8/12/2019 Edema Hyperemia Congestion

1/23

oedema

8/12/2019 Edema Hyperemia Congestion

2/23

2oed definition

Increased fluid in interstitial spaces

Anasarca -- severe generalized

oedema with profound subcutaneoustissue swellingFluid collection in various cavities is named

HydrothoraxHydroperitonium (ascities)

hydropericardium

8/12/2019 Edema Hyperemia Congestion

3/23

8/12/2019 Edema Hyperemia Congestion

4/23

3oed classification

Increase hydrostatic pressure

Reduced plasma osmotic pressure

(hypoproteinemia)

Lymphatic obstruction

Sodium retention

inflammation

8/12/2019 Edema Hyperemia Congestion

5/23

4oedincreased hydrostatic pressure

Impaired venous return Congestive heart failure

Constrictive pricarditis

Ascities (liver cirrhosis)Venous obstruction Thrombosis

External pressure (mass)

Inactivity with prolonged dependency

Arteriolar dilation heart

8/12/2019 Edema Hyperemia Congestion

6/23

5oed hyoproteinemia

Reduced plasma osmotic pressure

Protein loosing glomerulopathies

(nephrotic syndrome)Liver cirrhoses (ascities)

malnutrition

protein loosing gastro-entero pathy

8/12/2019 Edema Hyperemia Congestion

7/23

8/12/2019 Edema Hyperemia Congestion

8/23

8/12/2019 Edema Hyperemia Congestion

9/23

8/12/2019 Edema Hyperemia Congestion

10/23

7oed sodium retention

Excessive salt intake ,with renal

insufficiency

Increase tubular reabsorption of sodium

Renal hyoperfusion

Increased renin-angiotensin-aldosteron

secretion

8/12/2019 Edema Hyperemia Congestion

11/23

8oed inflammation

Acute inflammation

Chronic inflammationangiogenesis

8/12/2019 Edema Hyperemia Congestion

12/23

9oed variables of pressures

Affecting fluid transit across capillary wall

Capillary hydrostatic & osmatic forces are

balanced

No net loss or gain of fluid across capillary bed

Increase hydrostatic pressure or decreased

plasma osmotic pressure leads to

net accumulation of extra vascular fluid (oedema) As the interstitial fluid pressure increases

tissue lymphatics remove much of the excess fluid

Eventually returning it to circulation via thoracic duct

Oth ff i

8/12/2019 Edema Hyperemia Congestion

13/23

pathways leading

To systemic

oedema

Heart failure

Cardiac output

Effective arterial

Blood volume

rennin

aldosteron

Renal sodium

reabsorption

Rena retention

Of Na+, H2O

Plasmavolumetransudation oedema

MALNUTRITION

Hepatic SYNTHEIS

NEPHROTIC SYNDROM

PLASMA

Osmotic pressure

Blood volume

Other effusions

Renal

vasoconstriction

Tubular reabsorption

Na+, H2O

GFR

CVP capillarypressure

8/12/2019 Edema Hyperemia Congestion

14/23

11oed clinical presentation

Ranges from annoying to fatal

Signals the underlying disease

Impairs wound healing & clearance ofinfection

Pulmonary oedema interferes with

ventilation & can cause deathBrain oedema is serious and can be fatal

by herniation or pressure ischemia

8/12/2019 Edema Hyperemia Congestion

15/23

MORPHOLOGY

SUBCUTANEOUS EDEMA Dependent, site of higher osmotic pressure

Prominent feature of right heart failure

NEPHROTIC EDEMA PERIORBITAL EDEMA

PULMONARY EDEMA

Frothy blood tinged fluid, with air

BRAIN EDEMASwollen brain,narrow sulci distended gyri

8/12/2019 Edema Hyperemia Congestion

16/23

12hyp

Hyperaemia

and congestion

8/12/2019 Edema Hyperemia Congestion

17/23

13hyp definition

Both indicate a local increased volume of bloodin particular tissue

Hyperemia is an active process

augmented tissue inflow

arteriolar dilatation

skeletal muscle in exercise

place of inflammation

Congestion is passive process

impaired outflow

cardiac failure

8/12/2019 Edema Hyperemia Congestion

18/23

8/12/2019 Edema Hyperemia Congestion

19/23

14hyp hyperemia versus congestive

In both cases there is

Increased volume

and pressure of bloodin a given tissue with

associated capillary dilatation and

potential for fluid extravasations

8/12/2019 Edema Hyperemia Congestion

20/23

15hyphyperemia versus congestion

hyperemiaIncreased inflow leads to

Engorgement with oxygenated blood

Resulting in erythemaCongestionDiminished out flow leads to

Capillary be swollenWith deoxygenated venous blood

Resulting in cyanosis

8/12/2019 Edema Hyperemia Congestion

21/23

8/12/2019 Edema Hyperemia Congestion

22/23

MORPHOLOGY

Cut surfacewet and hemorrhagic

Alveolar capillaries engorged with blood

Focal intra alveolar hemorrhage

HEPATIC CONGESTION

Hepatocyte degeneration

Chronic congestion.nutmeg liver

Centrilobular necrosis

Hepatic fibrosisin severe cases

8/12/2019 Edema Hyperemia Congestion

23/23