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 .

A positive net flow equals filtration A negative net flow equals absorption . that exceeds the ability of lymphatic system to return it to the circulation.• EDEMA -Accumulation of fluid in interstitial space (due to filtration out of the capillaries) -Usually caused by a disruption in Starling forces.

trauma. deep vein thrombosis. infection) – local edema Standing.g. parasitic infection of lymph nodes (filariasis) Impaired Lymphatic drainage . burns.Mechanisms of edema formation CAUSE Pc EXAMPLE Increased capillary pressure (venous constriction. heart failure) πc Decreased plasma protein osmotic pressure (severe liver failure. nephrotic syndrome) –general edema πi Increased capillary protein permeability (due to release of vasoactive substances) (e.

flow becomes more positive (filtration).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) – (πc – πi) If this increases. .

intrinsic kidney disease) -Liver disease (not enough endogenous albumin produced) Severe loss of protein in urine produces foamy urine. diabetes.Edema – Decreased πc (plasma protein osmotic pressure) -Nephrotic syndrome: urinary protein loss > liver replacement (~3. EDEMA FLOWnet = (Pc – Pi) – (πc – πi) .5g/day) (glomerulonephritis.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). Nephrotic syndrome (protein loss > 3.

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

. favoring water movement out of capillaries (filtration). making Δπ more positive.Edema – Increased πi (interstitial protein pressure) Burns/tissue injury FLOWnet = (Pc – Pi) – (πc – πi) Capillary permeability changes cause plasma protein to flow into interstitial space.

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

FILARIASIS .

Any question? .