1. EDEMAEDEMA Fluid extravasation and accumulation in the interstitial spaces

2. EDEMA Localized ( a limb) or systemicLocalized ( a limb) or systemic Inflammatory or non inflammatoryInflammatory or non inflammatory AnasarcaMassive edema is called Anasarca body cavities:Fluid may also accumulate in body cavities: Hydrothorax Hydrothorax Hydro pericardium Hydro pericardium Hydro peritoneum is also called Ascites Hydro peritoneum is also called Ascites

3. Edema Fluid TRANSUDATEA TRANSUDATE is protein-poor (specific gravity <1.012)(non inflammatory) EXUDATE (inflammatory edema) An EXUDATE is protein-rich (specific gravity >1.020) (inflammatory edema)

4. Pathophysiologic Categories of Edema I.Increased Hydrostatic Pressure II.Reduced Plasma Oncotic Pressure III.Sodium retention IV.Lymphatic obstruction

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

6. Edema Morphology GrosslyEdema of the subcutaneous tissue is most easily detected Grossly (not microscopically) Push your finger into it and a depression remains

7. Compare between: Hyperemia & Congestion HYPEREMIA: is an active process resulting from increase blood inflow into tissue due to arteriolar dilation (e.g. acute inflammation)Congestion is a passive process resulting from impaired outflows from a tissue Impaired venous return (e.g. cardiac failure or venous obstruction)

8. Cross Section of a Nutmeg “Nutmeg” Liver Liver - Chronic Passive Congestion

9. HemorrhageHemorrhage Extravasation of blood due to rupture of blood vessels

10. HemorrhageCauses: –Rupture of a large vessel: –Trauma –Atherosclerosis –Inflammatory –Neoplastic Erosion –Rupture of small vessels: »hemorrhagic diathesis Forms: May be: –external –into a body cavity –into a tissue

11. Hemorrhage: into tissue 1) Haematoma: accumulation of blood ENCLOSED OR CONFINED WITHIN TISSUE e.g. - Bruise (insignificant) retroperitoneal haematoma - retroperitoneal haematoma due to ruptured aortic aneurysm  fatal

12. Hemorrhage 2) Petechiae: minute hemorrhages into skin, mucous membranes, or serosal surfaces (1-2 MM) Associated with:Associated with: –Local increase hydrostatic pressure –Thrombocytopenia

13. Hemorrhage 3) Purpura: –Slightly larger hemorrhages than Petechiae (3-5 MM) –Causes: Causes as Petechiae Trauma Vasculitis Increased vascular fragility

14. Hemorrhage 4) Ecchymoses: –Subcutaneous haematoma ‘ bruise ’ OVER 1-2 CM bruises change color 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)

15. Accumulation of blood in a body cavity: Hemorrhage: Accumulation of blood in a body cavity: –Hemothorax –Hemopericardium –Hemoperitoneum –Hemarthrosis

16. Hemorrhage Cerebral hemorrhage