dr. heny a. l. - edema
TRANSCRIPT
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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?