Edema

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1. Pre by lect: MR ZAHID REHMAN
IPMS(KMU)
EDEMA

2. Fluid distribution
60% of lean body weight is water
2/3 is intracellular
1/3 is extracellular (mostly interstitial)
5% of total body water is in blood plasma

3. EDEMA
Abnormal and excesses amount of fluid in the
interstitial tissue spaces is called edema.
 Fluid collections in different body cavities
may have various designations
Hydrothorax (pleural effusion)
Hydropericardium
Hydroperitoneum (usually called ascites)
Anasarca is severe, generalized edema with
profound subcutaneous tissue swelling.

4. Edema is swelling caused by the increase
extra fluid in the interstatial space. It
usaually happen in feet , ankle , legs,
but also involve the entire body.
There are many causes of edema
including certain health condition and
some medication. Older adult and
pregnant women are more likely to get
edema , but it can happen to any one.
Edema is a disease of many symptom. It
happen to build up fluid in the interstial
fluid. It also happen when the blood flow
to the heart is restricted.

5. In this condition the fluid and blood back
up and leak in to the surrounding tissue.
Edema may also be the body respone
to inflammation or injury. In injury or
inflammation can leak the small blood
vessel(capallaries) and cause edema.
When capallaries leak , they release fluid
in to the sorrounding tissue , these
tissue swell up due to the extra cellular
fluid.

6. Signs of edema
Swelling
Skin that hold a dample or pit after being
hold or pressed
Shiny skin
Enlarge abdomen
Sudden weight gain
Severe edema may cause severe leg
pain , feel heavy and difficult to walk.
Ulcer may also developed on the skin of
leg since sever leg edema can interfere
the blood flow.

8. An ulcer form when surface cell become
inflammed and die . When the skin
broke down the ulcer developed. Some
time the ulcer become very dangerous
and life threating if left untreated.

9. Morphology of edema
Anasarca:
Generaliz edema

10. Dependent edema:
Prominent feature of congestive
heart failure,particularly of the right
ventricle.

11. Renal edema: Edema as a result of renal
dysfunction or nephrotic syndrome is
generally more severe than cardiac edema
and affects all parts of the body equally

12. Pitting edema:
Finger pressure over substantially edematous
subcutaneous tissue displaces the interstitial
fluid and leaves a finger-shaped depression

13. Pulmonary edema:
Most typically seen in the setting of left
ventricular failure

14. Hydrostatic pressure.
Hydrostatic pressure tends to pull the fluid
out of the vessel.
Colloid osmotic pressure.
plasma colloid osmotic pressure which is
opposite to hydrostatic pressure.
Either increased vascular hydrostatic
pressure or diminshed plasma colloid
somotic pressure can result in increased
interstitial fluid and edema formation.

15. Mechanism of edema formation
1.Increased vascular hydrostatic
pressure in:
Increased hydrostatic pressure leads to
accumulation of fluid in extravascular
space, this fluid has very low amount of
protein and is called transudate.
Local
e.g., Impaired venous outflow, such as
in deep venous
thrombosis, or lower extremity inactivity
with prolonged
dependency

16. Generalized
e.g., Congestive heart failure, affecting
right ventricular
function.
The reduce cardaic output lead to
hypoperfusion of the kidney, triggering
the renin angiotension aldosterone and
inducing soduim and water retension,
this is called hyperaldosteronism..
Hyper aldosteronism is a common feature
of generalised edema, salt restriction,
diuretics, and aldosterone antagoinst
also are of value in the managment of
generalised edema .

17. .Reduced Plasma Osmotic Pressure
Excessive loss or reduced synthesis of
albumin (which is
the serum protein most responsible for
maintaining colloid
osmotic pressure)
i. Nephrotic syndrome
Leaky glomerular capillary wall,
(nephrotic syndrome) albumin loss, and
generalized edema occur.(protineuria)
ii. Diffuse liver pathology or
protein malnutrition
Reduced albumin synthesis

18. Decreased albumin leads to reduced plasma
osmotic
pressure, with subsequent net movement of
fluid into
interstitial tissues and resultant plasma volume
contraction.
Decrease protein intake ( malnutrition ) also
causes decreased plasma proteins and colloid
osmotic pressure.
Renal disease
loss of albumin across glomerulus
Hepatic disease
inadequate albumin synthesis
Malnutrition
inadequate albumin synthesis

19. 3. Lymphatic obstruction :
Lymphatic removes interstitial fluid and return it
to the blood stream via thoracic duct. Impaired
lymphatic drainage and consequent
lymphedema usually result from a localised
obstruction caused by an an inflammatory or
neoplastic condition.
Causes of lymphatic obstruction are
•surgery
•due to radiation treatment
•due to tumer
•due to inflammation

20. For example , the parasitic(WUCHERERIA
BANCROFTI) infection filariasis can cause
massive edema of the lower extremity and
external genitalia( so called elephantiasis) due
to inuginal lymphatic and lymph node fibrosis.
Women with the breast cancer who undergo to
mastectomy proceduer and also resect
axillary lymphnode, can disrupt and obtruct
lymphatic drainage , result in severe
lymphedema of the superoir arm.
Some time the thoracic duct rupture and
release the content the lymphe node in the
thoracic is called chylothorax, in abdominal
cavity is called chylous ascites.
MILROY,S disease is a hereditory
lymphaedema. Development abnormality in
lymphatic by birth, causes lymphaedema in
lower extremeties either one or both.

21. 4. Sodium and water retention :
Increased salt (with accompanying water)
causes:
a. Increased hydrostatic pressure due to
intravascular fluid
volume expansion
b. Diminished vascular colloid osmotic
pressure

22. Sodium is retain by the kidney in two
condition.
Decrease GFR :
Glomerular filtration rat is reduced in
acute glomerulonephritis and renal
failure resulting in sodium and water
retention.
Increased renin angiotension aldosterone
secretion which causes sodium
reabsorption in distal convulated tubules
accompanied by water reabosorption
.this sodium and water retention causes
generalized edema.

23. 23
5. Increased vascular
permeability
Edema can also result from
increased vascular permeability due
to inflammation . Exudat is the
protein rich fluid that is accumulated
due to increased vascular
permeability that result in increased
osmotic pressure in interstitail or
extravascular space due to free
passage of plasma protein.

24. Localized edema
Causes of localized edema are
 . Increased vascular permeability due
to inflmmation
 . Impaired venous draingae dut to
venous thrombosis or compression by
external pressure.
 . Obstruction of lymphatic by
inflammation or radiation.
 . Due to exudation processes of acute
inflammation.

25. Allergic reaction :
In acute allergic reaction causes local release of
histamine that produces increased vascular
permeability and arteriolar dilation resulting in
exudation of fluid and edema formation.
Edema of venous obstruction :
obstruction of a vein leads to increased
hydrostatic pressure in capallaries resulting in
edema formation . Fluid is transduate.
e.g.
Edema of face due to superoir vena caval
obstruction.

26. Edema of hypoproteinemia :
Hypoproteinemia decrease plasma colloid
osmotic pressure . Due to this reduced
plasma colloid pressure fluid leaves the
vessel and accumulate in extravascular
tissue resulting in edema formation.
Causes
Decrease protein intake
Decrease synthesize of albumin in liver
( hepatic edema)

27. Pulmonary edema :
Fluid build up in the air sac of the lungs
developed pulmonary edema.
Symptom of pulmonary edema are
Shortness of breath
Cough with blood
Wheezing sound when breathing
Low blood oxygen level in the body

28. Hyperemia and Congestion
Hyperemia
hypermia is an active process resulting
from tissue inflow because of arteriolar
dilation, e.g. skeletal muscle during
exercise or at sites of inflammation. The
affected tissue is redder because of the
engorgement of vessels with
oxygenated blood.
Both indicate a local increased volume of
blood in aparticular tissue.

29. In both cases there is an increased
volume and pressure of blood in a given
tissue with associated capillary dilatation
and apotential for fluid extravsation.

30. In hyperemia ,increased inflow
leads to engorgement with
oxygenated blood,resulting in
erythema.

31. In congestion, diminished outflow
leads to acapillary bed swollen with
deoxygenated venous blood and
resulting in cyanosis

32. hypermia

33. congestion

34. Cerebral Oedema
Causes increased intracranial pressure
Fatal if left untreated
Generalised in hypoxia, injury
Surrounding other lesions eg tumour, abscess

35. Fluid in Body Cavities
Pleural effusion
heart failure, inflammation, tumour

36. Pericardial effusion
inflammation, tumour

37. Ascites (peritoneal effusion)
cirrhosis, heart failure, tumour

39. THANK YOU