Normal body water distribution:Two compartments:
1. Intracellular – comprising of two- thirds of
total body fluid.
2. Extracellular – comprising of one- third of
total body fluid.
1. Interstitial compartment- 75%
2. Intra vascular compartment – 25%
Normal fluid exchange
are two ends for a capillary
1. Arteriolar end
2. Venous end
The pressure is high in the arteriolar end
then the venous end.Normally the fluid
moves out from the vessel in arteriolar
end into interstitial tissue. From
interstitial tissue same fluid moves back
into vessel at venous end.The small
amount of fluid which is left in interstitial
space is cleared by lymphatics.
Normal fluid pressures
1. Osmotic pressure
Is exerted by the chemical constituents of the
Eg. Electrolytes – crystalloid osmotic
proteins (albumin)- oncotic osmotic
2. Hydrostatic pressure
Pressure within the blood vessel.
accumulation of excessive fluid
in the interstitial spaces.
Classification of edema according to
distribution of fluid
involving one organ or part of the body.
2. Generalized edema
Involving the entire body- ANSARCA
Pathogenesis of edema:1.
Increased hydrostatic pressure
Increased permeability of the vessel
Decreased oncotic pressure
Sodium retention in the kidneys
Obstruction of lymph flow
1. Hydrostatic edema
from increased intra
vascular pressure (hydrostatic
2. Increased vascular
inflammation.Release of inflammatory
mediators like histamine, bradykinin,
PAF & others leads to increased
Other causes: Injury,
3.Decreased plasma oncotic
1.Decresed synthesis in the liver – end
stage liver disease.
2.Incresed loss in urine(nephrotic
syndrome) or stool (protein losing
Excessive salt intake with renal
Increased tubular reabsorption of
Increased renin-angiotensinaldosterone secretion
of the arm following surgical
resection of axillary lymph nodes
Edema of hand following post irradiation
TRANSUDATE & EXUDATE
Ultra filtrate of
Endothelial No changes
Non inflammatory Inflammatory
Volume Repletion Reaction
Goldman: Cecil Textbook of Medicine, 22nd ed.
Pitting & non pitting edema
is clinical terms for subcutaneous edema
Clinical Features of Oedema
Considerable quantities must accumulate before clinically
apparent (oedema can be assessed by weighing the
approx. 5 litres)
- gravitational distribution
- pitting oedema holds depression for a few minutes
- fluid retention
- generally distributed in C.T. puffy face/eyelids
- e.g. hydrothorax/ascites
- swollen; narrow sulci & flattened gyri
- prone to infection e.g. bronchopneumonia
extravasation of blood
due to rupture of vessel.
Classification based on origin
1. Cardiac- penetrating wound
rupture of ventricles in MI
2. Arterial – trauma
rupture of aneurysm
3. Capillary – trauma, surgery
4. Venous – trauma, surgery
Petechiae, Pupura, Ecchymoses
to the hemorrhage into the skin
Petechiae- pinpoint hemorrhage ( < 1mm)
Purpura- 1mm- 1cm in diameter
grossly visible accumulation of
extravasted blood in tissue.
First it is red, then as the blood is
deoxygenated it becomes dusky &
Body cavity hemorrhage
Hemothorax – accumulation of blood in
Hemopericardium – in pericardial cavity
Hemoperitonium – in peritonial cavity
Hemoarthrosis – in intra – articular space
Hematocephalus – in ventricles of brain
Is appearance of blood in urine.
1. Microscopic – detectable by
microscopic examination of urine.
2. Macroscopic – visible to naked eye
Hematuria signifies disease of kidney or
vomiting of blood.
Sign of esophageal & gastric
hemorrhage like rupture of esophageal
varices & peptic ulcer bleeding.
Sign of diseases in large intestine.
colored blood in stools.
Indicates bleeding in upper GIT.
Blood is partialy digested by HCLof
gastric juice & transformed into a black
pigment called hematein.This pigmentis
not digested in the intestines & is
passed in the feces.
Epistaxis & Hemoptysis
is bleeding from the nose.
Hemoptysis is bleeding from lungs.
Menorrhagia & Metrorrahagia
is heavy menstrual
Metrorrhagia occurs at any time & is
not related to menstrual cycle.
Effects of Hemorrhage
– brain, pericardium, pleural spac
of blood loss
• loss of > 20% of blood volume may cause
hypotension or hypovolemic shock
• hemoglobin concentration not altered
• volume loss compensated by shift of fluid from
extravascular to intravascular compartment
• hemoglobin concentration decreased
increase in volume of blood in a
Hyperemia is an “active process” , the
increased blood influx results from
Congestion, also known as “passive
hyperemia”, results due to stagnation of
blood because of venous obstruction.
2. Blushing – adrenergic stimulation
3. Exercise – incresed blood flow to the
Congestion:Obstruction of veins due to thrombi or
backward pressure due to heart failure.
Color of hyperemic & congested
tissue contains increased
amounts of oxygenated blood &
therefore the tissue appears bright red.
Congested tissue contains increased
amounts of deoxygenated blood &
Hyperemic tissue is warm, while
congested blood is cold & clammy.
Chronic venous congestion
CVC there is long standing there is
accumulation of deoxygenated blood &
hence there is damage to the tissue.
left heart failure
right heart failure
pressure into the
systemic venous system
CVC LIVER SPLEEN KIDNEY
Causes:Left heart failure
Gross :The lungs are heavy. Lungs appear
brown- BROWN INDURATION OF
Micro:Rupture of congested vessel results in
edema & hemorrhage. Lysis of RBC’s
releases hemosiderin pigment which is
taken up by macrophages – HEART
Causes:1. Right heart failure
2. Occlusion of inferior vena cava or
GROSS APPEARANCE:NUTMEG APPEARANCE – Alternate
areas of red & yellow .
CVC Liver (MICRO)
Blood fills up the central vein & sinusoids
around it. Followed by centrilobular
In the long standing cases the necrotic
area is replaced by fibrous tissue.
The areas with blood appears red &
areas with fibrosis appears whitish
yellow- NUTMEG APPEARANCE.
Causes:1. Right heart failure
2. Portal hypertension
GROSS:Spleen is enlarged & congested.
CVC Spleen (micro)
Red pulp appears congested.
GAMMA GANDY BODIES OR
SIDEROFIBROTIC NODULES:Deposits of hemosiderin & calcium salts
on fibrous tissue.
Gamma gandy bodies
Cause:1. Right heart failure
2. Obstruction of renal vein
Gross:Kidney is congested.