edema

Tuesday, 2 April 2024 8:35 am

Excess of fluids in the tissue

Types:
1. Extracellular
2. Intracellular

Mostly it refers to extracellular though it can be intracellular

Causes of intracellular edema

- Hyponatremia
- Inflammation - in skin infection, there is boils formation
- Depression of cellular metabolism
- Inhibition of na/k pump- increased intracellular na- more water

Causes of extracellular edema:

Four factors are imp in interstitial fluid formation
1. Capillary pressure
2. Plasma colloid osmotic pressure
3. Capillary permeability
4. Lymphatic obstruction

Edema is caused by inc capillary pressure caused by

- Inc in venous pressure which is caused by
 cardiac failure,
 incompetent valves,
 gravity, inc,
 ecf volume
- Dilatation of arterioles- angioneurotic edema

Due to dec plasma osmotic pressure (28mmHg)

- In hypoproteinemia - caused by
 malnutrition - inadequate intake
 chronic liver disease ( except gamma globulins all plasma
proteins are synthesised there),
 nephrotic syndrome - loss of protein in urine
 in severe burns, proteins are lost through skin
Destruction of proteins in body due to hyperthyroidism and
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  Destruction of proteins in body due to hyperthyroidism and
chronic fever
Due to Increased capillary permeability
When theyre exposed to
- Heat
- Hypoxia
- Ischemia
- Certain allergic conditions - due to release of histamine and bradikinin

Due to Lymphatic obstruction:

In
- filarial nematodes (Wuchereria bancrofti),( which are microscopic
threadlike worms) - transmittied to humans through mosquito bite-
enters the lymphatics and obstruct them
(leg is swollen like that of an elephant- elephantiasis)
- Enlargement of scrotum
- Breast cancer - leads to oedema of arms - for treatment, radical
mastectomy is done which also leads to edema ( so malignancy and
treatment both lead to lypmphatic edema)

Formation of tissue fluid/interstitial fluid

There are interstial spaces between cells, in these spacews there are two
types of solid subtances
- Collagen filaments - strong, long and provide strength
- Proteoglycan - long, thin , coiled moecules - consisting of 98%
hyalaronic acid and 2% protein
Interstitial gel = proteoglycan filament+ fluids

Advantages of interstitial fluid

1. Keeps the cells in tissue held apart, so that space is available for
nutrient and water to move across - acts as a spacer
2. Prevents movement of fluid from upper to lower part of tissue due to
gravity
3. Immobilizes bacteria and prevents the spread of infection

According to sterling hypothesis:

Formation of tissue fluid involves filtration at arterial end and reabsorption
at venous end of capillaries
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at venous end of capillaries

At arterial end:
Outward forces:
30mmhg
8mmhg - colloid osmotic pressure
3mmhg
=41 mmhg

Fluid is filtered with with the pressure of 41mmhg

At venous end:
Inward force
10mmhg
8mmhg
-3 - hydrostatic pressure
=21
Outward force
28- Plasma colloid osmotic pressure

Reabsorption pressure is 7mmhg

Interstitial fluid is formed continuously at the rate of 20l

90% of it is reabsorbed at the venous end of capillary whereas 10% remains
in the interstitium which enters lymphatic capillaries

Safety factor
Development of edema is not easy
Safety factor is 17mmhg to prevent the development of edema

Components of safety factor:

1. 3mmhg - due to low compliance of tissue ( when interstitial fluid
formation inc, hydrostatic pressure will be normally be -3 and change
to 0 for edema to form)
2. 7mmhg - due to ability of lymph flow to increase 10-15x ( in inc fluid
formation , lymph flow also inc to prevent edema, if capillary pressure
is inc by 7mmhg will inc the formation of interstitial fluid which is
drained by lymphatic flow)
3. 7mmhg - due to washdown of proteins from interstitial spaces ( colloid
osmotic pressure in interstium can decrease from 8mmhg to 1mmhg
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 osmotic pressure in interstium can decrease from 8mmhg to 1mmhg
before edema starts)

Edema starts happening after safety factor is overcome-

Capillary pressure must increaseMore than 17mmhg
Colloid osmotic pressure must decrease by 17mmhg

Clinical types of edema

1. Pitting
You exert pressure over the part with a finger tip, there is a
pit/depression formed
Because of pressure the free fluid is displaced
When u remove the finger, the pit disappears after 30 sec
Most of the cases are pitting
2. Non- pitting
If no pit is formed
Inflammatory edema is non pitting ( boils)
Endocrine diseases ( mixed edema is present which is non pitting)

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