3. EDEMAEDEMA
Increased fluid in theIncreased fluid in the interstitial tissue spacesinterstitial tissue spaces
Fluid may also accumulate in body cavities:body cavities:
1.1. HydrothoraxHydrothorax
2.2. HydropericardiumHydropericardium
3.3. Hydroperitoneum is also calledHydroperitoneum is also called AscitesAscites
Massive generalized edema is calledMassive generalized edema is called AnasarcaAnasarca
4. Fluid HomeostasisFluid Homeostasis
Homeostasis is maintained byHomeostasis is maintained by
thethe opposing effectsopposing effects of:of:
1.1. Vascular HydrostaticVascular Hydrostatic
PressurePressure
andand
2.2. Plasma Colloid OsmoticPlasma Colloid Osmotic
PressurePressure
Lymphatics
5. Edema Fluid = TRANSUDATEEdema Fluid = TRANSUDATE
A transudatetransudate is protein-poor (specific gravity <1.012)
An exudateexudate is protein-rich (specific gravity >1.020)
= (inflammatory edema)(inflammatory edema)
6. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Others
I. Increased Hydrostatic Pressure
7. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
Increased Hydrostatic PressureIncreased Hydrostatic Pressure
1. Due to impaired venous returnvenous return
A)A) Localized:Localized:
Venous Thrombosis
A)A) Generalized:Generalized:
Congestive Heart Failure
2. Due o increased arteriolar dilatationarteriolar dilatation
8. Increased Hydrostatic PressureIncreased Hydrostatic Pressure
Congestive Heart Failure:Congestive Heart Failure:
““Generalized increaseGeneralized increase in venous pressure,
with resultant SYSTEMIC EDEMASYSTEMIC EDEMA occurs
MOST COMMONLYMOST COMMONLY inin CONGESTIVE HEART FAILURE”CONGESTIVE HEART FAILURE”
{*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to{*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to
Increased Hydrostatic Pressure}Increased Hydrostatic Pressure}
9. Congestive Heart FailureCongestive Heart Failure
Overall, there are TWO main effects...
1. Increased Central Venous Pressure
2. Decreased Renal Perfusion
10. Increased Hydrostatic PressureIncreased Hydrostatic Pressure::
Congestive Heart FailureCongestive Heart Failure
Mechanism:Mechanism:
The Pump is FAILING!!! ↓ Cardiac output
Blood backs up, first into the lungs
then into the venous circulation
increasing Central Venous Pressure (CVP)
increased capillary pressure (Hydrostatic Pressure)increased capillary pressure (Hydrostatic Pressure)
Leading to EdemaEdema
13. Congestive Heart Failure -Congestive Heart Failure - SummarySummary
Central
Venous
Pressur
e
Renal
Perfusion
Renin
Renal
Vasoconstriction
ADH
14. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Other
II. Reduced Plasma Oncotic PressureII. Reduced Plasma Oncotic Pressure
15. Reduced PlasmaReduced Plasma
Osmotic PressureOsmotic Pressure
“…“…AlbuminAlbumin::
is the serum protein MOST responsible for theis the serum protein MOST responsible for the
maintenance ofmaintenance of colloid osmotic pressure.”colloid osmotic pressure.”
A decrease in osmotic pressuredecrease in osmotic pressure can result from:
1. Protein Loss
oror
22 Protein Synthesis
16. Reduced PlasmaReduced Plasma
Osmotic PressureOsmotic Pressure
1.1. Increased albumin loss:Increased albumin loss:
Nephrotic Syndrome
Increased permeability of the glomerular capillary wall
loss of protein
2.2. Reduced albumin synthesisReduced albumin synthesis
Cirrhosis
Protein malnutrition
17. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Other
III. InflammationIII. Inflammation
18. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. OthersIV. OthersIV. Others::
- Lymphatic Obstruction
- Sodium & water retention
19. Lymphatic ObstructionLymphatic Obstruction
Impaired lymphatic drainage with resultant
lymphedemalymphedema
usually localized
usually due to:
INFLAMMATIONINFLAMMATION
or
NEOPLASTIC OBSTRUCTIONNEOPLASTIC OBSTRUCTION
21. Lymphatic ObstructionLymphatic Obstruction
NeoplasticNeoplastic
Resection and/or radiation to axillary lymphatics in
breast cancer patients can lead to -- arm edemaarm edema
Carcinoma of breast with obstruction of superficial
lymphatics can lead to edema of breast skin -- --with an
unusual appearance:
““peau d’orange” (orange peel)peau d’orange” (orange peel)
24. EdemaEdema
MorphologyMorphology
Dependent EdemaDependent Edema is a prominent
feature of Congestive Heart Failure
Facial EdemaFacial Edema is often the initial
manifestation of Nephrotic
Syndrome
Subcutaneous EdemaSubcutaneous Edema
Edema of the subcutaneous tissue is most easily detected GrosslyGrossly (not
microscopically)
Push your finger into it
and a depression remains
26. EdemaEdema
MorphologyMorphology
Pulmonary EdemaPulmonary Edema
is most frequently seen in Congestive Heart FailureCongestive Heart Failure
May also be present in renal failure, adult respiratory
distress syndrome (ARDS), pulmonary infections and
hypersensitivity reactions
27. Pulmonary EdemaPulmonary Edema
Gross:Gross:
The Lungs are typically 2-3 times the normal weight
Cross sectioning causes an outpouring of frothy,outpouring of frothy,
sometimes blood-tinged fluidsometimes blood-tinged fluid
29. EdemaEdema
Clinical Correlation:Clinical Correlation:
Pulmonary EdemaPulmonary Edema
May cause deathdeath by interfering with Oxygen and
Carbon Dioxide exchange
Creates a favorable environment for infectioninfection
THINK it resembles “Culture Media”!!!
30. Edema of the BrainEdema of the Brain
Trauma, Abscess, Neoplasm, Infection
(Encephalitis due to say… West Nile Virus), etc
