Starling Force and Pathophysiology

of Oedema

Group Name: The Avengers [A]

By: Abikesh Neupane
 Objectives

• To Elucidate
• Starling force
• Pathophysiology of edema
• Correaltion of specified topic with PBL session
 Starling Forces
The primary forces that determine whether fluid will move
out of the blood into the interstitial fluid or in the opposite
direction.
• Capillary Hydrostatic Pressure
• Interstitial fluid pressure
• Capillary plasma colloid osmotic pressure(Oncotic)
• Interstitial fluid colloid osmotic pressure
• Starling Equilibrium : Amount of
fluid filtering outward from the
arterial ends of capillaries almost
exactly equals the fluid returned
returned to the circulation by
absorption through venule end.
 Pathophysiology of Edema
• Excess accumulation of fluid in the interstitial space and serous body
cavities.
• Causes
1. Increased capillary pressure
2. Decreased plasma proteins
3. Increase capillary permeability
Histamine and other immune products
Toxins
4. Blockage of lymph return
 Pitting and Non-Pitting Edema

• The excess fluid that builds up in pitting edema is mainly

Caption

composed of water.
• Non-pitting edema is typically associated with conditions
affecting the thyroid or lymphatic system, and the resulting
fluid build-up can be composed of a variety of substances,
including proteins, salts, and water.
 Angioedema
• Angioedema is non-pitting edema that involves swelling localized to the
subcutaneous and submucosal tissues.
• causes urticaria, also commonly known as hives, is a skin reaction characterized
by wheals(raised skin rashes).
• The underlying mechanism typically involves histamine or bradykinin.
• Histamine-mediated angioedema is a commonly encountered condition in
emergency departments.
• The most well-characterized mechanism of histamine-mediated angioedema is a
type I hypersensitivity reaction.
 Corelation with the PBL case
• Trigger 1: Swelling ( may be edema)
• Trigger 2: Allergic reactions (type of hypersensitivity) may have
caused wheals over the chest and abdomen
• Trigger 3: Confirmation of Agioedema
• Trigger 4 : Diphenhydramine (antihistamine drug)
• Trigger 5: Clinical improvement
 Question to the audience !
• Q. Which of the following is related to edema mechanism?
a. Lymphatic obstruction
b. Increase Hydrostatic pressure
c. imbalance in oncotic pressure
d. inflammation
e. all of them
 bibliography

• Guyton and Hall text book of medical

physiology
• Robbins and cotran Pathologic Basis of
disease
• osmosis.org
• wikipedia.com