Edema

dr. Heny Anggraeny Lenap

Edema:
The abnormal accumulation of fluid in a specific organ vs generalized. In capillary: Balance between hydrostatic pressure and oncotic (colloid osmotic) pressure.

Edema:
Due to disturbance in hydrostatic and/or oncotic pressure between intra-capillary and interstitial component.

Organ specific:
Brain: Cerebral edema Lung: Intra-alveolar=pulmonary edema, intrapleural=pleural effusion Peritoneum=ascites Severe generalized edema=anasarca

 EDEMA
-Accumulation of fluid in interstitial space (due to filtration out of the capillaries) -Usually caused by a disruption in Starling forces, that exceeds the ability of lymphatic system to return it to the circulation.

A positive net flow equals filtration A negative net flow equals absorption

Mechanisms of edema formation

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

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

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

Impaired Lymphatic drainage

Edema Increased Pc
(hydrostatic pressure)
Deep vein thrombosis (DVT)

Heart failure
Thrombus/clot in leg vein prevents venous return and raises venous pressure inhibiting absorption and promoting filtration.

FLOWnet = (Pc Pi) (c i)

If this increases, flow becomes more positive (filtration).

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 capillaries into the interstitial fluid

If this decreases, flow becomes more positive (filtration).

EDEMA

FLOWnet = (Pc Pi) (c i)

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

Edema Increased i

(interstitial protein pressure)

Burns/tissue injury
FLOWnet = (Pc Pi) (c i)

Capillary permeability changes cause plasma protein to flow into interstitial space, making more positive, favoring water movement out of capillaries (filtration).

Lymph
-The lymphatic capillaries are responsible for returning interstitial fluid and proteins to the vascular compartment. -Lymph capillaries merge into large thoracic duct which empties into the large veins. -Lymph vessels have smooth muscle for movement and surrounding skeletal muscle contractions and contain open ends.

FILARIASIS

Any question?