64965 hemodyn[1] edema
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Hemodynamic Disorders, Hemodynamic Disorders, Thrombosis & Thrombosis & ShockShock
Edema Hyperemia and Congestion Hemorrhage Hemostasis & Thrombosis Embolism Infarction Shock
• EdemaEdema
EDEMAEDEMA
Fluid extravasations and Fluid extravasations and
accumulation in the accumulation in the
interstitial spaces interstitial spaces
EDEMAEDEMA
Increased fluid in theIncreased fluid in the interstitial tissue spacesinterstitial tissue spaces
Fluid may also accumulate in body cavities:body cavities:
1.1. HydrothoraxHydrothorax
2.2. HydropericardiumHydropericardium
3.3. Hydroperitoneum is also called Hydroperitoneum is also called AscitesAscites
Massive generalized edema is called Massive generalized edema is called AnasarcaAnasarca
Fluid HomeostasisFluid Homeostasis
Homeostasis is maintained by Homeostasis is maintained by
the the opposing effectsopposing effects of: of:
1.1. Vascular Hydrostatic Vascular Hydrostatic
PressurePressure
and and
2.2. Plasma Colloid Osmotic Plasma Colloid Osmotic
PressurePressure
Lymphatics
Edema Fluid = TRANSUDATEEdema Fluid = TRANSUDATE
A transudatetransudate is protein-poor (specific gravity <1.012)
An exudateexudate is protein-rich (specific gravity >1.020)
= (inflammatory edema)(inflammatory edema)
Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I.Increased Hydrostatic Pressure
II.Reduced Plasma Oncotic Pressure
III.Inflammation
IV.Others
I. Increased Hydrostatic Pressure
Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
Increased Hydrostatic PressureIncreased Hydrostatic Pressure
1. Due to impaired venous returnvenous return
A)A) Localized:Localized:
Venous Thrombosis
B)B) Generalized:Generalized:
Congestive Heart Failure
2. Due o increased arteriolar dilatationarteriolar dilatation
Increased Hydrostatic PressureIncreased Hydrostatic Pressure
Congestive Heart Failure:Congestive Heart Failure:
““Generalized increaseGeneralized increase in venous pressure,
with resultant SYSTEMIC EDEMASYSTEMIC EDEMA occurs
MOST COMMONLYMOST COMMONLY in in CONGESTIVE HEART FAILURE”CONGESTIVE HEART FAILURE”
{*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to {*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to
Increased Hydrostatic Pressure}Increased Hydrostatic Pressure}
Congestive Heart FailureCongestive Heart Failure
Overall, there are TWO main effects...
1. Increased Central Venous Pressure
2. Decreased Renal Perfusion
Increased Hydrostatic PressureIncreased Hydrostatic Pressure::
Congestive Heart FailureCongestive Heart Failure
Mechanism: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)increased capillary pressure (Hydrostatic Pressure)
Leading to EdemaEdema
Congestive Heart Failure:Congestive Heart Failure:
& Decreased Renal Perfusion& Decreased Renal Perfusion
Congestive heart failure
Decreased Cardiac OutputDecreased Cardiac Output Decreased ARTERIAL blood volume
“Less arterial blood…Less renal perfusion...
The Kidney doesn’t see enough blood coming through …….
Congestive Heart Failure:Congestive Heart Failure:
& Decreased Renal Perfusion& Decreased Renal Perfusion
Decreased Renal Perfusion activates
the Renal Defense Mechanisms:Renal Defense Mechanisms:
1. Renin-Angiotensin-Aldosterone axis
Na & H2O Na & H2O
retentionretention
2. Renal Vasoconstriction
3. Increased Renal Anti-diuretic Hormone (ADH)
Congestive Heart Failure - Congestive Heart Failure - SummarySummary
CentralVenousPressure
Renal
Perfusion
Renin
Renal Vasoconstriction
ADH
Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I.Increased Hydrostatic Pressure
II.Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Other
II. Reduced Plasma Oncotic PressureII. Reduced Plasma Oncotic Pressure
Reduced PlasmaReduced PlasmaOsmotic PressureOsmotic Pressure
“…“…AlbuminAlbumin::
is the serum protein MOST responsible for the is the serum protein MOST responsible for the
maintenance of maintenance of colloid osmotic pressure.”colloid osmotic pressure.”
A decrease in osmotic pressuredecrease in osmotic pressure can result from:
1. Protein Loss
or or
22 Protein Synthesis
Reduced PlasmaReduced PlasmaOsmotic PressureOsmotic Pressure
1.1. Increased albumin loss: Increased albumin loss:
Nephrotic Syndrome
Increased permeability of the glomerular capillary wall
loss of protein
2.2. Reduced albumin synthesis Reduced albumin synthesis
Cirrhosis
Protein malnutrition
Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I.Increased Hydrostatic Pressure
II.Reduced Plasma Oncotic Pressure
III.Inflammation
IV.Other
III. InflammationIII. Inflammation
Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I.Increased Hydrostatic Pressure
II.Reduced Plasma Oncotic Pressure
III.Inflammation
IV.OthersIV. OthersIV. Others::- Lymphatic Obstruction- Sodium & water retention
Lymphatic ObstructionLymphatic Obstruction
Impaired lymphatic drainage with resultant
lymphedemalymphedema
usually localized
usually due to: INFLAMMATION INFLAMMATION
or
NEOPLASTIC OBSTRUCTION NEOPLASTIC OBSTRUCTION
Lymphatic ObstructionLymphatic Obstruction
FilariasisFilariasis –
A parasitic infection affecting
inguinal lymphatics resulting
in elephantiasis
Lymphatic Obstruction Lymphatic Obstruction
NeoplasticNeoplastic
Resection and/or radiation to axillary lymphatics in
breast cancer patients can lead to -- arm edemaarm 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)peau d’orange” (orange peel)
EDEMA - EDEMA - SummarySummary
INCREASEDHYDROSTATICPRESSURE
Congestive Heart FailureAscitesVenous Obstruction
DECREASED ONCOTICPRESSURE
Nephrotic SyndromeCirrhosisProtein Malnutrition
INCREASEDPERMEABILITY
Inflammation
LYMPHATICOBSTRUCTION
InflammatoryNeoplastic
HEART LIVER KIDNEY
EdemaEdemaMorphologyMorphology
Dependent EdemaDependent Edema is a prominent
feature of Congestive Heart Failure
Facial EdemaFacial Edema is often the initial
manifestation of Nephrotic
Syndrome
Subcutaneous EdemaSubcutaneous Edema
Edema of the subcutaneous tissue is most easily detected GrosslyGrossly (not microscopically)
Push your finger into it
and a depression remains
EdemaEdema
Clinical Correlation:Clinical Correlation:
Subcutaneous EdemaSubcutaneous Edema
Annoying but Points to Underlying Disease
However, it can impair wound healing or it can impair wound healing or
clearance of Infectionclearance of Infection
EdemaEdemaMorphologyMorphology
Pulmonary EdemaPulmonary Edema
is most frequently seen in Congestive Heart FailureCongestive Heart Failure
May also be present in renal failure, adult respiratory
distress syndrome (ARDS), pulmonary infections and
hypersensitivity reactions
Pulmonary Edema Pulmonary Edema
Gross:Gross:
The Lungs are typically 2-3 times the normal weight Cross sectioning causes an outpouring of frothy, outpouring of frothy,
sometimes blood-tinged fluidsometimes blood-tinged fluid
EdemaEdema
Clinical Correlation:Clinical Correlation:
Pulmonary EdemaPulmonary Edema
May cause deathdeath by interfering with Oxygen and
Carbon Dioxide exchange
Creates a favorable environment for infectioninfection THINK it resembles “Culture Media”!!!
Edema of the BrainEdema of the Brain
Trauma, Abscess, Neoplasm, Infection
(Encephalitis due to say… West Nile Virus), etc