1. Hemodynamic Disorders, Thrombosis & Shock
Edema
Edema
Hyperemia and Congestion
Hemorrhage
Hemostasis & Thrombosis
Embolism
Infarction
Shock

2. Fluid extravasations and accumulation in the interstitial spaces
EDEMA
Fluid extravasations and accumulation in the interstitial spaces

3. EDEMA Increased fluid in the interstitial tissue spaces
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EDEMA
Increased fluid in the interstitial tissue spaces
Fluid may also accumulate in body cavities:
Hydrothorax
Hydropericardium
Hydroperitoneum is also called Ascites
Massive generalized edema is called Anasarca

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Fluid Homeostasis
Homeostasis is maintained by the opposing effects of:
Vascular Hydrostatic Pressure
and
Plasma Colloid Osmotic Pressure
Lymphatics

5. Edema Fluid = TRANSUDATE
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Edema Fluid = TRANSUDATE
A transudate is protein-poor (specific gravity <1.012)
An exudate is protein-rich (specific gravity >1.020) = (inflammatory edema)

6. Pathophysiologic Categories of Edema
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Pathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Others

7. Pathophysiologic Categories of Edema
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Pathophysiologic Categories of Edema
Increased Hydrostatic Pressure
Due to impaired venous return
Localized:
Venous Thrombosis
Generalized:
Congestive Heart Failure
Due o increased arteriolar dilatation

8. Increased Hydrostatic Pressure
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Increased Hydrostatic Pressure
Congestive Heart Failure:
“Generalized increase in venous pressure,
with resultant SYSTEMIC EDEMA occurs
MOST COMMONLY in CONGESTIVE HEART FAILURE”
{*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to Increased Hydrostatic Pressure}

9. Congestive Heart Failure
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Congestive Heart Failure
Overall, there are TWO main effects...
1. Increased Central Venous Pressure
2. Decreased Renal Perfusion

10. Increased Hydrostatic Pressure: Congestive Heart Failure
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Increased Hydrostatic Pressure: Congestive Heart Failure
Mechanism:
The Pump is FAILING!!!   Cardiac output
Blood backs up, first into the lungs
 then into the venous circulation
 increasing Central Venous Pressure (CVP)
 increased capillary pressure (Hydrostatic Pressure)
Leading to Edema

11. Congestive Heart Failure: & Decreased Renal Perfusion
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Congestive Heart Failure: & Decreased Renal Perfusion
Congestive heart failure 
Decreased Cardiac Output 
Decreased ARTERIAL blood volume 
“Less arterial blood…Less renal perfusion...
The Kidney doesn’t see enough blood coming through …….

12. Congestive Heart Failure: & Decreased Renal Perfusion
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Congestive Heart Failure: & Decreased Renal Perfusion
Decreased Renal Perfusion activates
the Renal Defense Mechanisms:
Renin-Angiotensin-Aldosterone axis 
 Na & H2O retention
Renal Vasoconstriction
Increased Renal Anti-diuretic Hormone (ADH)

13. Congestive Heart Failure - Summary
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Congestive Heart Failure - Summary
Central
Venous
Pressure
Renal
Perfusion
ADH
Renin
Renal Vasoconstriction

14. Pathophysiologic Categories of Edema
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Pathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Other
II. Reduced Plasma Oncotic Pressure

15. Reduced Plasma Osmotic Pressure
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Reduced Plasma Osmotic Pressure
“…Albumin:
is the serum protein MOST responsible for the maintenance of colloid osmotic pressure.”
A decrease in osmotic pressure can result from:
 Protein Loss or
 Protein Synthesis

16. Reduced Plasma Osmotic Pressure
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Reduced Plasma Osmotic Pressure
Increased albumin loss:
Nephrotic Syndrome
Increased permeability of the glomerular capillary wall  loss of protein
Reduced albumin synthesis
Cirrhosis
Protein malnutrition

17. Pathophysiologic Categories of Edema
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Pathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Other
III. Inflammation

18. Pathophysiologic Categories of Edema
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Pathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Others
IV. Others:
- Lymphatic Obstruction
- Sodium & water retention

19. Lymphatic Obstruction
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Lymphatic Obstruction
Impaired lymphatic drainage with resultant lymphedema
usually localized
usually due to:
INFLAMMATION or
NEOPLASTIC OBSTRUCTION

20. Lymphatic Obstruction
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Lymphatic Obstruction
Filariasis –
A parasitic infection affecting inguinal lymphatics resulting in elephantiasis

21. Lymphatic Obstruction Neoplastic
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Lymphatic Obstruction Neoplastic
Resection and/or radiation to axillary lymphatics in breast cancer patients can lead to -- arm edema
Carcinoma of breast with obstruction of superficial lymphatics can lead to edema of breast skin -- --with an unusual appearance:
“peau d’orange” (orange peel)

22. EDEMA - Summary HEART LIVER KIDNEY INCREASED DECREASED HYDROSTATIC
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EDEMA - Summary
INCREASED
HYDROSTATIC
PRESSURE
Congestive Heart Failure
Ascites
Venous Obstruction
DECREASED
ONCOTIC
PRESSURE
Nephrotic Syndrome
Cirrhosis
Protein Malnutrition
HEART
LIVER
KIDNEY
LYMPHATIC
OBSTRUCTION
Inflammatory
Neoplastic
INCREASED
PERMEABILITY
Inflammation

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GENERALIZED EDEMA
HEART
LIVER
KIDNEY

24. Edema Morphology Subcutaneous Edema
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Edema Morphology
Subcutaneous Edema
Edema of the subcutaneous tissue is most easily detected Grossly (not microscopically)
Push your finger into it
and a depression remains
Dependent Edema is a prominent feature of Congestive Heart Failure
Facial Edema is often the initial manifestation of Nephrotic Syndrome

25. Edema Clinical Correlation: Subcutaneous Edema
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Edema
Clinical Correlation:
Subcutaneous Edema
Annoying but Points to Underlying Disease
However, it can impair wound healing or clearance of Infection

26. Edema Morphology Pulmonary Edema
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Edema Morphology
Pulmonary Edema
is most frequently seen in Congestive Heart Failure
May also be present in renal failure, adult respiratory distress syndrome (ARDS), pulmonary infections and hypersensitivity reactions

27. Pulmonary Edema Gross:
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Pulmonary Edema Gross:
The Lungs are typically 2-3 times the normal weight
Cross sectioning causes an outpouring of frothy,
sometimes blood-tinged fluid

28. Normal Pulmonary Edema
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Normal
Pulmonary Edema

29. Edema Clinical Correlation: Pulmonary Edema
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Edema
Clinical Correlation:
Pulmonary Edema
May cause death by interfering with Oxygen and Carbon Dioxide exchange
Creates a favorable environment for infection
THINK it resembles “Culture Media”!!!

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Edema of the Brain
Trauma, Abscess, Neoplasm, Infection (Encephalitis due to say… West Nile Virus), etc

31. Clinical Correlation: Edema of the Brain
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Clinical Correlation: Edema of the Brain
The big problem is: There is no place for the fluid to go!
Herniation into the foramen magnum will kill