Oedema new edited

1. EDEMAEDEMA
Prepared byPrepared by
Dr. Mizanur Rahman ChowdhuryDr. Mizanur Rahman Chowdhury

2. EdemaEdema
DefinitionDefinition
Excessive accumulation of abnormal Excessive accumulation of abnormal
amount of fluid into the interstitial amount of fluid into the interstitial
space and or body cavities.space and or body cavities.

3. Normal homeostasisNormal homeostasis
Factor 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 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

5. Classification of edemaClassification of edema
OnOn the basis of involvementthe basis of involvement
Localized edemaLocalized edema
Generalized edemaGeneralized edema
On the basis of inflammationOn the basis of inflammation
Inflammatory/Exudative edemaInflammatory/Exudative edema
Non inflammatory/Transudative edemaNon inflammatory/Transudative edema
Clinical ClassificationClinical Classification
Pitting edemaPitting edema
Non pitting edemaNon pitting edema

6. Pathophysiological Categories of Pathophysiological Categories of
edemaedema
Increase 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

7. Pathophysiological Categories of Pathophysiological Categories of
edemaedema
Decrease plasma colloidal osmotic Decrease plasma colloidal osmotic
pressurepressure
Nephrotic syndromeNephrotic syndrome
Liver cirrhosisLiver cirrhosis
MalnutritionMalnutrition
Protein loosing gastroenteropathyProtein loosing gastroenteropathy

8. Pathophysiological Categories of Pathophysiological Categories of
edemaedema
Lymphatic obstructionLymphatic obstruction
oInflammatoryInflammatory
oNeoplastic Neoplastic
oPost surgicalPost surgical
oPost irradiationPost irradiation

9. 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 sodiumIncrease tubular reabsorption of sodium
Renal hypoperfusionRenal hypoperfusion
Increase renal angiotensin aldosterone Increase renal angiotensin aldosterone
secretionsecretion

10. Pathophysiological Categories Pathophysiological Categories
of edemaof edema
InflammatoryInflammatory
• Acute inflammationAcute inflammation
• Chronic inflammationChronic inflammation
• AngiogenesisAngiogenesis

11. 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 of oedema of high protein content but not as that of
exudateexudate
Hypersensitivity edemaHypersensitivity edema

12. Generalized edemaGeneralized edema
Cardiac edemaCardiac edema
Renal edemaRenal edema
Hepatic edemaHepatic edema
Famine edemaFamine edema
Others Others

13. Cardiac edemaCardiac edema
Most common cause is right sided congestive Most common cause is right sided congestive
cardiac failurecardiac failure
Transudative edemaTransudative edema
Dependant peripheral edemaDependant peripheral edema
Distribution 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 edema
Edema pits on pressureEdema pits on pressure

14. 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

15. 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

16. 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

17. 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

18. Renal edemaRenal edema
Cause of renal edemaCause of renal edema
 Acute glomerulonephritisAcute glomerulonephritis
Nephrotic syndromeNephrotic syndrome

19. 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.

20. 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.

21. 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

22. 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.

23. Famine edema/Nutritional edema:Famine edema/Nutritional edema:
oIt is due to hypoproteinaemiaIt is due to hypoproteinaemia
o 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.
oThe 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

24. 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

25. 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.

26. Pulmonary edemaPulmonary edema
Cause 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
ARDSARDS
Associated with anaemia, Associated with anaemia,
Nephrotic syndromeNephrotic syndrome
Overloading of circulationOverloading of circulation
Withdrawal of pleural fluidWithdrawal of pleural fluid

27. Cerebral edemaCerebral edema
There are two types of cerebral There are two types of cerebral
edemaedema
 Vesogenic edemaVesogenic edema
Cytotoxic edemaCytotoxic edema

28. 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

29. 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.

30. Thank youThank you