Unit Ii-Fluid and Hemodynamic Derangements: Edema

UNIT II- FLUID AND
HEMODYNAMIC
DERANGEMENTS
• Edema
Edema
 Hyperemia and Congestion
 Hemorrhage
 Hemostasis & Thrombosis
 Embolism
 Infarction
 Shock
EDEMA
Fluid extravasations and

accumulation in the
interstitial spaces
EDEMA
Increased fluid in the interstitial tissue spaces
 Fluid may also accumulate in body cavities:
1. Hydrothorax
2. Hydropericardium
3. Hydroperitoneum is also called Ascites
 Massive generalized edema is called Anasarca

Fluid Homeostasis
Homeostasis is maintained by
the opposing effects of: Lymphatics
1. Vascular Hydrostatic
Pressure
and
2. Plasma Colloid Osmotic

Pressure
Edema Fluid = TRANSUDATE
 A transudate is protein-poor (specific gravity <1.012)
 An exudate is protein-rich (specific gravity >1.020)

= (inflammatory edema)
Pathophysiologic Categories of Edema
I.I. Increased Hydrostatic
Increased Pressure
Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Others
Increased Hydrostatic Pressure
1. Due to impaired venous return
A) Localized:
 Venous Thrombosis
B) Generalized:
 Congestive Heart Failure
2. Due to increased arteriolar dilatation

Increased Hydrostatic Pressure
Congestive Heart Failure:
“Generalized increase in venous pressure,
with resultant SYSTEMIC EDEMA occurs
MOST COMMONLY in CONGESTIVE HEART FAILURE”
{*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to
Increased Hydrostatic Pressure}
Congestive Heart Failure
Overall, there are TWO main effects...
1. Increased Central Venous Pressure
2. Decreased Renal Perfusion

Increased Hydrostatic Pressure:
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)
 Leading to Edema
& Decreased Renal Perfusion
 Congestive heart failure 

Decreased Cardiac Output 
Decreased ARTERIAL blood volume 
“Less arterial blood…Less renal perfusion...

The Kidney doesn’t see enough blood coming
through …….
& Decreased Renal Perfusion
Decreased Renal Perfusion activates

the Renal Defense Mechanisms:
1. Renin-Angiotensin-Aldosterone axis 
 Na & H2O retention
2. Renal Vasoconstriction
3. Increased Renal Anti-diuretic Hormone (ADH)
Congestive Heart Failure - Summary
Central Renal
Venous Perfusion
Pressure
Renin ADH
Renal
Vasoconstriction
I. Increased Hydrostatic Pressure

II. Reduced
II. Reduced Plasma
Plasma Oncotic
Oncotic Pressure
Pressure
III. Inflammation
IV. Other
Reduced Plasma
Osmotic Pressure
 “…Albumin:
is the serum protein MOST responsible for the
maintenance of colloid osmotic pressure.”
 A decrease in osmotic pressure can result from:

1.  Protein Loss
or
2.  Protein Synthesis
Reduced Plasma
Osmotic Pressure
1. Increased albumin loss:

 Nephrotic Syndrome
 Increased permeability of the glomerular capillary wall 
loss of protein
2. Reduced albumin synthesis

 Cirrhosis
 Protein malnutrition
III.III.Inflammation
Inflammation
IV. Other
III. Inflammation
IV. :Others
IV. Others
- Lymphatic Obstruction
- Sodium & water retention
Lymphatic Obstruction
 Impaired lymphatic drainage with resultant
lymphedema
 usually localized
 usually due to:
 INFLAMMATION
or
 NEOPLASTIC OBSTRUCTION
 Filariasis –
 A parasitic infection affecting
inguinal lymphatics resulting
in elephantiasis
Neoplastic
 Resection and/or radiation to axillary lymphatics in
breast cancer patients can lead to -- arm 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)

EDEMA - Summary
INCREASED DECREASED
HYDROSTATIC  HEART ONCOTIC
PRESSURE PRESSURE
 LIVER
Nephrotic Syndrome
Ascites
Venous Obstruction
 KIDNEY Cirrhosis
Protein Malnutrition
LYMPHATIC
INCREASED OBSTRUCTION
PERMEABILITY Inflammatory
Inflammation Neoplastic
GENERALIZED EDEMA
 HEART
 LIVER
 KIDNEY
Edema
Morphology
Subcutaneous Edema
 Edema of the subcutaneous tissue is most easily detected Grossly (not microscopically)
 Push your finger into it
 and a depression remains
 Dependent Edema is a prominent

feature of Congestive Heart Failure
 Facial Edema is often the initial

manifestation of Nephrotic
Syndrome
Edema
Clinical Correlation:
Subcutaneous Edema
 Annoying but Points to Underlying Disease
 However, it can impair wound healing or
clearance of Infection
Edema
Morphology
Pulmonary Edema
is most frequently seen in Congestive Heart Failure

 May also be present in renal failure, adult respiratory
distress syndrome (ARDS), pulmonary infections and
hypersensitivity reactions
Pulmonary Edema
Gross:
 The Lungs are typically 2-3 times the normal weight

 Cross sectioning causes an outpouring of frothy,
sometimes blood-tinged fluid
Normal
Pulmonary Edema
Edema
Pulmonary Edema
 May cause death by interfering with Oxygen and
Carbon Dioxide exchange
 Creates a favorable environment for infection
 THINK it resembles “Culture Media”!!!
Edema of the Brain
 Trauma, Abscess, Neoplasm, Infection

(Encephalitis due to say… West Nile Virus), etc
Edema of the Brain
 The big problem is: There is no place for the fluid to go!
 Herniation into the foramen magnum will kill

Unit Ii-Fluid and Hemodynamic Derangements: Edema

Uploaded by

Copyright:

Available Formats

Unit Ii-Fluid and Hemodynamic Derangements: Edema

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Unit Ii-Fluid and Hemodynamic Derangements: Edema

Uploaded by

Copyright:

Available Formats

UNIT II- FLUID AND

Fluid extravasations and

 Massive generalized edema is called Anasarca

2. Plasma Colloid Osmotic

 A transudate is protein-poor (specific gravity <1.012)

 An exudate is protein-rich (specific gravity >1.020)

Increased Hydrostatic Pressure

1. Due to impaired venous return

2. Due to increased arteriolar dilatation

Congestive Heart Failure:

“Generalized increase in venous pressure,

with resultant SYSTEMIC EDEMA occurs

MOST COMMONLY in CONGESTIVE HEART FAILURE”

Overall, there are TWO main effects...

1. Increased Central Venous Pressure

2. Decreased Renal Perfusion

 then into the venous circulation

 increasing Central Venous Pressure (CVP)

 increased capillary pressure (Hydrostatic Pressure)

 Congestive heart failure 

“Less arterial blood…Less renal perfusion...

Decreased Renal Perfusion activates

I. Increased Hydrostatic Pressure

 A decrease in osmotic pressure can result from:

1. Increased albumin loss:

2. Reduced albumin synthesis

 Resection and/or radiation to axillary lymphatics in

breast cancer patients can lead to -- arm edema

 Carcinoma of breast with obstruction of superficial

lymphatics can lead to edema of breast skin -- --with an

“peau d’orange” (orange peel)

 Dependent Edema is a prominent

 Facial Edema is often the initial

is most frequently seen in Congestive Heart Failure

 The Lungs are typically 2-3 times the normal weight

 Trauma, Abscess, Neoplasm, Infection

You might also like