Lecture no 1

3 Year MBBS
rd

Hemodynamics
Dr.Shabana Nauman
Shabananauman@gmail.com

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EDEMA

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Nature
Nature
• Excessive accumulation of extracellular fluid in the
tissues. It may be an exudate (specific gravity > 1.020)
or transudate (Spec. gravity <1.012)
• Extracellular fluid:
– Total volume 10-11 litre. It bathes all the cells of the body and
through which all the cell metabolites pass. It is not static but in
constant exchange with intracellular fluid and blood.
• Fluid collection in different body cavities:
– Hydrothorax
– Hydropericardium
– Hydroperitonium
• Anasarca
– Severe generalized edema with profound subcutaneous swelling.
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• Normal Tissue Fluid
– Factors involved in formation and removal of tissue fluid
• Capillary blood pressure: Hydrostatic pressure
• 25-30 mmHg arterial end (outflow)
• 7-12 mmHg venous end (inflow)
• Capillary permeability:
• Semipermeable membrane
• Increased in inflammation
• Osmotic Pressure of blood:
• Due to albumin, 25 mmHg pressure attract fluid back in blood.
• Osmotic pressure of Extraceullular fluid:
• 4-6 g/l albumin , 2-3 mmHg, pressure attract fluid from the
blood.
• Electrolyte content of plasma and extracellular fluid are normally
in equilibrium.

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 • Hydrostatic pressure of extracellular fluid:
– Elastic property of tissue (tissue tension) deters the
escape of fluid from blood
– Subcutaneous tissue has  tissue tension hence greater
degree of edema.
• Lymphatic Drainage
– Normally removes excess of extracellular fluid.

In edema one or more these factors become

deranged to result in pathological excess of
extracellular fluid.

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Causes of Edema
• Increased hydrostatic pressure will force fluid out of the
blood vessels.
– Systemic : Cardiac Failure
– Local : Gravid uterus, venous thrombosis, varicose veins.
• Decreased osmotic pressure of Blood (< 40g/l)
Causes Of Protein Decrease
– Inadequate intake:
• Starvation
• Malabsorption syndrome
– Excessive Output
• Nephrotic syndrome
• Severe Burns
• Ascieties
– Under production
• Severe Liver disease

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• Increased Capillary permeability (Inflammation)
Causes
• Systemic
– Anaphylaxsis due to bacterial products and chemicals.
– Cardiac Failure  anoxia
• Local
– Burns, Chemical, Infection, Angioneurotic edema of glottis
• Increased osmotic pressure of the Extracellular fluid
– Excess of Na ions and its obligatory associated H2O
– Cardiac failure, renal failure,  adrenal cortiticoids,  dietary intake of
salt.
• Lymphatic Obstruction
• Lymphoedema:- Brawny, non-pitting with subsequent overgrowth of
connective tissue and skin : “Elephentiasis
Causes:
– Congenital Milroy’s disease
– Parasitic Filarial infection
– Scarring Infection e.g lymphogranuloma venereum
Radiation
– Surgery carcinoma breast “Peau d orange”
– Malignant Tumour cells

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• Clinical Types
Two common clinical types of generalized pitting
edema are:
– Cardiac edema: usually dependant edema
•  hydrostatic pressure in the veins.
• Stagnant anoxia with vascular permeablity
• Na ion rention along with H2O with increased osmotic
pressure of extracelluar fluid
– Renal edema: Usually starts as periorbital edema.
• Albuminuria and  plasma protein and  plasma osmotic
pressure e.g. nephrotic syndrome.
• Electrolytes disturbance and  osmotic pressure of
extracellular fluid e.g. acute renal failure.
•  capillary permeability eg acute glomerulonephritis.
• Edema of cardiac failure when there is associated
hypertension secondary to renal disease.

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• Effects:
– Depends upon site of accumulation
– Subcutaneous edema:
• Impaired wound healing and impaired clearing of infection.
– Cerebral edema:
• Herniation of brain stem, stoppage of brain stem vascular
supply.
– Pulmonary edema:
• Impeding gaseous exchange, bacterial infection.