Mechanisms of Edema

What is edema?
 formerly referred to as dropsy or hydropsy, is
the swelling of the body's tissues due to excess
interstitial fluid retention. Edema can occur locally,
often affecting the extremities(peripheral edema), or
generally, affecting the entire body (anasarca)
 Type of edema?
 Generalised
 Affects visceral organs and skin of trunk and lower extremities
 Reflects global disorder of fluid and electrolyte metabolism, most often due to heart
failure
 Seen when blood oncotic pressure is reduced (in renal diseases in which serum
proteins are lost in urine [nephrotic syndrome]) and in cirrhosis of liver (production of
serum proteins is impaired)
 Anasarca: extreme form, with conspicuous fluid accumulation in subcutaneous
tissues, visceral organs, and body cavities (hydrothorax: pleural space; ascites:
peritoneum; hydropericardium: pericardial sac)
 Localised
 –Occurs mostly with inflammation
 –In leg: results from venous or lymphatic obstruction
 –Burns cause prominent oedema by altering permeability of local
vasculature
 –Prominent component of immune reaction (urticaria; oedema of epiglottis
or larynx [angioneurotic oedema])
  OEDEMA CAUSED BY INCREASED HYDROSTATIC
PRESSURE
 •Unopposed increases in hydrostatic
pressure result in greater filtration into
interstitial space and its retention as
oedema
 OEDEMA CAUSED BY DECREASED ONCOTIC
PRESSURE
 •The difference in pressure between
intravascular and interstitial compartments
is largely determined by concentration of
plasma proteins, especially albumin

M  •Occurs in decompesated heart disease;

back-pressure in lungs due to left ventricle
 •Decreased plasma albumin leads to
decreased oncotic pressure and promotes
generalised oedema
E failure leads to acute pulmonary oedema
and right-sided heart failure, and
 –Albuminuria in nephrotic syndrome
contributes to systemic oedema
C  •Back-pressure caused by venous  –Reduced albumin synthesis in chronic liver
disease or severe malnutrition
obstruction in lower extremity causes
H oedema of leg

A  •Obstruction to portal blood flow in cirrhosis

of liver contributes to formation of
abdominal fluid (ascites)
N OEDEMA CAUSED BY LYMPHATIC OBSTRUCTION
I •Normal condition: more fluid is filtered into interstitial spaces than is reabsorbed into vascular bed;
the excess interstitial fluid is removed by lymphatics
S •Lymphatic obstruction leads to localised oedema
–Malignant neoplasms
M –Fibrosis (inflammation or irradiation)
–Surgical ablation (radical mastectomy for breast cancer)
S –Lymphatic filariasis (elephantiasis)
•Lymphoedema: high protein dermal fibrosis (chronic or indurated oedema)
 Sodium&water metabolisms

 –Water: 50-70% of body weight; extracellular and intracellular fluid

 –Extracellular: interstitial (75%) and vascular
 –Total body sodium (TBS): the principal determinant of extracellular fluid (ECF) volume
because the major cation
 –Increased TBS must be balanced by more ECF
 –Control of ECF volume depends on regulation of renal sodium excretion
 •ROLE OF SODIUM RETENTION IN OEDEMA
 –Increased TBS (renal sodium retention) lead generalised oedema and ascites
 –The most common conditions for generalised oedema:
 •Congestive heart failure, Hepatic cirrhosis, Nephrotic syndrome, Chronic renal
insufficiency/failure
Complications

If left unchecked, edema can result in the overlying skin becoming stretched,
developing infections or ulcerating. Also, decreased blood circulation can
lead to blood clots in the deep veins of the body, also known as deep vein
thrombosis.
Treatments & Interventions for Edema

 Avoid tight clothing and jewelry that could constrict the affected area
 Avoid extreme temperatures.
 Keep the affected limb above your heart when possible.
 Massaging the affected area firmly (but not painfully) towards the heart can
help reduce excess fluid. Consider finding a qualified physical therapist or
masseuse to properly perform this procedure.
 During activity, monitor the affected limb for any change in size, shape, tissue,
texture, soreness, heaviness, or firmness.
 Pay particular attention to the limb during air travel, as the decrease in pressure
and extended time seated can exacerbate existing symptoms of edema.
Consider wearing a compression garment for such travel, except if you have
open wounds or poor circulation in the affected limb.
 Apply topically neomycin on the area of skin infection.