dr. heny a. l. - edema

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  • 7/29/2019 dr. Heny A. L. - Edema

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    Edemadr. Heny Anggraeny Lenap

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    Edema:

    The abnormal accumulation of fluid in a specificorgan vs generalized.

    In capillary: Balance between hydrostaticpressure and oncotic (colloid osmotic)

    pressure.

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    Edema:

    Due to disturbance in hydrostatic and/or oncoticpressure between intra-capillary and interstitialcomponent.

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    Organ specific:

    Brain: Cerebral edema

    Lung: Intra-alveolar=pulmonary edema, intra-pleural=pleural effusion

    Peritoneum=ascites

    Severe generalized edema=anasarca

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    EDEMA

    -Accumulation of fluid in interstitial space (due tofiltration out of the capillaries)

    -Usually caused by a disruption in Starling forces, that

    exceeds the ability of lymphatic system to return itto the circulation.

    A positive net flow equals filtrationA negative net flow equals absorption

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    Mechanisms of edema formation

    Pc Increased capillary pressure(venous constriction, deep vein thrombosis, heart failure)

    CAUSE EXAMPLE

    c Decreased plasma protein osmotic pressure(severe liver failure, nephrotic syndrome) general edema

    i

    Increased capillary protein permeability(due to release of vasoactive substances)(e.g. burns, trauma, infection) local edema

    ImpairedLymphatic drainage

    Standing, parasitic infection of lymph nodes (filariasis)

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    Edema Increased Pc

    (hydrostatic pressure)

    Deep vein thrombosis (DVT)

    Thrombus/clot in leg vein preventsvenous return and raises venous pressure

    inhibiting absorption and promoting filtration.

    FLOWnet= (Pc Pi) (c i)

    If this increases,flow becomes morepositive (filtration).

    Heart failure

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    Edema Decreased c(plasma protein osmotic pressure)

    -Nephrotic syndrome: urinary protein loss > liver replacement (~3.5g/day)(glomerulonephritis, diabetes, intrinsic kidney disease)

    -Liver disease (not enough endogenous albumin produced)Severe loss of protein in urine produces foamy urine.

    Nephrotic syndrome(protein loss > 3.5g/day)

    Liver damage(reduced albumin production)

    Reduced plasma protein concentration

    Fluid efflux from capillariesinto the interstitial fluid

    EDEMA

    FLOWnet= (Pc Pi) (c i)

    If this decreases,

    flow becomes morepositive (filtration).

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    Kwashiorkor

    -Severe protein deficiency and malnutrition-Edema results from decreased plasma proteins(decreased plasma oncotic pressure).

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    FLOWnet= (Pc Pi) (c i)

    Edema Increased i

    (interstitial protein pressure)Burns/tissue injury

    Capillary permeability changes

    cause plasma protein to flow intointerstitial space, making morepositive, favoring water movementout of capillaries (filtration).

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    Lymph

    -The lymphatic capillaries areresponsible for returninginterstitial fluid and proteins tothe vascular compartment.

    -Lymph capillaries merge intolarge thoracic duct which emptiesinto the large veins.

    -Lymph vessels have smoothmuscle for movement andsurrounding skeletal musclecontractions and contain openends.

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    FILARIASIS

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    Any question?