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Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
Body fluids and edema by Dr. Irum
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Body fluids and edema by Dr. Irum

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  • 1.  
  • 2. The physiology of edema. By Dr Irum Junaid
  • 3. Body Fluid Distrbution
    • Total body water(TBW): 2/3 body weight
    TBW intracellular 2/3 extracellular 1/3 Interstitial 3/4 intravascular 1/4 starling force
  • 4. Body Fluid Compartments Copyright 2009, John Wiley & Sons, Inc.
  • 5.  
  • 6.
    • Functions of Fluids
        • Body fluids:
          • Facilitate in the transport [nutrients, hormones, proteins, & others…]
          • Aid in removal of cellular metabolic wastes
          • Provide medium for cellular metabolism
          • Regulate body temperature
          • Provide lubrication of musculoskeletal jts.
          • Component in all body cavities [parietal, pleural… fluids]
    • Water is the principal body fluid & essential for life.
  • 7. Edema
    • Edema refers to the presence of excess fluid in the body tissues.
    • It is abnormal accumulation of fluid beneath the skin or in one or more cavities of the body.
    • Types
    • It can be intracellular or extracellular
  • 8. Intracellular Edema
    • Hyponatremia
    • Depression of tissue metabolic systems
    • (e.g. hypothyroidism)
    • Inadequate tissue nutrition
    • (e.g. ischemia)
    • Inflammation of tissues (increased cell
    • membrane permeability)
  • 9.
    • Increased interstitial fluid volume
    • Increased Capillary Filtration
    • Failure of lymphatics to return interstitial fluid to circulation
    Extracellular Edema
  • 10. Determinants of Capillary Filtration Capillary Pressure (P c ) Plasma Colloid Osmotic Pressure ( π c ) Interstitial Fluid Pressure ( P if ) Interstitial Colloid Osmotic Pressure ( π if ) K f FILT = K f (P c - P if - π c + π if )
  • 11. Causes of Increased Capillary Filtration FILT = K f (P c - P if - π c + π if ) Increased K f : Toxins, ischemic damage, infections, etc. Increased Pc:
    • Increased arterial pressure, excess fluid retention,
    • Decreased arteriolar resistance
    • Increased venous resistance, increased venous pressure
    Decreased π c :
    • Nephrotic syndrome
    • Cirrhosis
    • Malnutrition
    • Burns
  • 12.  
  • 13. “ PRINCIPALES OF EQUILIBRIUM OF FORCES ACROSS CAPILLARIES ”
    • MEAN FORCES TENDING TO MOVE FLUID OUTWARD.
    • MEAN CAPILLARY HYDROSTATIC PRESSURE 17.3
    • NEGATIVE INTERSTITIAL FREE FLUID PRESSURE 3.0
    • INTERSTITIAL FLUID COLLOID OSMOTIC PRESSURE 8.0
    • TOTAL OUTWARD FORCE 28.3
  • 14. “ PRINCIPALES OF EQUILIBRIUM OF FORCES ACROSS CAPILLARIES ”
    • MEAN FORCE TENDING TO MOVE FLUID INWARD.
    • PLASMA COLLOID OSMOTIC PRESSURE 28.0
    • TOTAL INWARD FORCE 28.0
  • 15. “ PRINCIPALES OF EQUILIBRIUM OF FORCES ACROSS CAPILLARIES ”
    • SUMMATION OF MEAN FORCES
    • OUTWARD 28.3
    • INWARD -28.0
    • NET OUTWARD FORCE ----------- 0.3
  • 16. Normal Filtration FILT = K f x Net Filt Pressure = 6.6 x ( 17.3 - (-3) - 28 +8) = 6.6 x ( + 0.3) = 1.89 ml/min FILT = 2722 ml/day Where does all of this fluid (and protein in it) go? FILT = K f (P c - P if - π c + π if )
  • 17.  
  • 18.  
  • 19.  
  • 20.  
  • 21. Figure 25-1; Guyton and Hall
    • Lymphatic
    • Failure = Edema
    • Causes :
    • Infections
    • Filarial nematodes
    • Surgery
    • Removal of lymph nodes
    Lymphatic Failure and Edema X
  • 22. Conditions Causing Edema
    • 1. High capillary hydrostatic pressure
      • Excess fluid retention by kidneys
      • acute or chronic kidney failure
      • glomerulonephritis
      • mineralocorticoid excess
  • 23.
    • 1. High capillary hydrostatic pressure (cont’d)
      • Decreased arteriolar resistance
      • - vasodilator drugs
      • - autonomic insufficiency
      • Increased venous pressure
      • - congestive heart failure
      • - high output heart failure (e.g. anemia)
      • - venous obstruction
      • - venous valve failure
      • - cirrhosis
  • 24.
    • 2. Decreased plasma proteins
    • (low oncotic pressure)
      • Loss of proteins
    • - burns, wounds
    • - nephrosis
    • - gastroenteropathy
      • Failure to produce proteins
    • - malnutrition (“kwashiorkor”)
    • - cirrhosis
    • - analbuminemia
  • 25.
    • 3. Increased capillary permeability
      • Immune reactions (histamine)
      • Toxins
      • Burns
      • Prolonged ischemia
      • Vitamin deficiency (e.g. vitamin C)
      • Pre-eclampsia and eclampsia in
    • pregnancy
  • 26.
    • 4. Blockage of lymphatics
      • Cancer
      • Surgery
      • Infections (e.g. filarial nematodes)
      • Congenital absence or abnormality of lymphatic vessels
    Conditions Causing Edema
  • 27. Safety Factors Against Edema
    • Low compliance of interstitium when = 3 mmHg
    • interstitial fluid pressure is negative
    • Increased lymph flow = 7 mmHg
    • “ Wash-down” of interstitial protein = 7 mmHg
    • at high lymph flow rates
    Total Safety factor = 17 mmHg
  • 28. I. Low Tissue Compliance and Negative Interstitial Fluid Hydrostatic Pressure Interstitial Volume Interstitial Fluid Hydrostatic Pressure Capillary Filtration
  • 29. Interstitial Fluid Volume (liters) Interstitial Fluid Pressure (mmHg) Free Fluid Gel Fluid Low compliance High Compliance Copyright © 2006 by Elsevier, Inc. - 8 - 4 0 + 4 12 24 36 48 60 0
  • 30. Importance of Interstitial Gel in Preventing Fluid Accumulation in the Interstitium.
    • The fluid is bound in a proteoglycan meshwork so there are no “free” fluid spaces larger than a few hundredths of a micrometer in diameter.
    • Secondly, when the interstitial fluid pressure falls to very negative values, the gel does not contract greatly.
    • Thus, the compliance of the tissues is very low in the negative pressure range.
  • 31. Interstitial Fluid Volume (liters) Interstitial Fluid Pressure (mmHg) Free Fluid Gel Fluid Low compliance High Compliance Copyright © 2006 by Elsevier, Inc. - 8 - 4 0 + 4 12 24 36 48 60 0
  • 32.
    • Pitting edema
    • The brush pile of proteoglycan filaments is pushed apart.
    • Non-pitting edema
    • Tissue cells swell instead of the interstitium or
    • When the fluid in the interstitium becomes clotted with fibrinogen so that it cannot move freely within the tissue spaces.
  • 33.
    • The proteoglycan filaments act as a “spacer” for the cells and prevent rapid flow of fluid in the tissues.
    • However, the usual diffusion of nutrients to the cells and the removal of waste products from the cells are not compromised by the proteoglycan filaments of the interstitium.
  • 34. II. Increased Lymph Flow Interstitial Volume Interstitial Fluid Hydrostatic Pressure Lymph Flow
  • 35. Lymph Flow ( x normal) 20 10 1 - 6 - 4 - 2 0 2 4 Interstitial Fluid Pressure ( mmHg) Effect of Interstitial Fluid Pressure on Lymph Flow
  • 36. III. “Wash-down” of Interstitial Fluid Proteins Interstitial Volume Interstitial Fluid Oncotic Pressure Capillary Filtration Interstitial Fluid Hydrostatic Pressure Lymph Flow Protein Removal From Tissues
  • 37. 2 4 6 8 0 Plasma Protein Concentration Rate of Non-Visceral Lymph Flow (ml/hr) Interstitial Fluid Protein concentration (gm/100 ml) Wash-down of Interstitial Proteins 0 20 40 60 80 100 120 140 160 180
  • 38. Safety Factors Against Edema
    • Low compliance of interstitium when= 3 mmHg
    • interstitial fluid pressure is negative
    • Increased lymph flow = 7 mmHg
    • “ Wash-down” of interstitial protein = 7 mmHg
    • at high lymph flow rates
    Total Safety factor = 17 mmHg
  • 39. Hydrostatic pressure:
    • Intra-capillary vs interstitial pressure:
    • Capillary pressures vary:
    • Interstitial hydrostatic pressure:
    • Varies from one organ to another:
    • Subcutaneous tissue: Subatmospheric (-2 mmHg)
    • Liver, kidney: +
    • Brain: As high as 6 mmHg
    • Hydrostatic pressure gradient:
    • Intra-capillary hydrostatic pressure – interstitial fluid hydrostatic pressure
  • 40. Organ specific:
    • Brain: Cerebral edema
    • Lung: Intra-alveolar=pulmonary edema, intra-pleural=pleural effusion
    • Peritoneum=ascites
    • Severe generalized edema=anasarca
  • 41.  

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