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• Dry mouth
• Inelastic skin
• Sunken eyes( in extreme cases)
• ↑ hematocrit → ↑ blood viscosity → sluggish
circulation → ↓ function of many organs
Oedema
Accumulation of protein-poor fluid in the
interstitial spaces and the body cavities.
Main ingredient: water, specific gravity <1012
Localized Generalized
• Involves one organ • Involves the entire
or part of the body body, (in subcutis:
• Clinically important anasarca)
examples: • Clinical sign: pitting
Brain oedema oedema (depression in
Lung oedema the skin by pressing on
Hydrothorax Serous it with a finger)
Ascites effusion
Types of oedema
• Venous
Yield protein-
poor • Hypoalbuminaemic
transssudates • Lymphatic
• Na retention-associated
• Inflammatory Yields
protein-rich
(detailed later) exsudates
Physiology
Hydrostatic blood pressure forces water out of
capillaries at the arterial end, but the plasma oncotic pressure
attributable to albumin sucks it back into capillary beds at the
venous end.
A small amount of water drains from the tissues
through lymphatic channels.
Venous oedema
• Increased hydrostatic pressure due to impaired
venous return forces fluid out the capillaries that
exceeds that of plasma oncotic pressure and so
water remains in the tissues.
• Localisation follows gravity
Venous oedema
• Sudden onset of (acute) left-sided heart failure
(reduced systolic output accompanied by
inadequate emptying of the chamber) leads
to the elevation of hydrostatic pressure in
lung capillaries ⇒lung oedema
Lung oedema: the lungs 2 to 3 times exceed their
normal weight; sectioning reveals a frothy, blood-tinged,
foamy mixture of air, oedema fluid, and RBCs
Pulmonary oedema in acute left-HF
Venous oedema
• Chronic right-sided heart failure (reduced
systolic output accompanied by inadequate
emptying of the chamber) leads to the elevation
of hydrostatic pressure in capillaries of the
systemic circulation, and in turn, systemic
oedema and serous effusions:
- hydrothorax,
- hydropericardium
- ascites
Hydrothorax in right-sided HF
Venous oedema
Cirrhosis of liver causes increased hydrostatic
pressure in the portal venous circulation (portal
hypertension) ⇒ ascites
Venous oedema
Oedema of just one calf: due to thrombotic
obstruction of popliteal veins
Hypoalbuminaemic oedema
Low albumin concentration reduces the plasma
oncotic pressure so that the water cannot be sucked
back into the capillary bed at the venous end.
Causes of hypoalbuminaemia:
• Inadequate intake, as in protein-deficient diet
(kwashiorkor)
• Decreased synthesis in the liver, as seen in end-
stage liver disease
• Increased loss in the urine (e.g., nephrotic sy) or
stool (e.g., protein-losing enteropathy)
Lymphatic oedema
Lymphatic obstruction prevents drainage of water
from the tissues. Typically, this is a localized form
of oedema involving certain parts of the body.