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% male50% 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 Plasma oncotic
Negative interstitial pressure 28
fluid pressure 3
Interstitial oncotic
pressure 8

Total 41 Net out 13

(Filtration pressure)
 Balance Sheet - Venous

 Outward  Inward
Cap. pressure 10 Plasma oncotic
pressure 28
Negative interstitial
fluid pressure 3
Interstitial fluid
oncotic presure 8
Net inward 7
(Reabsorption
Total 21
pressure)
 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 effusion
 inflammation, tumour
 Ascites (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