EDEMA - Med Study Group

EDEMA - Med Study Group

EDEMA 60% of lean body weight = water (2/3) intracellular. (1/3)extracellular (interstitial fluid) 5% blood plasma. edema = an accumulation of interstitial fluid within tissues. Extravascular fluid collection in body cavities: - pleural cavity (hydrothorax)

- the pericardial cavity (hydropericardium) - peritoneal cavity (hydroperitoneum, or ascites). Anasarca is severe, generalized edema marked by profound swelling of subcutaneous tissues and accumulation of fluid in body cavities. Pathophysiologic categories of edema 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 Lymphatic Obstruction 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 Local : -impaired venous return- e.g. DVT Generalized: -congestive heart failure (most common): reduced cardiac output leads hypoperfusion of the kidneysrenin-angiotensin-aldosterone axis sodium and water retention (secondary hyperaldosteronism). (vicious circle): fluid retention increased venous hydrostatic pressuresworsening edema. Treatment of generalized edema: salt restriction

diuretics aldosterone antagonists Reduced Plasma Osmotic Pressure common causes: 1- albumin is lost from the circulation e.g. nephrotic syndrome loss of albumin (and other plasma proteins) in the urine . 2- albumin synthesized in inadequate amounts e.g. severe liver disease (e.g., cirrhosis) e.g. protein malnutrition Unfortunately, increased salt and water retention by the kidney not only fails to correct the plasma

volume deficit but also exacerbates the edema, since the primary defect (low serum protein) persists Lymphatic Obstruction = lymphedema Causes: 1- localized obstruction caused by an inflammation 2- neoplastic conditions. 3- post surgical 4- irradiation examples: -filariasis (so-called elephantiasis) breast cancer: Infiltration and obstruction of superficial lymphatics cause edema of the breasts overlying skin peau d'orange (orange peel).

breast cancer who undergo axillary lymph node resection and/or irradiation upper limb lymphedema Sodium and Water Retention leads to edema by increasing hydrostatic pressure (due to expansion of the intravascular volume) and reducing plasma osmotic pressure. causes: diseases that compromise renal function, including poststreptococcal glomerulonephritis and acute renal failure Clinical Correlation Subcutaneous edema: the most common, is important

to recognize primarily because it signals potential underlying cardiac or renal disease Can impair wound healing or the clearance of infections. Pulmonary edema Common causes: left ventricular failure - renal failure - ARDS inflammatory and infectious disorders of the lung. can cause death by interfering with normal ventilatory function & impeding oxygen diffusion creates a favorable environment for infections. Brain edema is life-threatening brain herniation (extrude) through the foramen magnum.

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