EDEMA

Water = 60% of lean body weight

 2/3 of the body’s water = intracellular compartment
 1/3 of the body’s water = extracellular compartment
 5% of total body water = blood plasma
*** The movement of water and low molecular weight solutes is controlled primarily by the opposing
effect of vascular hydrostatic pressure and plasma colloid osmotic pressure.
Increased Interstitial Fluid
 Due to either increased capillary pressure or diminished colloid osmotic pressure.
Edema
 An abnormal increase in interstitial fluid within tissues Fluid collections in different body
cavities:
 Hydrothorax
 Hydropericardium
 Hydroperitoneum (Ascites) Anasarca
 Severe and generalized edema with wide spread subcutaneous tissue swelling. Transudate
 Protein – poor edema (increased hydrostatic pressure or reduced plasma protein)
 Individuals suffering from heart failure, renal failure, hepatic failure, malnutrition Exudate
 Protein – rich edema (increased vascular permeability)

INCREASED HYDROSTATIC PRESSURE

Impaired venous return

Congestive heart failure

Constrictive pericarditis

Ascites (liver cirrhosis)

Venous obstruction or compression

Thrombosis

External pressure (e.g., mass)

Lower extremity inactivity with prolonged dependency

Arteriolar dilation
Heat

Neurohumoral dysregulation
REDUCED PLASMA OSMOTIC PRESSURE (HYPOPROTEINEMIA)
Protein-losing glomerulopathies (nephrotic syndrome)

Liver cirrhosis (ascites)

Malnutrition

Protein-losing gastroenteropathy
Inflammatory

Neoplastic

Postsurgical

Postirradiation
SODIUM RETENTION
Excessive salt intake with renal insufficiency

Increased tubular reabsorption of sodium

Renal hypoperfusion

Increased renin-angiotensin-aldosterone secretion

INFLAMMATION
Acute inflammation

Chronic inflammation

Angiogenesis

Increased Hydrostatic Pressure

 Regional increases HP – from focal impairment in venous return oDeep venous thrombosis
(lower extremity) – may cause localized edema in the affected leg
 Generalized increases VP oCongestive Heart Failure – compromised right ventricular function
leads to pooling of blood on the venous side of the circulation Reduced Plasma Osmotic Pressure
 Albumin is not synthesized in adequate amounts or is lost from the circulation
 Nephrotic Syndrome o Important cause of albumin loss o Glomerular capillaries = leaky o
Generalized edema
 Severe liver diseases
 Protein Malnutrition
 Leads to a net movement of fluid into the interstitial tissues with subsequent plasma volume
contraction.
 Reduced intravascular volume  decreased renal perfusion
Sodium Water Retention
· Increased salt retention with obligate assoc. water
· Causes both increased hydrostatic pressure
(intravascular fluid volume expansion) and diminished vascular colloid osmotic pressure
(dilution)
· Renal function is compromised
· Congestive Heart Failure o One of the most important causes of renal hypoperfusion results
in the activation of the renin-angiotensinaldosterone axis.
· Early (sodiunm and water retention, increased vascular
tone, elevated levels of ADH) – improve cardiac output and restore normal renal
perfusion
· Worse (CO diminish) – retained fluid increases the venous pressure (major cause of
edema in this disorder)
· Primary water retention – produced by the release of ADH from the posterior pituitary
· Increase ADH (malignancies, lung and pituitary disorders) oLead to hyponatremia and cerebral
edema Lymphatic Obstruction
· Lymphedema
· Due to impaired lymphatic drainage o Localized o Caused by:
· Chronic inflammation with fibrosis
· Invasive malignant tumors
· Physical disruption
· Radiation damage
· Infectious agents
· Parasitic filariasis o Lymphatic obstruction due to extensive inguinal lymphatic and lymph
node fibrosis  edema of the external genitalia and lower limbs (massive) = ELEPHANTIASIS
Morphology
· Edema
· Most commonly seen in subcutaneous tissues, the lungs and the brain.
· Subcutaneous Edema o Diffuse or more conspicuous in regions with high hydrostatic pressure.
· Dependent edema - distribution is influenced by gravity oPitting Edema - finger pressure
displaces the interstitial fluid and leaves a depression
· Periorbital Edema o Seen in severe renal disease
· Pulmonary Edema
· Lungs – 2 to 3x their normal weight oFrothy, blood-tinged fluid (mixture of air, edema,
extravasated red cells)
· Brain Edema
· Localized or generalized
· Generalized – grossly swollen with narrow sulci and
· Most frequently seen in the setting of left ventricular failure.
· Can also occur in renal failure, acute respiratory syndrome and pulmonary inflammation
or infection
· Brain Edema o Brain substance can herniate through the foramen magnum or the brain stem
vascular supply can be compressed.