Hemodynamic

Disorders

Humans
Body Water
75% of body weight in infant
60% of body weight in adult male
55% of body weight in adult
female
the exact percentage depending upon:
age newborn = 75%, lean adult man = 60%,
old age = 45%
body size obese = as little as 45%, very lean as
much as 75%
gender lean adult man = 60%,
lean adult women = 50%

Body fluid compartments

Fluid compartments
Intracellular fluid
Extracellular fluid
Interstitial fluid
Blood plasma
Lymph

Body fluid compartments

Total Body Weight

Intracellular fluid (67%)

Extracellular fluid (33%)

40% solids
67% ICF

Interstitial fluid (80%)

80%
interstitial
fluid

Plasma (20%)
Other fluids

60% fluids
33% ECF
20% plasma

Body Fluid Compartments

Intracellula
r (ICF)
Extracellul
ar (ECF)
Interstitial
Plasma

Figure 5-13: Body fluid compartments

Fluid Balance

Fluids Are In Constant Motion

Semi-permeable membranes separate the fluid compartments
Fluids are in constant motion between the 3 compartments

venula
rend

plasma

arteriolar
end

endothelium
reabsorption

interstitial fluid

filtration
osmosis

tissue cells

Fluids Are In Constant Motion

Forces acting across the capillary membrane
causing net movement of fluid among compartments

Edema Formation
Excess fluid in body tissue
Most cases in the extracellular fluid
compartment
Can also occur in the intracellular
fluid compartment as well

Edema Formation
Extracellular - pitting edema
Abnormal leakage of fluid from
plasma to the interstitial space
across the capillaries
Failure of lymphatics to return fluid
from the interstitium back into the
blood
*Excess capillary fluid filtration

Factors that increases capillary

filtration
Caused by major imbalance of capillary
filtration forces and/or lymphatic blockage
Filtration = Kf * (Pc - Pif - c + if)
Kf=capillary filtration coefficient (product of
permeability and surface area of the capillary)
Pc=capillary hydrostatic pressure
Pif=interstitial hydrostatic pressure

=capillary plasma colloid osmotic pressure

=interstitial fluid colloid osmotic pressure
c

if

Major factors: increased Pc and/or Kf and/or

decreased c

Extracellular - pitting edema

Lymphatic blockage
Filaria nematodes
Cancer

Wuchereria Bancroft

Extracellular - pitting edema

Heart failure
No pump of blood from veins into
arteries ( venous and capillary
pressure with capillary filtration)
arterial pressure excretion of salt
and water by kidneys ( blood volume
and capillary hydrostatic pressure)
renin, angiotensin II and aldosterone
secretion (more salt and water
retention)

Extracellular - pitting edema

Decreased kidney excretion of salt
and water
Disease state (acute
glomerulonephritis) with failure to
filtrate adequate amounts of fluid
Decreased plasma proteins
Failure of body to produce normal
amounts of proteins
Leakage of proteins from plasma

 Decreased plasma proteins (cont)

Nephrotic syndrome (damage to the
membranes of the renal glomeruli).
Serious edema when plasma protein
falls below 2.5g/100ml.
Cirrhosis of the liver (hepatic tissue
fibrosis). protein synthesis leading to
colloid osmotic pressure.

Edema Formation
Intracellular - non-pitting edema
Na+ pump depression: increases
intracellular Na+ osmolarity and
causes water to move to the inside of
the cell
metabolism disturbance ( blood supply)
nutrient supply disturbance

Inflammation: permeability to Na+ and

other ions leading to osmosis of water

Safety Factors Preventing

Edema
Low compliance of the tissues in the
negative pressure range
Lymphatic capacity for increasing
flow
Washdown of interstitial protein

Low compliance of the tissues in the

negative pressure range
Hydrostatic pressure in most
subcutaneous
tissues around - 3mmHg
Holds tissue together
Negative pressure range, the
compliance is low
Above 0 mmHg compliance is high
safety against edema is lost
SF = 3 mm Hg

 Free fluid forms

in the
interstitial
space only
after the
interstitial fluid
pressure rises
above 0
mmHg. Fluid is
in a Gel State
at negative
pressures.

Lymphatic capacity for increasing

flow
Return the circulation fluids and
proteins filtered from the capillaries
into the interstitium
Without this function, plasma
volume and edema occurs
Lymph flow increases 10-50 fold
when fluid start to accumulate
SF = 7 mm Hg

Washdown of interstitial protein

Fluid filtration, pressure,
lymph flow
Protein concentration with
lymph flow
Colloid osmotic pressure
Net result is net filtration across
capillaries
SF = 7 mm Hg

Total Safety Factor

17 mm Hg
The capillary pressure in a peripheral
tissue could theoretically rise by 17
mm Hg before marked edema would
occur

Fluid in Potential Spaces

Potential Space - Normally empty with (-)
pressure.
Pleural, peritoneal, pericardial, synovial
Fluid accumulates because of unbalance
of capillary forces or lymphatic blockage
due to infection or injury
Effusion: edema fluid from subcutaneous
space collects in the potential space

Edema fluid types

TRANSUDATE

EXUDATE

Watery in nature

Proteinesous in nature

Sp. Gr = 1.012 or <

Sp. Gr = 1.020 & >

Low Proteins
Low Colloids
No cells

High Protein content

High colloid levels
High cell cont
May contain various
enzymes & tissue
markers

Hyperemia
Local increase in blood flow in a tissue due
to vasodilation of blood vessels in that area.
(arteriolar dilation takes place)

Causes
Local factors
Temp., CO2, pH, chemicals
Systemic Factors
ANS, Hormones, chemical mediators

Features
Tissue become pink / red color & hot

Congestion
Accumulation of blood in a capillary
network in a tissue due to obstruction or
decreased venous outflow.
Causes
Compression
Thrombo embolism
Vasculitis/phelebitis

Features
It leads to edema formation
Tissue appears bluish / dusky in color

Thrombo - Embolism
Thrombosis
formation of collected mass of blood
inside cardiovascular system
(mass=thrombus)
Embolism
a detached thrombus or its part which
flows in CVS & occludes any blood vessel
Both of these result in tissue
Ischemia or Infarction

Thrombo Embolism

(contd)

Ischemia
decreased blood flow to any organ or
tissue due to any cause (reverscible)
Compression from outside or narrowing of
lumen of blood vessel

Infarction
death of tissue due to lack of blood
supply due to any cause (irreverscible)
90% infarcts are due to Thrombo-embolic
events & almost all result in arterial occlusion
in tissues