HUMAN PATHOLOGY

EDEMA
AND
HAEMORRHAGE
PRESENTED BY:

GIRISH KUMAR. K
EDEMA
• Edema comes from Greek word OIDEMA means Swelling.
• Edema is usually defined as abnormal and excessive accumulation of fluid in
interstitial tissue spaces and serous cavities.
• It is the normal response of the body to inflammation or injury.
E.g. : Twisted ankle, bee sting, skin infection.
• In some cases edema is beneficial such as an infection.
Because, increased fluid allows more infection fighting WBCs to enter
the affected areas.
TYPES
1. Localised
2. Generalised

LOCALISED
Limited to an organ or limb.
E.g. : Lymphatic edema
Inflammatory edema.
GENERALISED
Systemic in distribution, particularly
noticeable in subcutaneous tissue.
E.g.: Renal edema
Cardiac edema
 EDEMA FLUID
• Depending upon fluid composition edema fluid may be of following types:
1. Transudate. (PROTEIN POOR)
2. Exudate. (PROTEIN RICH)
TRANSUDATE EXUDATE
Filtrate of blood plasma without Edema of inflamatted tissues
changes in endothelial permeability. associated with increased
E.g.: Cardiac edema vascular permeability.
E.g.: Pus
PITTING AND NON-PITTING EDEMA
PITTING EDEMA
• When a pressure is applied to a small area, the
indentation persists even after the release of the
pressure. It is called as PITTING EDEMA.
• It is also known as Cutaneous edema.
NON-PITTING EDEMA
• The type of edema in which the indentation made
by a pressure on the affected area does not persist.
It is called as NON-PITTING EDEMA.
PATHOGENESIS OF EDEMA
• Decreased plasma oncotic pressure
• Increased plasma hydrostatic pressure
• Lymphatic obstruction
• Tissue factor
• Increased capillary permeability
• Sodium and water retention
DECREASED PLASMA OSMOTIC PRESSURE
Reduced albumin synthesis in liver / protein malnutrition
↓
Fall in plasma oncotic pressure
↓
Net movement of fluid into interstitial tissues
↓
EDEMA
INCREASED CAPILLARY HYDROSTATIC PRESSURE

Rise in hydrostatic pressure at the venular end of capillaries

to a level more than plasma oncotic pressure
↓
Minimal/ No reabsorption of fluid at venular end
↓
EDEMA
LYMPHATIC OBSTRUCTION
• The interstitial fluid in the tissues spaces escapes by the way of lymphatics.
Obstructions to outflow of these channels causes localised edema known as
LYMPHOEDEMA.
PULMONARY EDEMA
• It is the fluid accumulation in the air spaces and parenchyma of lungs.
• Causes impaired gas exchange and may cause respiratory failure.
• It is either due to failure of left ventricle of the heart to adequately remove blood
from pulmonary circulation.
• It can result from either Elevation of pulmonary hydrostatic pressure or the
increased capillary permeability.
NUTRITIONAL EDEMA

• The edema due to nutritional deficiency of protein, vitamins and chronic

alcoholism occurs on the legs.
• The main contribution factors are hypoproteinaemia and sodium water
retention related to metabolic abnormalities.
Protein Deficiency – Kwashiorkor, Prolonged starvation, Famine
Vitamins – beri-beri
KWASHIORKOR BERI-BERI
MYXOEDEMA

•Myxoedema from hyperthyroidism is a

form of non-pitting edema occurring on
skin of face and other parts of the body
also in the internal organs due to
excessive deposition of
glycosaminoglycan in interstitium.
CEREBRAL EDEMA
• It is the swelling of brain with fluid accumulation. It is the most threatening example of
edema.
• It is excess accumulation of fluid in the intracellular or extracellular spaces of the brain.
• Cerebral edema can result from brain trauma or from non-traumatic causes such as
ischemic stroke, cancer, or brain inflammation due to meningitis or encephalitis.
• The are of three types:
1. Vasogenic edema
2. Cytotoxic edema
3. Interstitial edema
HAEMORRHAGE
• Bleeding is technically known as HAEMORRHAGE.
• It is the escape of blood from a blood vessel of the circulatory system.
• The bleeding may be external or internal.
• External - Either through natural opening such as mouth, nose, ear, urethra, vagina
or anus or through a break in the skin.
• Internal - blood leaks from blood vessels inside the body
 TYPES

ARTERIAL VENOUS CAPILLARY

ARTERIAL

•Bright red
•Emitted as spurting jet
•Can lead to severe blood loss
•Often hard to control
VENOUS
•Darker red
•Steady and copious flow
•Color becomes further darker with oxygen desaturation
•Usually easy to control
CAPILLARY

•Bright red
•Rapid and oozing
•Blood loss becomes serious if continues for hours
•Generally minor & easy to control
 TIMING OF
HAEMORRHAGE

PRIMARY REACTIONARY SECONDARY

PRIMARY

•Occurs at the time of surgery

•Cause is injury to vessels
•May be arterial, venous or capillary
•More common in surgery on malignancies
REACTIONARY

•Bleeding within 24 hours ( usually 4-6 hrs. ) of surgery

•Cause is slipping of ligature, dislodgement of clot or cessation
of reflex vasospasm
•Bleed starts when there is a rise in the arterial or venous
pressure.
SECONDARY

•Occurs after 7-14 days of surgery

•Cause is sloughing of vessel due to infection, pressure necrosis
or malignancy.
•1st a warning stain followed by a sudden severe bleed
•Common after hemorrhoids surgery, GI surgery &
amputations.
EFFECTS
The effects of blood loss depends upon three main factors:
• Amount of blood loss
• The speed of blood loss
• The site of blood loss
The of blood upto 20% has little clinical effects.
The sudden loss of 33% of blood volume may lead to death.
CAUSES OF HAEMORRHAGE
• Bleeding arises either due to traumatic injury or due to some medical conditions.
• Traumatic bleeding is caused by some type of injury. There are different types
of wounds which may cause traumatic bleeding. These include:
Abrasion(Transverse action of foreign objects on the skin)
Excoriation(Mechanical destruction to the skin)
Hematoma(Damage to the blood vessels)
Incision (Cut into body tissue or organ)
Puncture wound (Caused by an object that penetrated the skin and underlying layers)
MEDICAL CONDITION
• Medical bleeding' denotes haemorrhage as a result of an underlying medical condition. Blood
can escape from blood vessels as a result of 3 basic patterns of injury. They are:
1. Intravascular changes - changes of the blood within vessels (e.g. blood pressure, clotting
factors)
2. Intramuscular changes – changes arising within the walls of blood vessels
(e.g. dissections, AVMs)
3. Extravascular changes - changes arising outside blood vessels (e.g. Brain abscess, brain
tumour)
Thank You!