Department of Pathology, MRDC Faridabad

OEDEMA
Dr. Savita Bansal

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 Department of Pathology,MRDC Faridabad

• Lecture topic— OEDEMA

Learning objectives—
• Definition and types of oedema
• Pathogenesis of various types of oedema
• Differences between transudate and exudate

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 Department of Pathology,MRDC Faridabad

At the end of session the students are expected

to know—

• The pathogenesis of oedema

• Cardiac and pulmonary oedema
• Differences between exudate and transudate

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
DISTRIBUTION OF BODY FLUIDS

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
Normal fluid pressures

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
Normal fluid exchange

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 Greek-Oidema=
OEDEMA Swelling

Definition
Abnormal & excessive accumulation
of free fluid in the interstitial tissue
spaces & serous cavities.

Fluid collection in various cavities—

Ascites– in peritoneal cavity
Hydrothorax – in pleural cavity
Pericadial effusion – in pericardial cavity
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
CLASSIFICATION
OF EDEMA

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 EDEMA

LOCALISED GENERALISED SPECIAL

Inflammatory Renal Pulmonary
Lymphatic Cardiac Cerebral
Toxic-allergic Nutritional

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
IN CASE OF EDEMA IN SUBCUTANEOUS
TISSUES , momentary pressure of
finger produces a depression known as
PITTING EDEMA .

If no pitting on pressure it is known as

NON- PITTING / SOLID EDEMA. e.g.
Myxodema, Elephantiasis

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 Pitting/Non Pitting
oedema

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
EDEMA FLUID MAY BE :

1] TRANSUDATE E.g. cardiac or renal

diseases

2] EXUDATE E.g. Inflammation

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
Transudate Vs Exudate

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 PATHOGENESIS
Edema is caused by mechanisms that interfere with normal fluid
balance of plasma, interstitial fluid & lymph flow.

1] Decreased plasma osmotic pressure

2] Increased capillary hydrostatic pressure 6
3] Lymphatic obstruction mechanisms
4] Tissue factors act singly
5] Increased capillary permeability /combination
6] Sodium and water retention

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
DECREASED PLASMA ONCOTIC PRESSURE :

Normally it tends to draw fluid into the vessels.

Hypoproteinemia
( hypoalbuminaemia<5gm/dl)

Fall in plasma oncotic pressure

Movement of fluid in interstitial space

OEDEMA Hypoproteinemia
usually produces
generalized edema
LRM 14, 11BDS,U.G curriculum,[ANASARCA].
Deptt.of
Pathology,MRDC
EXAMPLES 1] NEPHROTIC
SYNDROME

2] ACUTE
GLOMERULNEPHRITIS

3] CIRRHOSIS

4] MALNUTRITION

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
INCREASED CAPILLARY HYDROSTATIC
PRESSURE
Normally it drives fluid through the capillary wall into
interstitial space by counteracting the force of plasma
oncotic pressure.

A rise in hydrostatic pressure at the venular end of

capillary (>12mmHg) results in edema.

Eg: 1] CCF
2] CONSTRICTIVE PERICADITIS

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
2] CIRRHOSIS OF LIVER
3] POSTURAL EDEMA
4] DVT
5] VARICOSITIES

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 LYMPHATIC OBSTRUCTION

Normally fluid escapes through lymphatics so any

obstruction causes localized edema
[LYMPHOEDEMA] .
EXAMPLES :
1] Removal of axillary lymph node as in radical
mastectomy
2] Inflammation of lymphatic’s [filariasis, Elephantiasis]
3] Milroy’s disease[abnormal development of lymphatic
channels]

4] TISSUE FACTORS :
A] Elevation of oncotic pressure of interstitial fluid
B] Lowered tissueLRMtension
14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
5] INCREASED CAPILLARY
PERMEABILITY :

Normally, intact capillary endothelium is a semi –

permeable membrane which allows minimum
passage of plasma proteins.
Any injury leads to increased permeability resulting in
elevated oncotic pressure of interstitial fluid resulting in
edema.

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
EXAMPLES
1] GENERALISED EDEMA
Systemic Infection,
Poisoning
Anaphylactic reaction

2] LOCALISED EDEMA
Inflammatory edema- insect bite
Irritant drugs, chemicals
ANGIONECROTIC EDEMA -
Edema occurring on skin of face & trunk
triggered by an allergen.
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
6] SODIUM AND WATER RETENTION

Normally 80% of sodium is

reabsorbed by intrinsic or extra
renal mechanism

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
Role of sodium and water
retention in Edema

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 ADH MECHANISM

ADH is stimulated by increased concentration of

sodium . Large amounts of ADH produces highly
concentrated urine .

EXAMPLES : 1] Edema of cardiac

disease – CCF
2] Cirrhosis of liver
3] Nephrotic syndrome
4] Glomerulonephritis

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
PATHOGENESIS & MORPHOLOGY OF
IMPORTANT TYPES OF EDEMA :
RENAL EDEMA : NEPHROTIC SYNDROME
PERSISTENT & HEAVY PROTEINURIA

HYPOALBUMINEMIA

DECREASED PLASMA ONCOTIC PRESSURE

NEPHROTIC EDEMA

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
It is severe and present in subcutaneous
tissues

MICROSCOPICALLY :
Edema fluid is pale, eosinophilic or may
be deeply eosinophilic & granular.

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
EDEMA IN ACUTE TUBULAR INJURY:

The damaged tubules lose their

capacity for selective reabsorption &
concentration in the glomerular
filtrate resulting in increased
reabsorption & oliguria. Besides,
there is excessive retention of water
& electrolytes & rise in blood urea .

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
CARDIAC OEDEMA

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
• Cardiac oedema is influenced by gravity and is
dependent oedema
• In standing ---lower extremeties
• In lying down—sacral and genital region

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
PULMONARY EDEMA :
Acute pulmonary edema is the most
important form of local edema as
fluid accumulation is not only in the
tissue space but also in pulmonary
alveoli .

PATHOGENESIS : Normally, the

plasma oncotic pressure is adequate
to prevent the escape of fluid .
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
Pulmonary edema can result from :
1] Elevation in pulmonary hydrostatic
pressure [HEMODYNAMIC EDEMA]
Increase pressure
in pulmonary vein

Imbalance between hydrostatic &

oncotic pressure

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 Fluid & plasma protein moves into
interstitial space of lungs

normally Lymphatic's drain fluid, the

excess fluid accumulates in inerstitium around
bronchioles,arteries and lobular septa

Interestial edema

Thickening of alveolar walls

Prolonged elevation of hydrostatic pressure

leads to
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
 breaking of alveolar cell lining

Alveolar edema

EXAMPLES : 1] Left heart failure

2] MS
3] Pulmonary vein
obstruction

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
2] INCREASED VASCULAR
PERMEABILITY[IRRITANT EDEMA]
Alveolo-capillary membrane may be
damaged causing increased
vascular permeability resulting in
leak of excessive fluid & plasma
protein into the interstitium and
alveoli.
EXAMPLES : Hypersensitivity to drugs
ARDS
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
ACUTE ALTIDUDE PULMONARY
EDEMA :
Individuals climbing to high altitude
without halt suffer from serious
circulatory & respiratory ill-effects.
These changes may cause death
also
MECHANISM: Anoxic damage to
pulmonary vessels

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
PATHOLOGICAL CHANGES :
1] Fluid accumulates in basal region of
lungs.
2] Interlobular septa are thickened
with their dilated lymphatic's[which
are seen as perpendicular lines on
CXR known as KERLEY’S LINE]

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
GROSS: Lungs are heavy ,moist.
C/S : Exudes frothy fluid
MICROSCOPICALLY :
Congested alveolar capillaries,
minute haemorrhages
ALVEOLAR EDEMA – Eosinophilic ,
granular & pink proteinaceous
material, often mixed with RBCs
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
2] Alveolar spaces contain numerous
hemosiderin laden macrophages
[HEART FAILURE CELLS]
3] Later there is fibrosis.

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
CERBRAL EDEMA : Most threatening.
MECHANISM : Fluid electrolyte exchange
is by blood-brain barrier
CEREBRAL EDEMA IS OF 3 TYPES :
1] Vasogenic edema
2] Cytotoxic edema
3] Interstitial edema
VASOGENIC EDEMA :
 Most common.
 Results from increased hydrostatic
pressure or increased capillary
permeability LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
GROSS :
White matter is swollen, soft with
flattened gyri & narrowed sulci

C/S : Soft & gelatinous

MICROSCOPICALLY :
 Separation of tissue elements
 Swelling of astrocytes

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 Perivascular [ VIRCHOW-ROBIN]
space is widened clear halos are seen
around small blood vessels.

CYTOTOXIC EDEMA :
In this blood-brain barrier is intact &
The fluid accumulation is intracellular.
EXAMPLE : Metabolic derangements,
Acute hypoxia

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
INTERSTITIAL EDEMA :
It occurs when excessive fluid crosses
epidermal lining of ventricles &
accumulates in periventricular white
matter.
e.g. – Non-communicating
hydrocephalus

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 Dehydration
• Deficiency of water
• Sodium retention
• Intense thirst,mental confusion,fever,oliguria

• ETIOLOGY
• 1. GI excretion
• 2. Renal excretion
• 3. Loss of blood and plasma
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
• 4. Loss through skin
• 5. Accumulation in body cavities

• Organs become dark and shrunken

• Haemoconcentration(increased PCV)
• Renal shutdown and shock

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC
 OVERHYDRATION
• Increased extracellular fluid volume due to
pure water excess
• Nausea, vomiting, headache
• Etiology
• excessive intravascular infusion:
• Renal retention

• There will be decrease in PCV and electrolytes

LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
• Q1. define oedema. Describe in detail the
pathogenesis of oedema.

• Q2. Write short notes on—

• Oedema
• Pulmonary oedema
• Cardiogenic edema
• Differences between transudate and exudate
LRM 14, 11BDS,U.G curriculum, Deptt.of
Pathology,MRDC
THANK YOU

LRM 14, 11BDS,U.G curriculum, Deptt.of

Pathology,MRDC