ascites Pulmonary edema

Edema Definition Pathogenesis Treatment

Edema is defined as soft tissue swelling due to expansion of the interstitial volume.

Pathogenesis ★ Disturbance of Transcapillary Fluid Exchange ★ Sodium and Water Retention

Pc 20mmHg PTPT -10mmHg TT 15mmHg CC 25mmHg +-+ ﹝ ﹞ 〉0〉0

↑Capillary Hydrostatic Pressure eg: thrombophebitis, hepatic obstruction, tight clothing around the extremities, prolonged standing

↓Capillary Plasma Colloid Osmotic Pressure eg: glomerular diseases of the kidney,serous drainage from open wounds,burns,cirrhosis of the liver

↑Tissue Fluid Colloid Osmotic Pressure eg: Severe inflammation ↑Capillary Permeability

Obstruction of Lymphatic Return

Helminths are worms, that cause filariasis, hookworm, pinworm, schistosomiasis, tapeworm, trichinosis, etc. A typical filariasis infection is a chronic infestation with threadlike filaria nematodes. They congregate in the lymph nodes and surrounding tissue and eventually block the flow of lymph. This results in pain and significant swelling in the area involved Filariasis

Four interrelated mechanisms are major cause of edematous states ★ Deceased colloid osmotic pressure in the capillary ★ Increased capillary hydrostatic pressure ★ Increased capillary permeability ★ Lymphatic obstruction or increased interstitial colloid osmotic pressure

Pathogenesis ★ Disturbance of Transcapillary Fluid Exchange ★ Sodium and Water Retention

Reabsorption of salt Sodium and Water Retention ↓GFR ↑Reabsorption

Sodium and Water Retention ↓GFR Glomerulopathy ↓ ↓ Effective circulatory volume

Reabsorption of salt Sodium and Water Retention ↓GFR ↑Reabsorption

ADH

Aldosterone

ANP

Pathogenesis ★ Disturbance of Transcapillary Fluid Exchange ★ Sodium and Water Retention

How does Disturbance of Transcapillary Fluid Exchange effect on Sodium and Water Retention Fluid accumulates the interstitial space Effective circulation Sodium and Water Retention ADH Aldosterone ANP

How does Sodium and Water Retention effect on Disturbance of Transcapillary Fluid Exchange Sodium and Water Retention Disturbance of Transcapillary Fluid Exchange Capillary Hydrostatic Pressure

Right heart failure Edema ?

Sodium and Water Retention Venous return GFR ADH Aldosterone ANP ReabsorptionCapillary Hydrostatic Pressure Colloid Osmotic Pressure in the Capillary Lymphatic obstruction CO

Treatment 1. First, treat the underlying disease. 2. Decrease sodium intake, either dietary or intravenous. 3. Increase excretion of sodium and water a. Diuretics - remember, these are palliative, not curative. b. Bed rest, local pressure The treatment of edema should neither begin nor end with the administration of diuretics. The basic approaches to treatment are as follows.

Pathogenesis ★ Disturbance of Transcapillary Fluid Exchange ★ Sodium and Water Retention

Reabsorption of salt Sodium and water retention ↓GFR ↑Reabsorption ANP.ADH. Aldosterone

★ Increased capillary hydrostatic pressure ★ Deceased colloid osmotic pressure in the capillary ★ ★ Lymphatic obstruction