The document discusses various types of hemodynamic disorders and edema. It describes how edema can be caused by increased hydrostatic pressure, decreased plasma oncotic pressure, inflammation, and lymphatic obstruction. The most common cause of generalized edema is congestive heart failure, which increases hydrostatic pressure through elevated central venous pressure and decreases renal perfusion. Other causes mentioned include nephrotic syndrome, cirrhosis, and protein malnutrition. The key organs involved in fluid homeostasis are the heart, liver, and kidneys.

1. Hemodynamic Disorders,Hemodynamic Disorders,
Thrombosis &Thrombosis &
ShockShock
 Edema
 Hyperemia and Congestion
 Hemorrhage
 Hemostasis & Thrombosis
 Embolism
 Infarction
 Shock
• EdemaEdema

2. EDEMAEDEMA
Fluid extravasations andFluid extravasations and
accumulation in theaccumulation in the
interstitial spacesinterstitial spaces

3. EDEMAEDEMA
Increased fluid in theIncreased fluid in the interstitial tissue spacesinterstitial tissue spaces
 Fluid may also accumulate in body cavities:body cavities:
1.1. HydrothoraxHydrothorax
2.2. HydropericardiumHydropericardium
3.3. Hydroperitoneum is also calledHydroperitoneum is also called AscitesAscites

Massive generalized edema is calledMassive generalized edema is called AnasarcaAnasarca

4. Fluid HomeostasisFluid Homeostasis
Homeostasis is maintained byHomeostasis is maintained by
thethe opposing effectsopposing effects of:of:
1.1. Vascular HydrostaticVascular Hydrostatic
PressurePressure
andand
2.2. Plasma Colloid OsmoticPlasma Colloid Osmotic
PressurePressure
Lymphatics

5. Edema Fluid = TRANSUDATEEdema Fluid = TRANSUDATE
 A transudatetransudate is protein-poor (specific gravity <1.012)
 An exudateexudate is protein-rich (specific gravity >1.020)
= (inflammatory edema)(inflammatory edema)

6. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Others
I. Increased Hydrostatic Pressure

7. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
Increased Hydrostatic PressureIncreased Hydrostatic Pressure
1. Due to impaired venous returnvenous return
A)A) Localized:Localized:
 Venous Thrombosis
A)A) Generalized:Generalized:
 Congestive Heart Failure
2. Due o increased arteriolar dilatationarteriolar dilatation

8. Increased Hydrostatic PressureIncreased Hydrostatic Pressure
Congestive Heart Failure:Congestive Heart Failure:
““Generalized increaseGeneralized increase in venous pressure,
with resultant SYSTEMIC EDEMASYSTEMIC EDEMA occurs
MOST COMMONLYMOST COMMONLY inin CONGESTIVE HEART FAILURE”CONGESTIVE HEART FAILURE”
{*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to{*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to
Increased Hydrostatic Pressure}Increased Hydrostatic Pressure}

9. Congestive Heart FailureCongestive Heart Failure
Overall, there are TWO main effects...
1. Increased Central Venous Pressure
2. Decreased Renal Perfusion

10. Increased Hydrostatic PressureIncreased Hydrostatic Pressure::
Congestive Heart FailureCongestive Heart Failure
Mechanism:Mechanism:
 The Pump is FAILING!!!  ↓ Cardiac output
 Blood backs up, first into the lungs
 then into the venous circulation
 increasing Central Venous Pressure (CVP)
 increased capillary pressure (Hydrostatic Pressure)increased capillary pressure (Hydrostatic Pressure)
 Leading to EdemaEdema

11. Congestive Heart Failure:Congestive Heart Failure:
& Decreased Renal Perfusion& Decreased Renal Perfusion
 Congestive heart failure 
Decreased Cardiac OutputDecreased Cardiac Output 
Decreased ARTERIAL blood volume 
“Less arterial blood…Less renal perfusion...
The Kidney doesn’t see enough blood coming
through …….

12. Congestive Heart Failure:Congestive Heart Failure:
& Decreased Renal Perfusion& Decreased Renal Perfusion
Decreased Renal Perfusion activates
the Renal Defense Mechanisms:Renal Defense Mechanisms:
1. Renin-Angiotensin-Aldosterone axis 
↑↑ Na & H2O retentionNa & H2O retention
2. Renal Vasoconstriction
3. Increased Renal Anti-diuretic Hormone (ADH)

13. Congestive Heart Failure -Congestive Heart Failure - SummarySummary
Central
Venous
Pressur
e
Renal
Perfusion
Renin
Renal
Vasoconstriction
ADH

14. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Other
II. Reduced Plasma Oncotic PressureII. Reduced Plasma Oncotic Pressure

15. Reduced PlasmaReduced Plasma
Osmotic PressureOsmotic Pressure
 “…“…AlbuminAlbumin::
is the serum protein MOST responsible for theis the serum protein MOST responsible for the
maintenance ofmaintenance of colloid osmotic pressure.”colloid osmotic pressure.”
 A decrease in osmotic pressuredecrease in osmotic pressure can result from:
1.  Protein Loss
oror
22  Protein Synthesis

16. Reduced PlasmaReduced Plasma
Osmotic PressureOsmotic Pressure
1.1. Increased albumin loss:Increased albumin loss:
 Nephrotic Syndrome
 Increased permeability of the glomerular capillary wall 
loss of protein
2.2. Reduced albumin synthesisReduced albumin synthesis
 Cirrhosis
 Protein malnutrition

17. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Other
III. InflammationIII. Inflammation

18. Pathophysiologic Categories of EdemaPathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. OthersIV. OthersIV. Others::
- Lymphatic Obstruction
- Sodium & water retention

19. Lymphatic ObstructionLymphatic Obstruction
 Impaired lymphatic drainage with resultant
lymphedemalymphedema
 usually localized
 usually due to:
 INFLAMMATIONINFLAMMATION
or
 NEOPLASTIC OBSTRUCTIONNEOPLASTIC OBSTRUCTION

20. Lymphatic ObstructionLymphatic Obstruction
 FilariasisFilariasis –
 A parasitic infection affecting
inguinal lymphatics resulting
in elephantiasis

21. Lymphatic ObstructionLymphatic Obstruction
NeoplasticNeoplastic
 Resection and/or radiation to axillary lymphatics in
breast cancer patients can lead to -- arm edemaarm edema
 Carcinoma of breast with obstruction of superficial
lymphatics can lead to edema of breast skin -- --with an
unusual appearance:
““peau d’orange” (orange peel)peau d’orange” (orange peel)

22. EDEMA -EDEMA - SummarySummary
INCREASED
HYDROSTATIC
PRESSURE
Congestive Heart Failure
Ascites
Venous Obstruction
DECREASED
ONCOTIC
PRESSURE
Nephrotic Syndrome
Cirrhosis
Protein Malnutrition
INCREASED
PERMEABILITY
Inflammation
LYMPHATIC
OBSTRUCTION
Inflammatory
Neoplastic
 HEART
 LIVER
 KIDNEY

23. GENERALIZED EDEMAGENERALIZED EDEMA
 HEART
 LIVER
 KIDNEY

24. EdemaEdema
MorphologyMorphology
 Dependent EdemaDependent Edema is a prominent
feature of Congestive Heart Failure
 Facial EdemaFacial Edema is often the initial
manifestation of Nephrotic
Syndrome
Subcutaneous EdemaSubcutaneous Edema
 Edema of the subcutaneous tissue is most easily detected GrosslyGrossly (not
microscopically)
 Push your finger into it
 and a depression remains

25. EdemaEdema
Clinical Correlation:Clinical Correlation:
Subcutaneous EdemaSubcutaneous Edema
 Annoying but Points to Underlying Disease
 However, it can impair wound healing orit can impair wound healing or
clearance of Infectionclearance of Infection

26. EdemaEdema
MorphologyMorphology
Pulmonary EdemaPulmonary Edema
is most frequently seen in Congestive Heart FailureCongestive Heart Failure
 May also be present in renal failure, adult respiratory
distress syndrome (ARDS), pulmonary infections and
hypersensitivity reactions

27. Pulmonary EdemaPulmonary Edema
Gross:Gross:
 The Lungs are typically 2-3 times the normal weight
 Cross sectioning causes an outpouring of frothy,outpouring of frothy,
sometimes blood-tinged fluidsometimes blood-tinged fluid

28. Pulmonary Edema
Normal

29. EdemaEdema
Clinical Correlation:Clinical Correlation:
Pulmonary EdemaPulmonary Edema
 May cause deathdeath by interfering with Oxygen and
Carbon Dioxide exchange
 Creates a favorable environment for infectioninfection
 THINK it resembles “Culture Media”!!!

30. Edema of the BrainEdema of the Brain
 Trauma, Abscess, Neoplasm, Infection
(Encephalitis due to say… West Nile Virus), etc

31. Clinical Correlation:Clinical Correlation:
Edema of the BrainEdema of the Brain
 The big problem is: There is no place for the fluid to go!
 Herniation into the foramen magnum will kill