Edema
Edema
Definition Clinically apparent increase in the interstitial 可质) fluid volume Weight gain precedes overt edema Weight loss in edematous patients before dry weight Massive edema is called anasarca
Definition • Clinically apparent increase in the interstitial (间质) fluid volume • Weight gain precedes overt edema • Weight loss in edematous patients before “dry weight” • Massive edema is called Anasarca
Edema Localized or generalized Generalized form puffiness(浮肿) of the face edema of periorbital areas Indentation of the skin"pitting edema 凹陷性水肿 Fluid may also accumulate in body cavities ascite(腹水) hydrothorax(胸水)
Edema • Localized or generalized • Generalized form: puffiness（浮肿） of the face edema of periorbital areas Indentation of the skin “pitting edema” 凹陷性水肿 • Fluid may also accumulate in body cavities ascite（腹水） hydrothorax (胸水）
Edema Pitting edema
Edema Pitting edema
Pathogenesis Reduced plasma osmotic pressure Capillary damage Reduction of effective arterial volume Reduced cardiac output Renal factors Renin-Angiotension-Aldosterone
Pathogenesis Reduced plasma osmotic pressure Capillary damage Reduction of effective arterial volume Reduced cardiac output Renal factors Renin-Angiotension-Aldosterone
Starling forces 1/3 body water: extracellular space plasma volume(25%) interstitial space(75%) Regulating the disposition of fluid between two compartment (Law of Capillaries) Vascular system Interstitial space Hydrostatic pressure (流体静水压) Hydrostatic pressure Colloid oncotic pressure (tissue tension) (胶体渗透压) Colloid oncotic pressure
Starling forces • 1/3 body water: extracellular space plasma volume (25% ) interstitial space (75% ) • Regulating the disposition of fluid between two compartment (Law of Capillaries) Vascular system Interstitial space Hydrostatic pressure （流体静水压） Hydrostatic pressure Colloid oncotic pressure (tissue tension) （胶体渗透压） Colloid oncotic pressure
To thoracic duct and eventually Homeostasis is to left subclavian vein maintained by the opposIng eftects of vascular hydrostatic pressure and pl asmi Increased interstitial colloid osmotic Hydrostatic pressure Huid oressure pressure Plasma coloid osmotic pressure Arterial end CAPILLARY BED Venous end Ficure 4-1
Reduced plasma Osmotic pressure Vascular system Interstitial space Hydrostatic pressure Hydrostatic pressure Colloid oncotic pressure tissue tension Colloid oncotic pressure
Reduced Plasma Osmotic Pressure Vascular system Interstitial space Hydrostatic pressure Hydrostatic pressure Colloid oncotic pressure (tissue tension) Colloid oncotic pressure
Reduced plasma Osmotic pressure Albumin is the serum protein MOst responsible for the maintenance of colloid osmotic pressure (胶体渗透压) a decrease in osmotic pressure can result from increased protein loss or decreased protein synthesis Increase in capillary pressure may be due to congestive heart failure
Reduced Plasma Osmotic Pressure Albumin is the serum protein MOST responsible for the maintenance of colloid osmotic pressure (胶体渗透压） A decrease in osmotic pressure can result from increased protein loss or decreased protein synthesis Increase in capillary pressure may be due to congestive heart failure
Capillary damage Damage to the capillary endothelium(内皮) ncrease its permeability and permits the transfer of protein into interstitial compartment ° Injury agents D Viral/bacterial agents Thermal/mechanical trauma Immune Responsible for inflammatory edema Nonpitting localized redness and tenderness
Capillary Damage • Damage to the capillary endothelium(内皮) • Increase its permeability and permits the transfer of protein into interstitial compartment • Injury agents Drugs Viral/bacterial agents Thermal/mechanical trauma Immune • Responsible for inflammatory edema • Nonpitting localized redness and tenderness