EDEMA

Prepared by
Dr. Mizanur Rahman Chowdhury

Edema
Definition

Excessive accumulation of
abnormal amount of fluid into
the interstitial space and or
body cavities.

Normal homeostasis
Factor tending to drive the fluid out of the blood
vessels:
Hydrostatic pressure with in the
vessels
The colloidal osmotic pressure of
interstitial spaces
Factor tending to drive the fluid with in the
blood vessels:
Tissue tension
The colloidal osmotic pressure of
interstitial spaces

Classification of edema
On the basis of involvement
Localized edema
Generalized edema

On the basis of inflammation

Inflammatory/Exudative edema
Non inflammatory/Transudative edema

Clinical Classification
Pitting edema
Non pitting edema

Pathophysiological Categories of
Increase
edema hydrostatic pressure
Impaired venous return

Congestive cardiac failure

Constrictive pericardit
Liver cirrhosis
Venous pressure or obstruction
Thrombosis
External pressure
Arteriolar dilation
Heat
Neurohumoral dysregulation

Pathophysiological Categories of
edema
Decrease plasma colloidal osmotic
pressure

Nephrotic syndrome
Liver cirrhosis
Malnutrition
Protein loosing
gastroenteropathy

Pathophysiological Categories of
edema
Lymphatic obstruction
oInflammatory
oNeoplastic
oPost surgical
oPost irradiation

Pathophysiological Categories of
edema

Sodium retention
Excessive salt intake with renal
insufficiency
Increase tubular reabsorption of
sodium
Renal hypoperfusion
Increase renal angiotensin
aldosterone secretion

Pathophysiological
Categories of edema
Inflammatory
Acute inflammation
Chronic inflammation
Angiogenesis

Localised oedema
Inflammatory edema:
Exudate are formed due to increase vascular
permeability protein

Edema due to venous obstruction:

In venous obstruction there is rise of hydrostatic
pressure, this lead formation of exudates.

Edema due to lymphatic obstruction:

Excessive lymphatic obstruction can produce an
oedema of high protein content but not as that
of exudate

Hypersensitivity edema

Generalized edema

Cardiac edema
Renal edema
Hepatic edema
Famine edema
Others

Cardiac
edema
Most common cause is right sided

congestive cardiac failure

Transudative edema
Dependant peripheral edema
Distribution is influenced by gravity i.e.
When patient is ambulant: ankle
edema
When patient is recumbent: sacral
edema
Edema pits on pressure

Pathogenesis of Cardiac
oedema
Heart failure

Increase central venous pressure

Increase capillary pressure

Increase transudation

Oedema

Pathogenesis of Cardiac oedema

Heart failure

Decrease cardiac output

Decrease effective arterial blood volume

Renal vasoconstriction

Decrease GFR

Increase tubular reabsorption sodium and water

Increase plasma volume

Increase transudation

Oedema

Pathogenesis of Cardiac oedema

Heart failure

Decrease cardiac output

Decrease effective arterial blood volume

Increase renin secretion

Increase aldosterone

Increase renal reabsorption of sodium

Increase renal retention of sodium and water

Increase plasma volume

Increase transudation

oedema

Pathogenesis of Cardiac oedema

Heart failure

Decrease cardiac output

Decrease effective arterial blood volume

Increase ADH secration

Increase renal retention water

Increase renal retention of sodium and water

Increase plasma volume

Increase transudation

edema

Renal edema
Cause of renal edema

Acute

glomerulonephritis
Nephrotic syndrome

Pathogenesis of Renal
oedema
Acute glomerulonephritis:
Salt and water retention by the

damaged kidney.
There may be additional factor of
heart failure.
Nephritic edema affect the face
and eyelids predominantly; ankle
and genitalia also often affected.

Pathogenesis of Renal edema

Nephrotic syndrome:
Heavy proteinuria

Decrease plasma colloidal

osmotic pressure

Generalized oedema.

Pathogenesis of Renal
oedema
Nephrotic syndrome:
Salt and water retention occour in nephrotic
syndrome

Increase blood volume

Increase hydrostatic pressure

Generalized oedema

Pathogenesis of Renal edema

In some cases of nephrotic syndrome blood volume
decrease

Activate renin angiotensin aldosterone mechanism

Sodium and water retention by the kidney

blood volume increase

Increase hydrostatic pressure

Generalized edema.

Famine edema/Nutritional
edema:
o It is due to hypoproteinaemia
o sometimes oedema is extensive but
plasma protein level is normal in
famine oedema.
o The true explanation is unknown. But
there is an important factor is loss of
compact tissue and replace by loose
connective tissue which can
accumulate fluid without rise of tissue
tension

Hepatic edema
The main manifestation of hepatic edema is
ascitis.
The factor responsible for hepatic edema
Lymphatic obstruction
Low

plasma protein level

Increase

regional venous pressure due

to portal hypertension

Failure

to hepatic inactivation of

Pulmonary edema

Hydrostatic balance of lung capillaries is

some what different from the systemic

circulation.
Blood pressure in the pulmonary circuit is
about 15-25mm hg systolic and 6-12mm
Hg diastolic mean capillary pressure is
7mm Hg being highest at the base and
lowest at the apex.
The interstitial fluid pressure is -16mm
Hg. Both these forces tend to drive fluid
out of capillaries in to the interstitial
space which consist of
mucopolysacchadide. Normally the
plasma colloidal osmotic pressure2528mm Hg is adequate to prevent fluid

Pulmonary edema
Cause of pulmonary edema:
Left heart failure ,Left
ventricular failure ,Mitral
stenosis particularly in fibrilation
Inflammation of lung,
Pneumonia
ARDS
Associated with anaemia,
Nephrotic syndrome
Overloading of circulation
Withdrawal of pleural fluid

Cerebral edema
There are two types of
cerebral edema
Vesogenic edema
Cytotoxic edema

Vesogenic cerebral
edema

It occurs when the integrity of

the normal blood brain barrier
is disrupted and increased
vascular permeability occurs
allowing fluid to escape from
the intravascular space of the
brain

Cytotoxic Cerebral
Edema
It occurs

when there is increaseed

intracellular fluid secondary to
nneural, glial, or endothelial cell
membrene injury in a patient with
a generalized hypoxic/ischemic
insult or with some intoxication.

Thank you