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EDEMAEDEMA
Prepared byPrepared by
Dr. Mizanur Rahman ChowdhuryDr. Mizanur Rahman Chowdhury
EdemaEdema
DefinitionDefinition Excessive accumulation of Excessive accumulation of abnormal amount of fluid into abnormal amount of fluid into the interstitial space and or the interstitial space and or body cavities.body cavities.
Normal homeostasisNormal homeostasisFactor tending to drive the fluid out of the Factor tending to drive the fluid out of the
blood vessels:blood vessels:• Hydrostatic pressure with in the Hydrostatic pressure with in the vesselsvessels
• The colloidal osmotic pressure of The colloidal osmotic pressure of interstitial spacesinterstitial spaces
Factor tending to drive the fluid with in the Factor tending to drive the fluid with in the blood vessels:blood vessels:
• Tissue tensionTissue tension• The colloidal osmotic pressure of The colloidal osmotic pressure of interstitial spacesinterstitial spaces
Classification of edemaClassification of edemaOnOn the basis of involvementthe basis of involvement
Localized edemaLocalized edemaGeneralized edemaGeneralized edema
On the basis of inflammationOn the basis of inflammationInflammatory/Exudative edemaInflammatory/Exudative edemaNon inflammatory/Transudative edemaNon inflammatory/Transudative edema
Clinical ClassificationClinical ClassificationPitting edemaPitting edemaNon pitting edemaNon pitting edema
Pathophysiological Categories of Pathophysiological Categories of edemaedemaIncrease hydrostatic pressureIncrease hydrostatic pressure• Impaired venous returnImpaired venous return
Congestive cardiac failureCongestive cardiac failure
Constrictive pericarditConstrictive pericardit
Liver cirrhosisLiver cirrhosis
• Venous pressure or obstructionVenous pressure or obstruction
ThrombosisThrombosis
External pressureExternal pressure
• Arteriolar dilationArteriolar dilation
HeatHeat
Neurohumoral dysregulationNeurohumoral dysregulation
Pathophysiological Categories of Pathophysiological Categories of edemaedemaDecrease plasma colloidal osmotic Decrease plasma colloidal osmotic
pressurepressure
Nephrotic syndromeNephrotic syndromeLiver cirrhosisLiver cirrhosisMalnutritionMalnutritionProtein loosing Protein loosing gastroenteropathygastroenteropathy
Pathophysiological Categories of Pathophysiological Categories of edema edema
Lymphatic obstructionLymphatic obstructionoInflammatoryInflammatoryoNeoplastic Neoplastic oPost surgicalPost surgicaloPost irradiationPost irradiation
Pathophysiological Categories of Pathophysiological Categories of edemaedema
Sodium retentionSodium retention Excessive salt intake with renal Excessive salt intake with renal
insufficiencyinsufficiency Increase tubular reabsorption of Increase tubular reabsorption of
sodiumsodium Renal hypoperfusionRenal hypoperfusion Increase renal angiotensin Increase renal angiotensin
aldosterone secretionaldosterone secretion
Pathophysiological Pathophysiological Categories of edemaCategories of edema
InflammatoryInflammatory• Acute inflammationAcute inflammation• Chronic inflammationChronic inflammation• AngiogenesisAngiogenesis
Localised oedemaLocalised oedema
Inflammatory edema:Inflammatory edema: Exudate are formed due to increase vascular Exudate are formed due to increase vascular
permeability proteinpermeability protein
Edema due to venous obstructionEdema due to venous obstruction: : In venous obstruction there is rise of hydrostatic In venous obstruction there is rise of hydrostatic
pressure, this lead formation of exudates.pressure, this lead formation of exudates.
Edema due to lymphatic obstruction:Edema due to lymphatic obstruction: Excessive lymphatic obstruction can produce an Excessive lymphatic obstruction can produce an
oedema of high protein content but not as that oedema of high protein content but not as that of exudateof exudate
Hypersensitivity edemaHypersensitivity edema
Generalized edemaGeneralized edema
Cardiac edemaCardiac edemaRenal edemaRenal edemaHepatic edemaHepatic edemaFamine edemaFamine edemaOthers Others
Cardiac edemaCardiac edema
Most common cause is right sided Most common cause is right sided congestive cardiac failurecongestive cardiac failure
Transudative edemaTransudative edemaDependant peripheral edemaDependant peripheral edemaDistribution is influenced by gravity i.e.Distribution is influenced by gravity i.e.
When patient is ambulant: ankle When patient is ambulant: ankle edemaedema
When patient is recumbent: sacral When patient is recumbent: sacral edemaedema
Edema pits on pressureEdema pits on pressure
Pathogenesis of Cardiac Pathogenesis of Cardiac oedema oedema
Heart failureHeart failure
Increase central venous pressureIncrease central venous pressure
Increase capillary pressureIncrease capillary pressure
Increase transudation Increase transudation
OedemaOedema
Pathogenesis of Cardiac oedemaPathogenesis of Cardiac oedema
Heart failure Heart failure
Decrease cardiac output Decrease cardiac output
Decrease effective arterial blood volumeDecrease effective arterial blood volume
Renal vasoconstrictionRenal vasoconstriction
Decrease GFRDecrease GFR
Increase tubular reabsorption sodium and waterIncrease tubular reabsorption sodium and water
Increase plasma volumeIncrease plasma volume
Increase transudationIncrease transudation
OedemaOedema
Pathogenesis of Cardiac oedemaPathogenesis of Cardiac oedema
Heart failureHeart failure
Decrease cardiac outputDecrease cardiac output
Decrease effective arterial blood volume Decrease effective arterial blood volume
Increase renin secretion Increase renin secretion
Increase aldosterone Increase aldosterone
Increase renal reabsorption of sodium Increase renal reabsorption of sodium
Increase renal retention of sodium and waterIncrease renal retention of sodium and water
Increase plasma volume Increase plasma volume
Increase transudation Increase transudation
oedemaoedema
Pathogenesis of Cardiac oedemaPathogenesis of Cardiac oedema
Heart failureHeart failure
Decrease cardiac outputDecrease cardiac output
Decrease effective arterial blood volumeDecrease effective arterial blood volume
Increase ADH secrationIncrease ADH secration
Increase renal retention waterIncrease renal retention water
Increase renal retention of sodium and waterIncrease renal retention of sodium and water
Increase plasma volumeIncrease plasma volume
Increase transudationIncrease transudation
edemaedema
Renal edemaRenal edema
Cause of renal edemaCause of renal edema Acute Acute glomerulonephritisglomerulonephritis
Nephrotic syndromeNephrotic syndrome
Pathogenesis of Renal Pathogenesis of Renal oedemaoedema
Acute glomerulonephritis:Acute glomerulonephritis: Salt and water retention by the Salt and water retention by the
damaged kidney.damaged kidney.There may be additional factor of There may be additional factor of
heart failure.heart failure.Nephritic edema affect the face Nephritic edema affect the face
and eyelids predominantly; ankle and eyelids predominantly; ankle and genitalia also often affected.and genitalia also often affected.
Pathogenesis of Renal edemaPathogenesis of Renal edema
Nephrotic syndromeNephrotic syndrome::
Heavy proteinuria Heavy proteinuria
Decrease plasma colloidalDecrease plasma colloidal
osmotic pressureosmotic pressure
Generalized oedema.Generalized oedema.
Pathogenesis of Renal Pathogenesis of Renal oedemaoedema
Nephrotic syndromeNephrotic syndrome: : Salt and water retention occour in nephrotic Salt and water retention occour in nephrotic
syndromesyndrome
Increase blood volumeIncrease blood volume
Increase hydrostatic pressure Increase hydrostatic pressure
Generalized oedemaGeneralized oedema
Pathogenesis of Renal edemaPathogenesis of Renal edema
In some cases of nephrotic syndrome blood volume In some cases of nephrotic syndrome blood volume decrease decrease
Activate renin angiotensin aldosterone mechanismActivate renin angiotensin aldosterone mechanism
Sodium and water retention by the kidneySodium and water retention by the kidney
blood volume increaseblood volume increase
Increase hydrostatic pressureIncrease hydrostatic pressure
Generalized edema.Generalized edema.
Famine edema/Nutritional Famine edema/Nutritional edema:edema:
o It is due to hypoproteinaemiaIt is due to hypoproteinaemiao sometimes oedema is extensive but sometimes oedema is extensive but
plasma protein level is normal in plasma protein level is normal in famine oedema. famine oedema.
oThe true explanation is unknown. But The true explanation is unknown. But there is an important factor is loss of there is an important factor is loss of compact tissue and replace by loose compact tissue and replace by loose connective tissue which can connective tissue which can accumulate fluid without rise of tissue accumulate fluid without rise of tissue tensiontension
Hepatic edemaHepatic edema
The main manifestation of hepatic edema is The main manifestation of hepatic edema is ascitis.ascitis.
The factor responsible for hepatic edemaThe factor responsible for hepatic edemaLymphatic obstructionLymphatic obstruction
Low plasma protein levelLow plasma protein level
Increase regional venous pressure Increase regional venous pressure due to portal hypertensiondue to portal hypertension
Failure to hepatic inactivation of Failure to hepatic inactivation of aldosteronealdosterone
Pulmonary edemaPulmonary edema
Hydrostatic balance of lung capillaries is Hydrostatic balance of lung capillaries is some what different from the systemic some what different from the systemic circulation.circulation.
Blood pressure in the pulmonary circuit is Blood pressure in the pulmonary circuit is about 15-25mm hg systolic and 6-12mm about 15-25mm hg systolic and 6-12mm Hg diastolic mean capillary pressure is Hg diastolic mean capillary pressure is 7mm Hg being highest at the base and 7mm Hg being highest at the base and lowest at the apex.lowest at the apex.
The interstitial fluid pressure is -16mm The interstitial fluid pressure is -16mm Hg. Both these forces tend to drive fluid Hg. Both these forces tend to drive fluid out of capillaries in to the interstitial out of capillaries in to the interstitial space which consist of space which consist of mucopolysacchadide. Normally the mucopolysacchadide. Normally the plasma colloidal osmotic pressure25-plasma colloidal osmotic pressure25-28mm Hg is adequate to prevent fluid 28mm Hg is adequate to prevent fluid escaping in the interstitial tissue.escaping in the interstitial tissue.
Pulmonary edemaPulmonary edemaCause of pulmonary edema:Cause of pulmonary edema:
Left heart failure ,Left Left heart failure ,Left ventricular failure ,Mitral ventricular failure ,Mitral stenosis particularly in fibrilationstenosis particularly in fibrilation
Inflammation of lung, Inflammation of lung, PneumoniaPneumonia
ARDSARDSAssociated with anaemia, Associated with anaemia, Nephrotic syndromeNephrotic syndrome
Overloading of circulationOverloading of circulationWithdrawal of pleural fluidWithdrawal of pleural fluid
Cerebral edemaCerebral edema
There are two types of There are two types of cerebral edemacerebral edema
Vesogenic edemaVesogenic edemaCytotoxic edemaCytotoxic edema
Vesogenic cerebral Vesogenic cerebral edemaedema
It occurs when the integrity of It occurs when the integrity of the normal blood brain barrier the normal blood brain barrier is disrupted and increased is disrupted and increased vascular permeability occurs vascular permeability occurs allowing fluid to escape from allowing fluid to escape from the intravascular space of the the intravascular space of the brainbrain
Cytotoxic Cerebral Cytotoxic Cerebral EdemaEdema
It It occurs when there is increaseed occurs when there is increaseed intracellular fluid secondary to intracellular fluid secondary to nneural, glial, or endothelial cell nneural, glial, or endothelial cell membrene injury in a patient with membrene injury in a patient with a generalized hypoxic/ischemic a generalized hypoxic/ischemic insult or with some intoxication.insult or with some intoxication.
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