCYTESMONOCYTE/HISTIOCYTE/MACROPHAGEMONONUCLEARLEUKOCYTESMONOCYTE53PLATELETSPLATELETS54IntensityTimeNeutrophilsLymphocytesMacrophagesFibroblastsFibrosisAcuteChronicScarHOSTDEFENSEIntensityTimeNeutrophilsLympho55ACUTEINFLAMMATIONACUTEINFLAMMATION56ACUTEINFLAMMATIONINJURYAcuteinflammationMediatorsACUTEINFLAMMATIONINJURYAcute57ACUTEINFLAMMATIONACUTEINFLAMMATION58ACUTEINFLAMMATIONACUTEINFLAMMATION59VasoconstrictionVasodilationIncreasedvascularpermeabilityHemoconcentrationandstasisLeukocyteAdhesionTransmigrationChemotaxisAggregationPhagocytosisACUTEINFLAMMATIONSEQUENCEOFEVENTSVasoconstrictionACUTEINFLAMMA60ACUTEINFLAMMATIONVASODILATIONACUTEINFLAMMATIONVASODILATION61ACUTEINFLAMMATIONVASODILATIONACUTEINFLAMMATIONVASODILATION62IncreaseinPermeabilityTimeACUTEINFLAMMATIONINCREASEDVASCULARPERMEABILITYHistamine(MastCells)Seratonin(Platelets)IncreaseinPermeabilityTimeAC63ACUTEINFLAMMATIONINCREASEDVASCULARPERMEABILITYACUTEINFLAMMATIONINCREASEDVA64NormalflowStasisACUTEINFLAMMATIONHEMOCONCENTRATIONANDSTASISNormalflowStasisACUTEINFLAMM65ACUTEINFLAMMATIONLEUKOCYTEADHESIONACUTEINFLAMMATIONLEUKOCYTEAD66ACUTEINFLAMMATIONLEUKOCYTEADHESIONACUTEINFLAMMATIONLEUKOCYTEAD67ACUTEINFLAMMATIONEMIGRATION(TRANSMIGRATION)ACUTEINFLAMMATIONEMIGRATION(68ACUTEINFLAMMATIONEMIGRATION(TRANSMIGRATION)ACUTEINFLAMMATIONEMIGRATION(69ACUTEINFLAMMATIONCHEMOTAXISACUTEINFLAMMATIONCHEMOTAXIS70ACUTEINFLAMMATIONAGGREGATIONACUTEINFLAMMATIONAGGREGATION71ACUTEINFLAMMATIONPHAGOCYTOSIS-ATTACHMENTACUTEINFLAMMATIONPHAGOCYTOSIS72ACUTEINFLAMMATIONPHAGOCYTOSIS-ENGULFMENTACUTEINFLAMMATIONPHAGOCYTOSIS73ACUTEINFLAMMATIONPHAGOCYTOSIS–KILLINGANDDEGRADATIONACUTEINFLAMMATIONPHAGOCYTOSIS74ACUTEINFLAMMATIONACUTEINFLAMMATION75SerousCatarrhalFibrinousHemorrhagicSuppurativeGangrenousPseudomembranousACUTEINFLAMMATIONPATTERNSSerousACUTEINFLAMMATIONPATTER76ACUTEINFLAMMATIONSEROUSACUTEINFLAMMATIONSEROUS77ACUTEINFLAMMATIONSEROUSACUTEINFLAMMATIONSEROUS78ACUTEINFLAMMATIONCATARRHALACUTEINFLAMMATIONCATARRHAL79ACUTEINFLAMMATIONFIBRINOUSACUTEINFLAMMATIONFIBRINOUS80ACUTEINFLAMMATIONHEMORRHAGICACUTEINFLAMMATIONHEMORRHAGIC81ACUTEINFLAMMATIONSUPPURATIVE/PURULENTACUTEINFLAMMATIONSUPPURATIVE82ACUTEINFLAMMATIONSUPPURATIVE/PURULENT-ABSCESSACUTEINFLAMMATIONSUPPURATIVE83ACUTEINFLAMMATIONSUPPURATIVE/PURULENT-ABSCESSACUTEINFLAMMATIONSUPPURATIVE84ACUTEINFLAMMATIONSUPPURATIVE/PURULENT-EMPYEMAACUTEINFLAMMATIONSUPPURATIVE85ThomasMcGovernM.D.ACUTEINFLAMMATIONULCERATIVEThomasMcGovernM.D.ACUTEINFL86ACUTEINFLAMMATIONGANGRENOUSACUTEINFLAMMATIONGANGRENOUS87ACUTEINFLAMMATIONGANGRENOUSAppendixGallbladderACUTEINFLAMMATIONGANGRENOUSAp88AtlantaSouthGastroenterology,P.C.ACUTEINFLAMMATIONPSEUDOMEMBRANOUSAtlantaSouthGastroenterology89HeatRednessSwellingPainLossoffunctionACUTEINFLAMMATIONLOCALMANIFESTATIONSHeatACUTEINFLAMMATIONLOCALM90FeverChillsMyalgiaMalaiseACUTEINFLAMMATIONSYSTEMICMANIFESTATIONSFeverACUTEINFLAMMATIONSYSTEMI91Leukocytosis(granulocytosisvs.lymphocytosis)Elevatedserumacutephaseproteins(C-reactiveprotein,fibrinogen,etc)IncreasedESR(erythrocytesedimentationrate)HypercoagulabilityACUTEINFLAMMATIONLABORATORYMANIFESTATIONSLeukocytosisACUTEINFLAMMATIO92ACUTEINFLAMMATIONSEQUELAEINJURYRESOLUTIONAutoimmunediseaseChronicinflammationAcuteinflammationViralinfectionChronicirritationMediatorsMediatorsMediatorsACUTEINFLAMMATIONSEQUELAEINJU93PRINCIPLESOFHEMODYNAMICSPRINCIPLESOF94PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件95EndothelialInjury(IntrinsicPathway)XIIXIIaXIXIaIXIXaXXaVIIIPF-3Ca++TissueInjury(ExtrinsicPathway)VIIaVIIVProthrombin(II)THROMBIN(IIa)FibrinogenFibrinCross-LinkedMonomerFibrinXIIIXIIIaPF-3Ca++HEMOSTASISCOAGULATION/THROMBUSSTABILIZATIONEndothelialInjuryXII96PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件97PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件98PREDISPOSINGFACTORS(VIRCHOW’STRIAD)THROMBOSISAlterationofthevascularendotheliumAlterationofbloodflowAlterationofthebloodcomponentsPREDISPOSINGFACTORSTHROMBOSIS99CardiovascularstatusTissuesensitivitytoanoxiaRapidityofvascularocclusionVascularanatomyoftissueMODIFYINGFACTORSINFARCTIONCardiovascularstatusMODIFYING100TISSUESWITHSINGLEBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEBLOODSUPP101TISSUESWITHSINGLEBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEBLOODSUPP102TISSUESWITHSINGLEANASTOMOSINGBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEANASTOMOSI103TISSUESWITHSINGLEANASTOMOSINGBLOODSUPPLYINFARCTIONTISSUESWITHSINGLEANASTOMOSI104TISSUESWITHDUALBLOODSUPPLYINFARCTIONTISSUESWITHDUALBLOODSUPPLY105TISSUESWITHDUALBLOODSUPPLYINFARCTIONTISSUESWITHDUALBLOODSUPPLY106TISSUESWITHPARALLELBLOODSUPPLYINFARCTIONTISSUESWITHPARALLELBLOODSU107TISSUESWITHPARALLELBLOODSUPPLYINFARCTIONTISSUESWITHPARALLELBLOODSU108DISSEMINATEDINTRAVASCULARCOAGULATIONDISSEMINATED109DISSEMINATEDINTRAVASCULARCOAGULATIONDISSEMINATEDINTRAVASCULARCOA110DISSEMINATEDINTRAVASCULARCOAGULATIONDISSEMINATEDINTRAVASCULARCOA111EMBOLIZATIONEMBOLIZATION112Arterial(systemic)emboliVenous(pulmonary)emboliEMBOLIZATIONArterial(systemic)emboliEMBO113ARTERIALEMBOLIARTERIALEMBOLI114ARTERIALEMBOLIARTERIALEMBOLI115ARTERIALEMBOLIARTERIALEMBOLI116ARTERIALEMBOLIARTERIALEMBOLI117ARTERIALEMBOLIARTERIALEMBOLI118ARTERIALEMBOLIARTERIALEMBOLI119ARTERIALEMBOLIARTERIALEMBOLI120VENOUSEMBOLIVENOUSEMBOLI121VENOUSTHROMBOSISVENOUSTHROMBOSIS122VENOUSEMBOLIVENOUSEMBOLI123VENOUSEMBOLIVENOUSEMBOLI124FatAirBonemarrowTumorAmnioticfluidForeignbodyEMBOLIZATIONNON-THROMBOTICFatEMBOLIZATIONNON-THROMBOTIC125FATEMBOLIZATION/WebPathFATEMBOLIZATIONhttp://www-medl126FATEMBOLIZATION/WebPathFATEMBOLIZATIONhttp://www-medl127FATEMBOLIZATION/WebPathFATEMBOLIZATIONhttp://www-medl128AMNIOTICFLUIDEMBOLIZATIONAMNIOTICFLUIDEMBOLIZATION129SHOCKSHOCK130HypovolemicCardiogenicVascularNeurogenicSepticAnaphylacticDECREASEDPERFUSIONOFBODYTISSUESSHOCKHypovolemicDECREASEDPERFUSION131SHOCKSHOCK132ReducedbloodvolumeDecreasedbloodreturntotheheartDecreasedcardiacoutputDecreasedbloodflowTissuehypoxiaLacticacidosisVasodilationandIncreasedvascularpermeabilityPeripheralpoolingandfluidlossintotissuesSHOCKReducedbloodvolumeDecreased133CerebralneuronalnecrosisAcuterenaltubularnecrosis(ATN)CentrilobularhepaticnecrosisGastrointestinalmucosalnecrosisDiffusealveolardamageEFFECTSONTISSUESHOCKCerebralneuronalnecrosisEFF134CLINICALSEQUELAESHOCKTachycardiaIneffectivebloodvolumeCool,clammyskinWarm,moistskinOliguriaMetabolicacidosisCLINICALSEQUELAESHOCKTachycar135PRINCIPLESOFHOSTDEFENSEPRINCIPLESOF136PRINCIPLES-OF-HEMODYNAMI教學(xué)講解課件137IntensityTimeNeutrophilsLymphocytesMacrophagesFibroblastsFibrosisAcuteChronicScarHOSTDEFENSEINJURYREPAIRIntensityTimeNeutrophilsLympho138HOSTDEFENSEHOSTDEFENSE139HOSTDEFENSEHOSTDEFENSE140HOSTDEFENSEPOLYMORPHONUCLEARLEUKOCYTESNeutrophilsEosinophilsBasophilsCELLULARPARTICIPANTSHOSTDEFENSEPOLYMORPHONUCLEAR141POLYMORPHONUCLEARLEUKOCYTESNeutrophilEosinophilBasophilPOLYMORPHONUCLEARLEUKOCYTESNe142MASTCELLSMASTCELLS143HOSTDEFENSEMONONUCLEARLEUKOCYTESLymphocytesMonocytesCELLULARPARTICIPANTSHOSTDEFENSEMONONUCLEARLEUKO144MONONUCLEARLEUKOCYTESLYMPHOCYTESMONONUCLEARLEUKOCYTESLYMPHOCY145MONONUCLEARLEUKOCYTESMONOCYTE/HISTIOCYTE/MACROPHAGEMONONUCLEARLEUKOCYTESMONOCYTE146PLATELETSPLATELETS147IntensityTimeNeutrophilsLymphocytesMacrophagesFibroblastsFibrosisAcuteChronicScarHOSTDEFENSEIntensityTimeNeutrophilsLympho148ACUTEINFLAMMATIONACUTEINFLAMMATION149ACUTEINFLAMMATIONINJURYAcuteinflammationMediatorsACUTEINFLAMMATIONINJURYAcute150ACUTEINFLAMMATIONACUTEINFLAMMATION151ACUTEINFLAMMATIONACUTEINFLAMMATION152VasoconstrictionVasodilationIncreasedvascularpermeabilityHemoconcentrationandstasisLeukocyteAdhesionTransmigrationChemotaxisAggregationPhagocytosisACUTEINFLAMMATIONSEQUENCEOFEVENTSVasoconstrictionACUTEINFLAMMA153ACUTEINFLAMMATIONVASODILATIONACUTEINFLAMMATIONVASODILATION154ACUTEINFLAMMATIONVASODILATIONACUTEINFLAMMATIONVASODILATION155IncreaseinPermeabilityTimeACUTEINFLAMMATIONINCREASEDVASCULARPERMEABILITYHistamine(MastCells)Seratonin(Platelets)IncreaseinPermeabilityTimeAC156ACUTEINFLAMMATIONINCREASEDVASCULARPERMEABILITYACUTEINFLAMMATIONINCREASEDVA157NormalflowStasisACUTEINFLAMMATIONHEMOCONCENTRATIONANDSTASISNormalflowStasisACUTEINFLAMM158ACUTEINFLAMMATIONLEUKOCYTEADHESIONACUTEINFLAMMATIONLEUKOCYTEAD159ACUTEINFLAMMATIONLEUKOCYTEADHESIONACUTEINFLAMMATIONLEUKOCYTEAD160ACUTEINFLAMMATIONEMIGRATION(TRANSMIGRATION)ACUTEINFLAMMATIONEMIGRATION(161ACUTEINFLAMMATIONEMIGRATION(TRANSMIGRATION)ACUTEINFLAMMATIONEMIGRATION(162ACUTEINFLAMMATIONCHEMOTAXISACUTEINFLAMMATIONCHEMOTAXIS163ACUTEINFLAMMATIONAGGREGATIONACUTEINFLAMMATIONAGGREGATION164ACUTEINFLAMMATIONPHAGOCYTOSIS-ATTACHMENTACUTEINFLAMMATIONPHAGOCYTOSIS165ACUTEINFLAMMATIONPHAGOCYTOSIS-ENGULFMENTACUTEINFLAMMATIONPHAGOCYTOSIS166ACUTEINFLAMMATIONPHAGOCYTOSIS–KILLINGANDDEGRADATIONACUTEINFLAMMATIONPHAGOCYTOSIS167ACUTEINFLAMMATIONACUTEINFLAMMATION168SerousCatarrhalFibrinousHemorrhagicSuppurativeGangrenousPseudomembranousACUTEINFLAMMATIONPATTERNSSerousACUTEINFLAMMATIONPATTER169ACUTEINFLAMMATIONSEROUSACUTEINFLAMMATIONSEROUS170ACUTEINFLAMMATIONSEROUSACUTEINFL

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