Edema

Li Shiying
Department of Infectious Diseases,
the Second Affiliated Hospital, Chongqing Medical University
Aim and Requirements

1. Grasp the definition of edema.

2. Grasp the etiology and clinical manifestation of edema.

3. Familiar the pathogenesis of edema.

Definition
Edema, is defined as a clinically apparent increase in the
interstitial fluid volume. Edema may be localized or have a
generalized distribution.

Special forms of edema

• Ascites: accumulation of
excess fluid in the peritoneal
cavities.

• Hydrothorax: accumulation
of excess fluid in the pleural
cavities.
Pathogenesis
1. The alteration of hemodynamic force in capillary vessel
V
A
Capillary vessel
Hydrostatic pressure Colloid oncotic pressure
within the vascular system contributed by the plasma proteins

Colloid oncotic pressure Hydrostatic pressure

in the interstitial fluid within the interstitial fluid
Interstitial space

Starling forces Lymphatic return

Pathogenesis

1. The alteration of hemodynamic force in capillary vessel

(1) Hydrostatic pressure within the vascular system ↑

(2) Colloid oncotic pressure contributed by the plasma proteins ↓

(3) Colloid oncotic pressure in the interstitial fluid ↑

(4) Hydrostatic pressure within the interstitial fluid ↓

(5) Capillary permeability↑

Pathogenesis
2. Water-sodium retention

(1) Glomerular filtration ↓

(2) Water-sodium reabsorption by glomerulus ↑

3. Obstruction of lymphatic return or obstruction of

venous return: lead to localized edema
Etiology and clinical manifestation
• Cardiogenic edema

• Renal edema

• Hepatic edema
Generalized edema
• Endocrine-metabolic
disorders caused edema

• Nutritional edema
Edema
• Others

Localized edema
Etiology and clinical manifestation
1. Generalized edema
(1) Cardiogenic edema: the manifestation of right heart failure
Etiology
The increment accumulates in the The reduction of effective circulatory
venous circulation blood and renal blood volume

The increased capillary and The decreased glomerular filtration

lymphatic hydrostatic pressure rate

The reduction of fluid reabsorption Secondary elevation of aldosterone

secretion

Edema Tubular sodium reabsorption and

sodium and water retension
Etiology and clinical manifestation
(1) Cardiogenic edema

Clinical manifestation

• Edema can be first found in the legs and extends upwards, but scarcely
involving the head, face.

• Edema is symmetrically and pitting edema

• Distention of jugular vein, hepatomegaly,

• Hydrothorax, ascites in severe cases

Etiology and clinical manifestation
(2) Renal edema: the manifestation of nephritis and nephropathy

Etiology

Glomerular filtration rate (GFR) ↓

Glomerulotubular imbalance sodium and water retension

Decreased glomerular perfusion

Albuminuria → hypoproteinemia Edema

Etiology and clinical manifestation
(2) Renal edema:
Clinical manifestation

• Edema usually starts from the eyelids and face and tends to the most
pronounced in the morning.

• Abnormal urinalysis

• Hypertension

• Renal dysfunction
Etiology and clinical manifestation
Differential diagnosis
Renal edema Cardiac edema

Onset from the face, Onset from the lower part

Location
periorbital areas of the body

Progression Progress quickly Progress slowly

Relatively solid, less

Identity Soft and mobile
mobile

Signs of heart failure:

Accompany Proteinuria, hypertension, cardiac enlargement,
signs impaired renal function venous distension,
hepatomegaly
Etiology and clinical manifestation
(3) Hepatic edema: the manifestation of hepatic cirrhosis

Etiology

• Portal hypertension

• Hypoproteinemia: albumin ↓,

• Obstruction of lymphatic return in liver

• Renal perfusion↓ → Secondary aldosteronism.

Etiology and clinical manifestation
(3) Hepatic edema

Clinical manifestation

• Ascites
Liver palm Spider nevus Varicose veins

• edema occurs from the ankle and extends upwards, but scarcely
involving the head, face and upper extremities.
Etiology and clinical manifestation
(4) Endocrine-metabolic disorders caused edema:

• hypothyroidism: myxedema, nonpitting, pachyderma, pachylosis, pallor,

temperature↓

• hyperthyroidism: pitting edema, circumscribed myxedema, hypoproteinemia

• primary aldosteronism: by water-sodium retention

• Cushing syndrome: adrenal cortical hormone↑ → water-sodium retention

Etiology and clinical manifestation
(5) Nutritional edema: occurs from the lower extremities,
there may be a history of weight loss

• chronic wasting disease

• protein-losing gastroenteropathy (PLG)

• severe burn
Etiology and clinical manifestation
(6) Others reasons:

• premenstrual nervous syndrome

• pregnance

• allergic disease

• autoimmune disease: SLE, scleriasis, dermatomyositis

• Drug-induced: estrogens and vasodilators…

• idiopathic edema
Etiology and clinical manifestation

2. Localized edema
(1) Local inflammation: cellulitis, furuncle, carbuncle, erysipelas…

(2) Obstruction of lymphatic return:

non-specific lymphadenitis, post-lymphadenectomy,
filariasis

(3) Obstruction of venous return:

varicosis, venous thrombus, thrombophlebitis…
Etiology and clinical manifestation

(4) Angioneurotic edema: giant urticaria …

(5) Neurogenic edema

(6) Local myxedema

Accompanying Signs
• Hepatomegaly
Cardiogenic, hepatogenic edema and malnutrition,
+distension of jugular vein → cardiogenic

• Proteinuria
+ massive proteinuria→ renal disease
+ mild proteinuria →cardiogenic

• Dyspnea and cyanosis

Heart disease and superior vena caval obstruction syndrome
Accompanying Signs

• Slow rhythm and hypotension : hypothyroidism

• Menstrual cycle: premenstrual nervous syndrome

• Weight loss: Malnutrition.

History Taking
• When, where and how does the edema appear?

• Whether the edema is localized or generalized? Is the edema pitted?

• Illness history and related symptoms of heart, renal, hepatic and

allergic disease, e.g. palpitation, dyspnea, cough, expectoration,
hemoptysis, headache, insomnia, abdominal distension, abdominal
pain, and changes of weight, appetite and urinary volume.

• Relationship with drugs, diet , menstrual cycle and pregnancy

Questions

1. The classification of edema?

2. What is the difference between renal edema and cardiac

edema?
THANK YOU!