Congestion

Introduction Hyperemia refers to an increase in the blood content of blood vessels in tissues or organs. Can be divided into two types of arterial congestion and venous congestion. The blood volume of the local tissue or organ arteries is increased, so that the blood content in the arterial blood vessels is increased, which is called arterial congestion. Due to the obstruction of venous return, the blood volume in the capillaries and venules of local tissues or organs is increased, which is called venous congestion. Broadly speaking, it is a state in which the blood volume increases in a part of the organ. However, it generally does not include passive congestion (congestion) caused by an increase in venous blood, but a single-finger artery (dynamic) hyperemia. In addition to inflammation, warm, mechanical, chemical, and mental stimuli can also be caused by inflammation. These stimuli can cause hyperemia through the excitation of vasodilation or the paralysis of the vasoconstrictor nerve. When the arteries are congested, a large amount of blood is accelerated, and local redness, temperature increase, swelling, and hyperactivity are localized. The small blood vessels in the local tissues and organs of the body are over-expanded, and the blood content in the body is increased more than normal.

Cause

1. Arterial congestion:

Increased vasodilation of the vasodilation, decreased excitability of the vasoconstrictor nerve, increased release of vasoactive substances, etc., causing the expansion of the arterioles, the acceleration of blood flow, and the increase of perfusion of arterial blood into the microcirculation. Common ones are:

1 physiological congestion, such as gastrointestinal mucosa after eating, skeletal muscle during exercise, and uterine congestion during pregnancy;

2 inflammatory hyperemia, seen in the early stage of local inflammatory response, axonal reflex caused by the action of proinflammatory factors causes vasodilation of the vasodilatation, and the action of vasoactive substances such as histamine and bradykinin, so that the arterioles are dilated and congested;

3 After decompression and hyperemia, if the local organs or tissues are under long-term compression, after seeing the bandaged limb or a large amount of ascites pressing the intra-abdominal organs, the vascular tension in the tissue is reduced. If the pressure is suddenly relieved, the arterioles in the compressed tissue are reflected. Sexual expansion leads to local congestion.

2. Venous congestion (depression):

1 Intravenous compression causes the lumen to stenosis or occlusion, such as tumor compression local vein; pregnancy uterus compression of the common iliac vein; incarcerated intestinal fistula, intussusception and intestinal torsion when the mesenteric vein is compressed.

2 venous obstruction, such as venous thrombosis, and failure to establish an effective collateral circulation.

3 heart failure, such as mitral stenosis and left heart failure caused by hypertension, leading to pulmonary congestion; right heart failure occurred in pulmonary heart disease, resulting in systemic organ congestion.

an examination

Therefore, clinically, patients with congestion should be examined:

First, physical examination

Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.

Second, laboratory inspection

Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. Therefore, according to the medical history and clinical symptoms, patients with hyperemia can undergo corresponding laboratory tests, such as fluoroscopy and angiography.

Differential diagnosis

Arterial congestion: In general, arterial congestion is short-lived and beneficial to the body, called physiological congestion. Such as: skin congestion after hot water bath, gastric mucosal congestion after meals. Pathological arterial congestion is seen in inflammatory hyperemia.

Venous congestion: refers to the reduction of blood drawn from the tissue, the accumulation of blood in the venules and capillaries. The local venules and capillaries of the blood stasis significantly expanded, and the blood content increased, but the blood perfusion was reduced. According to the reasons and the scope of the spread can be divided into local and systemic congestion. Local congestion occurs due to local venous compression and venous occlusion. Systemic congestion occurs due to heart failure and increased intrathoracic pressure.

Under pathological conditions, venous congestion is much more common than arterial congestion, so the former is more clinically meaningful. When blood stasis occurs due to hypoxia, tissue metabolic disorders and accumulation of intermediate metabolites, lighter causes local parenchymal cell degeneration, corresponding morphological changes and functional decline, severe local tissue necrosis, and parenchymal cells often in chronic blood stasis Shrinking due to malnutrition. Common blood stasis has chronic pulmonary blood stasis and chronic liver stasis.

Arterial congestion: expansion of small arteries in organs and tissues of hyperemia, increased number of open capillaries, increased local arterial blood volume, and thus increased local tissue volume and increased metabolic and functional activities. The surface tissue is congested with a bright red color and an elevated temperature.

Venous congestion: due to obstruction of venous return, blood is deposited in the dilated venules and capillaries, so the volume of organs and tissues of the congestion increases. Due to slow blood flow and lack of oxygen in the congestion area, oxyhemoglobin is reduced and deoxyhemoglobin is increased. When the latter exceeds 50g/L (5g%), the finger (toe) end, lips and the like are blue-purple, called purpura ( Cyanosis). The lack of oxygen in the congestion area reduces the metabolic rate of the tissue and reduces the heat production. Because of the expansion of the blood vessels, the heat dissipation is excessive, so the temperature at the surface of the body is reduced.

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