Leicester Warwick Medical School

Tissue Fluid Formation

and Oedema
Dr. Kevin West
kpw2@le.ac.uk
Department of Pathology

Tissue Fluid Formation - Objectives 1

Control

of normal interstitial fluid

formation
Definition of oedema
Definition of pleural effusion, pericardial
effusion and ascites
Distinction between transudate and
exudate

Tissue Fluid Formation - Objectives 2

Common

causes and mechanisms of

development of oedema
Pulmonary oedema - causes and
effects
Cerebral oedema - causes and effects

Water
Major

body component
60% male
50% female
3 compartments

intracellular
extracellular interstitial
extracellular intravascular

Osmolality
Osmotic

pressure related to number of

particles of solute
Oncotic pressure describes osmotic
pressure exerted by proteins
Effect of oncotic pressure small but
significant across capillaries

Control of Interstitial Fluid

Hydrostatic

pressure
Oncotic pressure
Endothelial integrity
Lymphatic system

Interstitial Fluid
Fluid

between cells
Derived from capillaries
Solutes similar to plasma except for
protein content

Movement Of Fluid Across Capillaries

Capillary

(hydrostatic) pressure
Interstitial fluid (hydrostatic) pressure
Plasma oncotic pressure
Interstitial fluid oncotic pressure

Capillary Pressure
Forces

fluid from capillary to interstitium

Arterial end higher than venous end
Arterial approx. 30 mmHg
Venous approx. 10 mm Hg

Interstitial Fluid Pressure

Maybe

positive or negative
Negative - forces fluid into interstitium
Positive - forces fluid into capillary
Approx. minus 3 mm Hg in loose
connective tissue
Higher in denser connective tissue

Plasma Oncotic Pressure

Proteins

are the only solutes which do not

pass freely between plasma and interstitium
Thus it is only proteins which exert a
significant osmotic effect across capillary
walls
Albumin is the most abundant plasma protein
Approx 28 mm Hg (Albumin = 21.8)

Interstitial Oncotic Pressure

A small

amount of protein is present in

the interstitium
Tends to force fluid out of capillary
Concentration is approx 40 % of that in
plasma
Approx 8 mm Hg

Balance Sheet - Arterial

Outward

Inward

Cap. pressure
30
Negative interstitial
fluid pressure
3
Interstitial oncotic
pressure
8

Plasma oncotic
pressure

Total

Net out
13
(Filtration pressure)

41

28

Balance Sheet - Venous

Outward

Cap. pressure
10
Negative interstitial
fluid pressure
3
Interstitial fluid
oncotic presure
8
Total

21

Inward
Plasma oncotic
pressure

Net inward
(Reabsorption
pressure)

28

Lymphatic System
The

lymphatic system provides a route

for the transport of fluids and protein
away from the interstitium
System of fine lymphatic channels
throughout the body passing via lymph
nodes to thoracic duct
Valves ensure one-way flow

Oedema
Hydrostatic

pressure
Oncotic pressure
Endothelial integrity
Lymphatic integrity

Oedema
Definition

An increased volume of interstitial fluid

in a tissue or organ
May be localised or generalised
(systemic)

Causes of Oedema
Raised

capillary pressure
Reduced oncotic pressure
Endothelial damage (inflammation)
Impaired lymphatic drainage

Raised Capillary Pressure

Cardiac failure

right ventricular failure - systemic oedema

left ventricular failure - pulmonary oedema
congestive cardiac failure - both

Local venous obstruction

deep vein thrombosis

external compression
SVC obstruction

Reduced Oncotic Pressure

Renal

disease

loss of albumin across glomerulus

Hepatic

disease

inadequate albumin synthesis

Malnutrition

inadequate albumin synthesis

Lymphatic Obstruction
Tumours
Fibrosis
Inflammation
Surgery
Congenital

abnormality

Generalised Oedema
Congestive

cardiac failure
Right ventricular failure
Renal disease
Liver disease

Generalised Oedema
Commonly

causes
swelling of ankles
Swelling may extend
higher
Sacral oedema in
recumbent patients

Right Ventricular Failure

Raised

jugular
venous pressure
also seen
Enlarged liver also
common due to
congestion (nutmeg
liver)

Pulmonary Oedema

Usually caused by LVF

Raised pressure across
pulmonary capillaries
Causes shortness of
breath
Due to ischaemic heart
disease or hypertension

Pulmonary Oedema

Congestive Cardiac Failure

Combination

of left and right ventricular

failure
Common in ischaemic heart disease
Causes systemic and pulmonary
oedema

Cerebral Oedema
Causes

increased
intracranial pressure
Fatal if left untreated
Generalised in
hypoxia, injury
Surrounding other
lesions eg tumour,
abscess

Fluid in Body Cavities

Pleural

effusion

heart failure, inflammation, tumour

Pericardial

inflammation, tumour

Ascites

effusion

(peritoneal effusion)

cirrhosis, heart failure, tumour

Pleural Effusion

Pericardial Effusion

Ascites
Most

severe cases
associated with

cirrhosis of the liver

intra-abdominal
malignancy

Superior Vena Cava Obstruction