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Edema
- 2. WHAT IS EDEMA? • Abnormally increased accumulation of fluid in the interstitial space. • may be localised to one organ (e.g. abdomen- ascites) or region or it may be generalised (anasarca)
- 3. PATHOPHYSIOLOGY OF EDEMA • Starling’s equation Jv = Kf[(Pc-Pi)-(πc- πI)] Where: Jv = fluid flow Kf = filtration coefficient Pc = capillary hydrostatic pressure Pi = interstitial fluid hydrostatic pressure πc = capillary oncotic pressure πi = interstitial oncotic pressure
- 5. TYPES OF EDEMA Venous edema • low-viscosity, protein-poor interstitial fluid. • results from increased capillary filtration • normal lymphatic system • pitting lymphedema • excess protein-rich interstitial fluid. • resulting from lymphatic dysfunction. • Usually non tender. • a warty texture (hyperkeratosis) is characteristic of chronic lymphedema. • Usually non-pitting.
- 6. CAUSES OF VENOUS EDEMA • High venous pressure (heart failure, venous pump failure, venous obstruction) • Excessive kidney retention of salt and water • Decreased plasma proteins- low intake: malnutrition decreased production: liver disease increased loss: nephrotic syndrome, burns • Increased capillary permeability
- 7. CAUSES OF LYMPHEDEMA • BLOCKAGE OF LYMPH RETURN - infections (filarial nematodes) - cancer - surgery - congenital absence or abnormality of lymph vessels. (milroy’s disease)
- 8. PITTING PEDAL EDEMA SCROTAL ELEPHANTIASIS
- 9. PULMONARY EDEMA BRAIN EDEMA
- 10. TREATMENT • Identify and treat underlying cause.
Editor's Notes
- If Jv is positive, then there is net fluid movement out of the capillary (filtration) If Jv is negative, then there is net fluid movement into the capillary (absorption) Kf- depends on the permeability of the capillary and is increased in inflammation states Pc- Increases in Pc favors filtration out of the capillary. It is determined by the arterial and venous pressures and resistances An increases in either arterial or venous pressure will increase Pc but increases in venous pressure have a greater effect. Pi- Increases in Pi oppose filtration out of the capillary. It is normally close to 0mmHg or negative) Πc- Increases in πc oppose filtration out of the capillary It is increased by increases in protein concentration in blood πi - Increases in πi favour filtration out of the capillary It is dependant upon the protein concentration of interstitial fluid Its value is normally quite low because little protein is filtered out of capillaries into interstitial fluid
- High venous pressure- Heart failure (systemic-right heart), venous pump failure (muscle paralysis, immobilization, valve failure), venous obstruction. Kidney- Kidney failure and mineralocorticoid excess (aldosterone- increased Na and water reabsorption) . Permeability – inflammation
- Milroy’s disease- mutation of flt4 gene. Responsible for production of vascular endothelial growth factor. Mutation= malformed or absent lymphatic vessels= lymphmdema at birth.
- Pulmonary edema: two types- Cardiogenic- is caused by elevated pulmonary capillary hydrostatic pressure leading to transudation of fluid into the pulmonary interstitium and alveoli. Left sided heart failure increases pulmonary venous pressure and pressure in the lung microvasculature. Non cardiogenic- fluid overload- renal, iatrogenic