EDEMAEDEMA

Prepared by: Ahmed JemalPrepared by: Ahmed JemalJimma university medical seniorJimma university medical senior

EdemaEdema

• EdemaEdema: is the accumulation of excessive body fluid : is the accumulation of excessive body fluid in interstitial space or serous body cavity, which is a in interstitial space or serous body cavity, which is a pathologic process caused by diseases rather than pathologic process caused by diseases rather than a disease entity.a disease entity.

• Hydrops: when body fluid is accumulated in serous Hydrops: when body fluid is accumulated in serous body cavity, edema is also called hydrops, such as body cavity, edema is also called hydrops, such as ascites and hydrothorax.ascites and hydrothorax.

Isotonic fluid

Edema is not accompanied with cellular edema

Normal homeostasisNormal homeostasisFactor tending to drive the fluid out of the blood Factor tending to drive the fluid out of the blood

vessels:vessels:• Hydrostatic pressure with in the Hydrostatic pressure with in the

vesselsvessels• The colloidal osmotic pressure of The colloidal osmotic pressure of

interstitial spacesinterstitial spacesFactor 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

pressurepressureNephrotic syndromeNephrotic syndromeLiver cirrhosisLiver cirrhosisMalnutritionMalnutritionProtein loosing gastroenteropathyProtein loosing gastroenteropathy

Pathophysiological Categories of Pathophysiological Categories of edemaedema

Lymphatic obstructionLymphatic obstructionoInflammatoryInflammatoryoNeoplastic Neoplastic oPost surgicalPost surgicaloPost irradiationPost irradiation

Pathophysiological Categories of Pathophysiological Categories of edemaedemaSodium retentionSodium retention

Excessive salt intake with renal Excessive salt intake with renal insufficiencyinsufficiency

Increase tubular reabsorption of sodiumIncrease tubular reabsorption of sodium Renal hypoperfusionRenal hypoperfusion Increase renal angiotensin aldosterone Increase renal angiotensin aldosterone

secretionsecretion

Pathophysiological Categories Pathophysiological Categories of edemaof edema

InflammatoryInflammatory• Acute inflammationAcute inflammation• Chronic inflammationChronic inflammation• AngiogenesisAngiogenesis

Localised oedemaLocalised oedemaInflammatory edema:Inflammatory edema: Exudate are formed due to increase vascular Exudate are formed due to increase vascular

permeability proteinpermeability proteinEdema 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 of oedema of high protein content but not as that of exudateexudate

Hypersensitivity edemaHypersensitivity edema

Generalized edemaGeneralized edema

Cardiac edemaCardiac edemaRenal edemaRenal edemaHepatic edemaHepatic edemaFamine edemaFamine edemaOthers Others

Cardiac edemaCardiac edemaMost common cause is right sided congestive Most common cause is right sided congestive

cardiac failurecardiac failureTransudative edemaTransudative edemaDependant peripheral edemaDependant peripheral edemaDistribution is influenced by gravity i.e.Distribution is influenced by gravity i.e. When patient is ambulant: ankle edemaWhen patient is ambulant: ankle edema When patient is recumbent: sacral edemaWhen patient is recumbent: sacral edemaEdema pits on pressureEdema pits on pressure

Pathogenesis of Cardiac oedema Pathogenesis of Cardiac 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 oedemaHeart 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 oedemaHeart 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 glomerulonephritisAcute glomerulonephritisNephrotic syndromeNephrotic syndrome

Pathogenesis of Renal oedemaPathogenesis of Renal oedema

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 heart There may be additional factor of heart

failure.failure.Nephritic edema affect the face and Nephritic edema affect the face and

eyelids predominantly; ankle and eyelids predominantly; ankle and genitalia also often affected.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 oedemaPathogenesis of Renal oedema

Nephrotic syndromeNephrotic syndrome: : Salt and water retention occour in nephrotic syndromeSalt and water retention occour in nephrotic syndrome

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 decrease In some cases of nephrotic syndrome blood volume 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 edema:Famine edema/Nutritional 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 famine plasma protein level is normal in famine oedema. oedema.

o The true explanation is unknown. But there The true explanation is unknown. But there is an important factor is loss of compact is an important factor is loss of compact tissue and replace by loose connective tissue and replace by loose connective tissue which can accumulate fluid without tissue which can accumulate fluid without rise of tissue tensionrise of tissue tension

Hepatic edemaHepatic edema

The main manifestation of hepatic edema is ascitis.The main manifestation of hepatic edema is ascitis. The factor responsible for hepatic edemaThe factor responsible for hepatic edema

Lymphatic obstructionLymphatic obstruction

Low plasma protein levelLow plasma protein level

Increase regional venous pressure due to Increase regional venous pressure due to portal hypertensionportal hypertension

Failure to hepatic inactivation of Failure to hepatic inactivation of aldosteronealdosterone

Pulmonary edemaPulmonary edema

Hydrostatic balance of lung capillaries is some Hydrostatic balance of lung capillaries is some what different from the systemic circulation.what different from the systemic circulation.

Blood pressure in the pulmonary circuit is Blood pressure in the pulmonary circuit is about 15-25mm hg systolic and 6-12mm Hg about 15-25mm hg systolic and 6-12mm Hg diastolic mean capillary pressure is 7mm Hg diastolic mean capillary pressure is 7mm Hg being highest at the base and lowest at the being highest at the base and lowest at the apex.apex.

The interstitial fluid pressure is -16mm Hg. The interstitial fluid pressure is -16mm Hg. Both these forces tend to drive fluid out of Both these forces tend to drive fluid out of capillaries in to the interstitial space which capillaries in to the interstitial space which consist of mucopolysacchadide. Normally the consist of mucopolysacchadide. Normally the plasma colloidal osmotic pressure25-28mm Hg plasma colloidal osmotic pressure25-28mm Hg is adequate to prevent fluid escaping in the is adequate to prevent fluid escaping in the interstitial tissue.interstitial tissue.

Pulmonary edemaPulmonary edemaCause of pulmonary edema:Cause of pulmonary edema:

Left heart failure ,Left ventricular Left heart failure ,Left ventricular failure ,Mitral stenosis particularly failure ,Mitral stenosis particularly in fibrilationin fibrilation

Inflammation of lung, Inflammation of lung, PneumoniaPneumonia

ARDSARDSAssociated with anaemia, Associated with anaemia,

Nephrotic syndromeNephrotic syndromeOverloading of circulationOverloading of circulationWithdrawal of pleural fluidWithdrawal of pleural fluid

Cerebral edemaCerebral edema

There are two types of cerebral There are two types of cerebral edemaedema

Vesogenic edemaVesogenic edemaCytotoxic edemaCytotoxic edema

Vesogenic cerebral edemaVesogenic cerebral edema

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 nneural, intracellular fluid secondary to nneural, glial, or endothelial cell membrene glial, or endothelial cell membrene injury in a patient with a generalized injury in a patient with a generalized hypoxic/ischemic insult or with some hypoxic/ischemic insult or with some intoxication.intoxication.

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