Cyanosis pathophysiology: Difference between revisions

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{{CMG}}; {{AE}} {{CK}}
{{CMG}}; {{AE}} {{CK}}
==Overview==
==Overview==
The exact pathogenesis of [disease name] is not fully understood.
[[Cyanosis]] is a bluish or purplish discoloration of [[skin]] and [[Mucous membrane|mucous membranes]]. Two mechanisms are involved in the development of [[cyanosis]], systemic [[Oxygen saturation|arterial oxygen]] desaturation and increased [[oxygen]] [[absorption]] by tissues. [[Cyanosis]] is evident when [[Oxygen saturation|arterial oxygen]] desaturation falls below 85% or the concentration of deoxygenated [[hemoglobin]] (Hb) exceeds 5 gm/dl. Several factors can affect the appearance of [[cyanosis]] which include: [[Human skin color|skin pigmentation]], [[Hemoglobin]] (Hb) levels, [[oxygen]] affinity to the [[hemoglobin]] (Hb).
 
OR
 
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Pathophysiology==
==Pathophysiology==
*[[Cyanosis]] is a bluish or purplish discoloration of the [[skin]] and [[Mucous membrane|mucous membranes]].
*[[Cyanosis]] is a bluish or purplish discoloration of the [[skin]] and [[Mucous membrane|mucous membranes]].
*Appearance of [[cyanosis]] depends on the absolute amount of deoxygenated [[hemoglobin]](Hb) present in the blood rather than the ratio of reduced to oxygenated [[hemoglobin]].<ref name="pmid4933007">{{cite journal |vauthors=Blount SG |title=Cyanosis: pathophysiology and differential diagnosis |journal=Prog Cardiovasc Dis |volume=13 |issue=6 |pages=595–605 |date=May 1971 |pmid=4933007 |doi= |url=}}</ref><ref name="pmid13098533">{{cite journal |vauthors=GERACI JE, WOOD EH |title=The relationship of the arterial oxygen saturation to cyanosis |journal=Med. Clin. North Am. |volume=1 |issue= |pages=1185–1202 |date=July 1951 |pmid=13098533 |doi= |url=}}</ref>
*Appearance of [[cyanosis]] depends on the absolute amount of deoxygenated [[hemoglobin]](Hb) present in the blood rather than the ratio of reduced [[hemoglobin]] (Hb) to oxygenated [[hemoglobin|hemoglobin (Hb)]].<ref name="pmid4933007">{{cite journal |vauthors=Blount SG |title=Cyanosis: pathophysiology and differential diagnosis |journal=Prog Cardiovasc Dis |volume=13 |issue=6 |pages=595–605 |date=May 1971 |pmid=4933007 |doi= |url=}}</ref><ref name="pmid13098533">{{cite journal |vauthors=GERACI JE, WOOD EH |title=The relationship of the arterial oxygen saturation to cyanosis |journal=Med. Clin. North Am. |volume=1 |issue= |pages=1185–1202 |date=July 1951 |pmid=13098533 |doi= |url=}}</ref>
*According to '''Lundsgaard and Van Slyke''' (1923), as well as subsequent investigators, [[cyanosis]] is evident when the subpapillary [[Capillary|capillaries]] contain from 4 to 6 gm/dl of deoxygenated [[hemoglobin]] and [[oxygenation]] of [[hemoglobin]] or [[oxygen saturation]] falls below 85%.<ref name="pmid19868357">{{cite journal |vauthors=Lundsgaard C |title=STUDIES ON CYANOSIS : I. PRIMARY CAUSES OF CYANOSIS |journal=J. Exp. Med. |volume=30 |issue=3 |pages=259–69 |date=September 1919 |pmid=19868357 |pmc=2126682 |doi= |url=}}</ref>  
*[[Artery|Arterial]] [[hemoglobin]] desaturation can be caused by following mechanisms :<ref name="pmid28144061">{{cite journal |vauthors=Sarkar M, Niranjan N, Banyal PK |title=Mechanisms of hypoxemia |journal=Lung India |volume=34 |issue=1 |pages=47–60 |date=2017 |pmid=28144061 |pmc=5234199 |doi=10.4103/0970-2113.197116 |url=}}</ref>
**Alveolar [[hypoventilation]]
**[[Diffusion]] impairment
**[[Ventilation (physiology)|Ventilation]] and [[perfusion]] mismatch
**Right-to-left [[shunting]]
**Inadequate [[oxygen]] transport by [[hemoglobin]]
**Low inspired [[oxygen]]
*According to '''Lundsgaard and Van Slyke''' (1923), as well as subsequent investigators, [[cyanosis]] is evident when the subpapillary [[Capillary|capillaries]] contain from 4 to 6 gm/dl of deoxygenated [[hemoglobin]] and [[oxygenation]] of [[hemoglobin]] or [[oxygen saturation]] falls below 85% (normal ABG PaO2 85-100%).<ref name="pmid19868357">{{cite journal |vauthors=Lundsgaard C |title=STUDIES ON CYANOSIS : I. PRIMARY CAUSES OF CYANOSIS |journal=J. Exp. Med. |volume=30 |issue=3 |pages=259–69 |date=September 1919 |pmid=19868357 |pmc=2126682 |doi= |url=}}</ref><ref name="pmid3206391">{{cite journal |vauthors=Snider HL, Roy TM |title=Deoxyhaemoglobin concentrations in the detection of central cyanosis |journal=Thorax |volume=43 |issue=10 |pages=801 |date=October 1988 |pmid=3206391 |pmc=461518 |doi= |url=}}</ref>
*[[Cyanosis]] occurs due to following [[Mechanism (biology)|mechanism]]<nowiki/>s:
*[[Cyanosis]] occurs due to following [[Mechanism (biology)|mechanism]]<nowiki/>s:
**Systemic [[Artery|arterial]] [[oxygen]] desaturation.
**Systemic [[Artery|arterial]] [[oxygen]] desaturation.<ref name="pmid29489181">{{cite journal |vauthors=Adeyinka A, Kondamudi NP |title= |journal= |volume= |issue= |pages= |date= |pmid=29489181 |doi= |url=}}</ref><ref name="pmid19868358">{{cite journal |vauthors=Lundsgaard C |title=STUDIES ON CYANOSIS : II. SECONDARY CAUSES OF CYANOSIS |journal=J. Exp. Med. |volume=30 |issue=3 |pages=271–93 |date=September 1919 |pmid=19868358 |pmc=2126678 |doi= |url=}}</ref>
***Reduced arterial oxygenation can result if the amount of oxygen in the alveoli is lowered or if the gradient between the alveolar oxygen and the arterial oxygen is elevated.
***Reduced arterial oxygenation can result if the amount of oxygen in the alveoli is lowered or if the gradient between the alveolar oxygen and the arterial oxygen is elevated.
**Increased [[oxygen]] extraction by the [[Tissue (biology)|tissues]]
**Increased [[oxygen]] extraction by the [[Tissue (biology)|tissues]]
*'''Central cyanosis:'''
***Sluggish movement of blood through the capillary circulation is responsible for increased oxygen extraction by the tissues.
**Central [[cyanosis]] is caused by reduced arterial [[Oxygen|oxygen saturation]] or the presence of abnormal [[hemoglobin]] derivatives ([[Methaemoglobin|methemoglobin]] or [[Sulfhemoglobinemia|sulfhemoglobin]]).
*'''Central cyanosis:'''<ref name="pmid19727322">{{cite journal |vauthors=Steinhorn RH |title=Evaluation and management of the cyanotic neonate |journal=Clin Pediatr Emerg Med |volume=9 |issue=3 |pages=169–175 |date=September 2008 |pmid=19727322 |pmc=2598396 |doi=10.1016/j.cpem.2008.06.006 |url=}}</ref>
**Central [[cyanosis]] is evident when the systemic [[Artery|arterial]] deoxygenated [[hemoglobin]] concentration in the blood exceeds 5 g/dL (oxygen saturation ≤85 percent).
**Central [[cyanosis]] is caused by reduced arterial [[Oxygen|oxygen saturation]] or the presence of abnormal [[hemoglobin]] derivatives ([[Methaemoglobin|methemoglobin]] or [[Sulfhemoglobinemia|sulfhemoglobin]]).<ref name="pmid6722683">{{cite journal |vauthors=Whelan JF |title=Methemoglobin as a cause of cyanosis |journal=Can Med Assoc J |volume=130 |issue=10 |pages=1260 |date=May 1984 |pmid=6722683 |pmc=1483499 |doi= |url=}}</ref><ref name="pmid26556978">{{cite journal |vauthors=Ananthakrishna R, Moorthy N, Rao DP, Nanjappa MC |title=An adult with central cyanosis and differential pulmonary vascularity |journal=Ann Pediatr Cardiol |volume=8 |issue=3 |pages=253–4 |date=2015 |pmid=26556978 |pmc=4608209 |doi=10.4103/0974-2069.150701 |url=}}</ref><ref name="pmid19868355">{{cite journal |vauthors=Stadie WC |title=THE OXYGEN OF THE ARTERIAL AND VENOUS BLOOD IN PNEUMONIA AND ITS RELATION TO CYANOSIS |journal=J. Exp. Med. |volume=30 |issue=3 |pages=215–40 |date=September 1919 |pmid=19868355 |pmc=2126679 |doi= |url=}}</ref><ref name="pmid19144126">{{cite journal |vauthors=Bailliard F, Anderson RH |title=Tetralogy of Fallot |journal=Orphanet J Rare Dis |volume=4 |issue= |pages=2 |date=January 2009 |pmid=19144126 |pmc=2651859 |doi=10.1186/1750-1172-4-2 |url=}}</ref>
**Central [[cyanosis]] is evident when the systemic [[Artery|arterial]] deoxygenated [[hemoglobin]] concentration in the blood exceeds 5 g/dL (oxygen saturation ≤85 percent).<ref name="pmid18851735">{{cite journal |vauthors=Martins P, Castela E |title=Transposition of the great arteries |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=27 |date=October 2008 |pmid=18851735 |pmc=2577629 |doi=10.1186/1750-1172-3-27 |url=}}</ref><ref name="pmid27257469">{{cite journal |vauthors=Jain A, Patel A, Hoppe IC |title=Benzocaine-Induced Cyanosis |journal=Eplasty |volume=16 |issue= |pages=ic18 |date=2016 |pmid=27257469 |pmc=4879862 |doi= |url=}}</ref>
**The increased amount of deoxygenated [[hemoglobin]] is the result of either increased amount of venous admixture or reduced capillary arterial [[oxygen]] tension.
**The increased amount of deoxygenated [[hemoglobin]] is the result of either increased amount of venous admixture or reduced capillary arterial [[oxygen]] tension.
*'''Peripheral cyanosis:'''
*'''Peripheral cyanosis:'''<ref name="pmid29060838">{{cite journal |vauthors=Baranoski GVG, Van Leeuwen SR, Chen TF |title=On the detection of peripheral cyanosis in individuals with distinct levels of cutaneous pigmentation |journal=Conf Proc IEEE Eng Med Biol Soc |volume=2017 |issue= |pages=4260–4264 |date=July 2017 |pmid=29060838 |doi=10.1109/EMBC.2017.8037797 |url=}}</ref><ref name="pmid24249890">{{cite journal |vauthors=Das S, Maiti A |title=Acrocyanosis: an overview |journal=Indian J Dermatol |volume=58 |issue=6 |pages=417–20 |date=November 2013 |pmid=24249890 |pmc=3827510 |doi=10.4103/0019-5154.119946 |url=}}</ref>
**In peripheral [[cyanosis]], systemic arterial [[oxygen]] saturation is normal.
**In peripheral [[cyanosis]], systemic arterial [[oxygen]] saturation is normal.
**Increased [[oxygen]] extraction by tissues causes wide systemic arteriovenous oxygen difference and increased deoxygenated blood on the venous side of the capillary beds.
**Increased [[oxygen]] extraction by tissues causes wide systemic arteriovenous oxygen difference and increased deoxygenated blood on the venous side of the capillary beds.
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***Low [[cardiac output]]
***Low [[cardiac output]]
***Vasomotor instability
***Vasomotor instability
**Factors can affect the development of [[cyanosis]]:
*Factors can affect the development of [[cyanosis]]:
***[[Hemoglobin]] concentration
**[[Hemoglobin]] concentration
***[[Human skin color|Skin pigmentation]]
**[[Human skin color|Skin pigmentation]]
***Presence of abnormal [[Hemoglobin|hemoglobins]] interfering with [[oxygen]] [[Chemical affinity|affinity]]
**Presence of abnormal [[Hemoglobin|hemoglobins]] interfering with [[oxygen]] [[Chemical affinity|affinity]]
**Lighting conditions


==Genetics, Associated Conditions, Gross Pathology, Microscopic Pathology==
[[File:Cynosis.JPG|center|thumb|Hand with cyanosis - By James Heilman, MD - Own work, CC BY-SA 3.0,<ref>https://commons.wikimedia.org/w/index.php?curid=17978808</ref>]]


==Genetics, Associated Conditions, Gross Pathology, Microscopic Pathology==
For detailed information on the genetics, associated conditions, gross and microscopic pathological features associated with conditions causing cyanosis, click the links below.
For the details of the genetics, associated conditions, gross and microscopic pathology of the following causes of cyanosis, click the links below.
*[[Tetralogy of Fallot]]
*[[Tetralogy of Fallot]]
*[[Tricuspid atresia]]
*[[Tricuspid atresia]]
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*[[Deep vein thrombosis]]
*[[Deep vein thrombosis]]
*[[Superior vena cava syndrome]]
*[[Superior vena cava syndrome]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category:Primary care]]
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[[Category:Up-To-Date]]
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Latest revision as of 12:57, 14 April 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Cyanosis is a bluish or purplish discoloration of skin and mucous membranes. Two mechanisms are involved in the development of cyanosis, systemic arterial oxygen desaturation and increased oxygen absorption by tissues. Cyanosis is evident when arterial oxygen desaturation falls below 85% or the concentration of deoxygenated hemoglobin (Hb) exceeds 5 gm/dl. Several factors can affect the appearance of cyanosis which include: skin pigmentation, Hemoglobin (Hb) levels, oxygen affinity to the hemoglobin (Hb).

Pathophysiology

Genetics, Associated Conditions, Gross Pathology, Microscopic Pathology

Hand with cyanosis - By James Heilman, MD - Own work, CC BY-SA 3.0,[17]

For detailed information on the genetics, associated conditions, gross and microscopic pathological features associated with conditions causing cyanosis, click the links below.

References

  1. ↑ Blount SG (May 1971). "Cyanosis: pathophysiology and differential diagnosis". Prog Cardiovasc Dis. 13 (6): 595–605. PMID 4933007.
  2. ↑ GERACI JE, WOOD EH (July 1951). "The relationship of the arterial oxygen saturation to cyanosis". Med. Clin. North Am. 1: 1185–1202. PMID 13098533.
  3. ↑ Sarkar M, Niranjan N, Banyal PK (2017). "Mechanisms of hypoxemia". Lung India. 34 (1): 47–60. doi:10.4103/0970-2113.197116. PMC 5234199. PMID 28144061.
  4. ↑ Lundsgaard C (September 1919). "STUDIES ON CYANOSIS : I. PRIMARY CAUSES OF CYANOSIS". J. Exp. Med. 30 (3): 259–69. PMC 2126682. PMID 19868357.
  5. ↑ Snider HL, Roy TM (October 1988). "Deoxyhaemoglobin concentrations in the detection of central cyanosis". Thorax. 43 (10): 801. PMC 461518. PMID 3206391.
  6. ↑ Adeyinka A, Kondamudi NP. PMID 29489181. Missing or empty |title= (help)
  7. ↑ Lundsgaard C (September 1919). "STUDIES ON CYANOSIS : II. SECONDARY CAUSES OF CYANOSIS". J. Exp. Med. 30 (3): 271–93. PMC 2126678. PMID 19868358.
  8. ↑ Steinhorn RH (September 2008). "Evaluation and management of the cyanotic neonate". Clin Pediatr Emerg Med. 9 (3): 169–175. doi:10.1016/j.cpem.2008.06.006. PMC 2598396. PMID 19727322.
  9. ↑ Whelan JF (May 1984). "Methemoglobin as a cause of cyanosis". Can Med Assoc J. 130 (10): 1260. PMC 1483499. PMID 6722683.
  10. ↑ Ananthakrishna R, Moorthy N, Rao DP, Nanjappa MC (2015). "An adult with central cyanosis and differential pulmonary vascularity". Ann Pediatr Cardiol. 8 (3): 253–4. doi:10.4103/0974-2069.150701. PMC 4608209. PMID 26556978.
  11. ↑ Stadie WC (September 1919). "THE OXYGEN OF THE ARTERIAL AND VENOUS BLOOD IN PNEUMONIA AND ITS RELATION TO CYANOSIS". J. Exp. Med. 30 (3): 215–40. PMC 2126679. PMID 19868355.
  12. ↑ Bailliard F, Anderson RH (January 2009). "Tetralogy of Fallot". Orphanet J Rare Dis. 4: 2. doi:10.1186/1750-1172-4-2. PMC 2651859. PMID 19144126.
  13. ↑ Martins P, Castela E (October 2008). "Transposition of the great arteries". Orphanet J Rare Dis. 3: 27. doi:10.1186/1750-1172-3-27. PMC 2577629. PMID 18851735.
  14. ↑ Jain A, Patel A, Hoppe IC (2016). "Benzocaine-Induced Cyanosis". Eplasty. 16: ic18. PMC 4879862. PMID 27257469.
  15. ↑ Baranoski G, Van Leeuwen SR, Chen TF (July 2017). "On the detection of peripheral cyanosis in individuals with distinct levels of cutaneous pigmentation". Conf Proc IEEE Eng Med Biol Soc. 2017: 4260–4264. doi:10.1109/EMBC.2017.8037797. PMID 29060838. Vancouver style error: initials (help)
  16. ↑ Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.
  17. ↑ https://commons.wikimedia.org/w/index.php?curid=17978808
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