Transcript EDEMA Fluid extravasation and accumulation in the interstitial spaces

EDEMA
Fluid extravasation and accumulation in
the interstitial spaces
EDEMA
• Localized ( a limb) or systemic
• Inflammatory or non inflammatory
•
Massive edema is called Anasarca
•
Fluid may also accumulate in body cavities:
 Hydrothorax
 Hydro pericardium
 Hydro peritoneum is also called Ascites
Edema Fluid
• A TRANSUDATE is protein-poor (specific
gravity <1.012)(non inflammatory)
• An EXUDATE is protein-rich (specific gravity
>1.020) (inflammatory edema)
Pathophysiologic Categories of
Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III.Sodium retention
IV. Lymphatic obstruction
•EDEMA - Summary
•INCREASED
•HYDROSTATIC
•PRESSURE
• Congestive Heart Failure
•
•
• HEART
• LIVER
• KIDNEY
Ascites
Venous Obstruction
•LYMPHATIC
•OBSTRUCTION
• Inflammatory
•
Neoplastic
•DECREASED
•ONCOTIC
•PRESSURE
• Nephrotic Syndrome
•
•
Cirrhosis
Protein Malnutrition
Edema
Morphology
Edema of the subcutaneous tissue is most •
easily detected Grossly (not microscopically)
Push your finger into it •
and a depression remains •
Compare between:
Hyperemia & Congestion
HYPEREMIA:
Congestion
•
• is a passive process
is an active process
• resulting from increase blood
inflow into tissue
• resulting from
• due to arteriolar dilation
impaired outflows
• (e.g. acute inflammation)
from a tissue
• Impaired venous
return
• (e.g. cardiac failure or
venous obstruction)
Liver - Chronic Passive
Congestion
“Nutmeg” Liver
Cross Section of a Nutmeg
Hemorrhage
Extravasation of blood
due to rupture of blood vessels
Hemorrhage
Forms:
Causes:
– Rupture of a large vessel:
– Trauma
– Atherosclerosis
– Inflammatory
– Neoplastic Erosion
– Rupture of small vessels:
» hemorrhagic
diathesis
May be:
– external
– into a body
cavity
– into a tissue
Hemorrhage: into tissue
1) Haematoma:
accumulation of blood ENCLOSED OR CONFINED WITHIN
TISSUE
e.g.
- Bruise (insignificant)
- retroperitoneal haematoma
due to ruptured aortic aneurysm
 fatal
Hemorrhage
2) Petechiae:
minute hemorrhages into skin,
mucous membranes, or serosal
surfaces (1-2 MM)
Associated with:
•
–
Local increase hydrostatic
–
pressure
Thrombocytopenia
Hemorrhage
3) Purpura:
– Slightly larger hemorrhages than Petechiae (3-5 MM)
– Causes:
• Causes as Petechiae
• Trauma
• Vasculitis
• Increased vascular fragility
Hemorrhage
4)
Ecchymoses:
– Subcutaneous haematoma ‘bruise’ OVER 1-2 CM
Q: Why do bruises change color as they Resolve?
• The RBC’s in a hemorrhage
are broken down:
– hemoglobin (red) 
– bilirubin (blue-green) 
– hemosiderin (golden-brown)
Hemorrhage:
Accumulation of blood in a
body cavity:
– Hemothorax
– Hemopericardium
– Hemoperitoneum
– Hemarthrosis
Hemorrhage
Cerebral hemorrhage