6. PATHOGENESIS OF EDEMA
1) Capillary permeability
2) Hydrostatic pressure of intracapillary fluid
3) Oncotic pressure of intracapillary fluid
4) Oncotic pressure of interstitial fluid
5) Tissue resistance
6) Lymphatic drainnage
7) Renal hormonal factors
8) Atrial natriüretic peptide
6
7. 7
Capillary permeability
Water, electrolytes,gases – Diffusion
Proteins - Filtration
Chemical, bacterial, thermal, mechanical factors
may cause the increasing of permeability
– inflamatory edema / angioedema
8. 8
Hydrostatic pressure:
It forces the blood fluid pass into the tissues
through the capillary wall.
It is 32 mmHg at the arteriolar end of the
capillary, and 12 mmHg at the venule hand.
9. 9
Oncotic pressure:
Formed by plasma proteins (especially albumin)
It tries to keep the fluid in the capillary
The oncotic pressure of the capillary is 24 mmHg.
10. 10
Plasma protin content > İnterstitial protein content →
Plasma oncotic pressure > ınterstitial oncotic pressre
Effective oncotic pressure = Plasma oncotic pressure –
Interstitium oncotic pressure
Effective oncotic pressure decreases:
- As the decreasing of plasma oncotic pressure
( cirrhosis, malnutrition, nephrotic syndrome, protein
loosing ent.)
- As the increasing of interstitium oncotic pressure
(Increasing of permeability – inflamatory / allergy)
11. 11
Arteriolar end: Hydrostatic pressure > Oncotic pressure
⇒ Fluid passes into interstitium
Venule end: Oncotic pressure > Hydrostatic pressure
⇒ Fluid returns capillary bed
* The increase of pressure at the venule end ⇒Fluid
cannot return capillary and stay at the interstitium
12. 12
Oncotic pressure of the interstitium:
The amount of protein is nearly 0.3 % g / dl
and it is not so important
13. 13
Lymph drainege:
Some of the fluid in the interstitium and a few
amount of protein diffused into interstitium is carried
by lymph vessels. Obstruction of the vessels causes
edema.
14. 14
RENAL HORMONAL MECHANISM
Decreasing of stroke volume
Increasing of ADH Decreasing of kidney blood perfusion
Reabsorbtion of water Poor perfusion of juxta glomerular
in tubules of kidneys aparatus
Secretion of renin
16. 16
Angiotensin II:
1) Causes vasoconstriction
2) Increases the secretion of aldosteron from adrenal
gland ( seconder hyperaldosteronism) – İncreases
sodium reabsorbtion in distal tubules
17. 17
-Secreted by the secretory granules in the atrium
-Secretion is stimulated by atrial enlargement ( plasma volume
increases)
-Increases diuresis and sodium output.
-Causes vasodilatation
-Inhibits renin and angiotensin release
19. Disseminated Edema
Edema due to cardiac failure
Nephritic edema
Nephrotic edema
Edema caused by liver failure
Nutritional edema (inadequate intake)
Protein loss through gastrointestinal system
Edema due to endocrine pathologies
Edema during pregnancy
19
20. Local edema
- Traumatic
- Inflammatory edema
- Obstriction of venous circulation
- Thrombophlebitis
- Compression of veins
-Lymphatic edema
-Angioneurotic edema
20
21. 21
- Blood volume per minute decreases ⇒ Water is
conserved by renal and hormonal mechanisms
- Hydrostatic pressure increases
22. 22
Mild and hard edema is seen in acute glomerulonephritis
Glomerular filtration decreases, but tubular reabsorbtion is
not disturbed. (glomerulotubular inbalance)
Capillaritis (generalized capillary disorder)
23. 23
-It is very soft and in anasarca type
-Low oncotic pressure due to protein loss
-Secondary hyperaldosteronism
24. Cirrhotic Edema
It is usually seen with ascites
Albumin synthesis in liver decreases
Some blood proteins are excreted in feces due to
portal hypertension
Aldosteron breakdown in liver decreases ;
secretion by adrenal gland increases (secondary
hyperaldosteronism)
24
28. 28
Due tu increased permeability
- Microorganisms
- Connective tissue disorders
29. Venous Edema
Thrombophlebitis: Local inflamations cause
thrombus ⇒ venous obstriction
-Large and hard edema
- Erythema, hotness,pain
Compression of veins
-Ganglion, tumor,ascites
Edema related to varices
High hydrostatic pressure in veins
29
30. Lymphatic Edema
Due to obstruction of lymph vessels,plasma proteins
cannot be taken from the interstitium
30
31. 31
Vessels insubcutaneous tissue enlarge due to local
histamine discharge and extravasation from
capillaries occurs
-Food allergy -Drug allergy
-Infections -Emotional