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HUMAN PATHOLOGY
EDEMA
AND
HAEMORRHAGE
PRESENTED BY:
GIRISH KUMAR. K
EDEMA
• EdemacomesfromGreekwordOIDEMAmeansSwelling.
• Edemaisusuallydefinedasabnormalandexcessiveaccumulationoffluidin
interstitialtissuespacesandserouscavities.
• Itisthenormalresponseofthebodytoinflammationorinjury.
E.g.:Twistedankle,beesting,skininfection.
• Insomecasesedemaisbeneficialsuchasaninfection.
Because,increasedfluidallowsmoreinfectionfightingWBCstoenter
theaffectedareas.
TYPES
1. Localised
2. Generalised
LOCALISED
Limitedtoanorganorlimb.
E.g.:Lymphaticedema
Inflammatoryedema.
GENERALISED
Systemicindistribution,particularly
noticeableinsubcutaneoustissue.
E.g.:Renaledema
Cardiacedema
EDEMA FLUID
•Dependinguponfluidcompositionedemafluidmaybeoffollowingtypes:
1.Transudate.(PROTEINPOOR)
2.Exudate.(PROTEINRICH)
TRANSUDATE EXUDATE
Filtrateofbloodplasmawithout
changesinendothelialpermeability.
E.g.:Cardiacedema
Edemaofinflamattedtissues
associatedwithincreased
vascularpermeability.
E.g.:Pus
PITTING AND NON-PITTING EDEMA
PITTING EDEMA NON-PITTING EDEMA
• When a pressure is applied to a small area, the
indentation persists even after the release of the
pressure. It is called as PITTING EDEMA.
• It is also known as Cutaneous edema.
• The type of edema in which the indentation made
by a pressure on the affected area does not persist.
It is called as NON-PITTING EDEMA.
PATHOGENESIS OF EDEMA
• Decreasedplasmaoncoticpressure
• Increasedplasmahydrostaticpressure
• Lymphaticobstruction
• Tissuefactor
• Increasedcapillarypermeability
• Sodiumandwaterretention
DECREASED PLASMA OSMOTIC PRESSURE
Reducedalbuminsynthesisinliver/proteinmalnutrition
↓
Fallinplasmaoncoticpressure
↓
Netmovementoffluidintointerstitialtissues
↓
EDEMA
INCREASED CAPILLARY HYDROSTATIC PRESSURE
Riseinhydrostaticpressureatthevenularendofcapillaries
toalevelmorethanplasmaoncoticpressure
↓
Minimal/Noreabsorptionoffluidatvenularend
↓
EDEMA
LYMPHATIC OBSTRUCTION
• Theinterstitialfluidinthetissuesspacesescapesbythewayoflymphatics.
Obstructionstooutflowofthesechannelscauseslocalisededemaknownas
LYMPHOEDEMA.
PULMONARY EDEMA
• Itisthefluidaccumulationintheairspacesandparenchymaoflungs.
• Causesimpairedgasexchangeandmaycauserespiratoryfailure.
• Itiseitherduetofailureofleftventricleofthehearttoadequatelyremoveblood
frompulmonarycirculation.
• ItcanresultfromeitherElevationofpulmonaryhydrostaticpressureorthe
increasedcapillarypermeability.
NUTRITIONAL EDEMA
•Theedemaduetonutritionaldeficiencyofprotein,vitaminsandchronic
alcoholismoccursonthelegs.
•Themaincontributionfactorsarehypoproteinaemiaandsodiumwater
retentionrelatedtometabolicabnormalities.
ProteinDeficiency–Kwashiorkor,Prolongedstarvation,Famine
Vitamins–beri-beri
KWASHIORKOR BERI-BERI
MYXOEDEMA
•Myxoedemafromhyperthyroidismisa
formofnon-pittingedemaoccurringon
skinoffaceandotherpartsofthebody
alsointheinternalorgansdueto
excessivedepositionof
glycosaminoglycanininterstitium.
CEREBRAL EDEMA
• Itistheswellingofbrainwithfluidaccumulation.Itisthemostthreateningexampleof
edema.
• Itisexcessaccumulationoffluidintheintracellularorextracellularspacesofthebrain.
• Cerebraledemacanresultfrombraintraumaorfromnon-traumaticcausessuchas
ischemicstroke,cancer,orbraininflammationduetomeningitisorencephalitis.
• Theareofthreetypes:
1.Vasogenicedema
2.Cytotoxicedema
3.Interstitialedema
HAEMORRHAGE
• BleedingistechnicallyknownasHAEMORRHAGE.
• Itistheescapeof bloodfromabloodvesselofthecirculatorysystem.
• Thebleedingmaybeexternalorinternal.
• External-Eitherthroughnaturalopeningsuchasmouth,nose,ear,urethra,vagina
oranusorthroughabreakintheskin.
• Internal-bloodleaksfrombloodvesselsinsidethebody
TYPES
ARTERIAL VENOUS CAPILLARY
ARTERIAL
•Brightred
•Emittedasspurtingjet
•Canleadtoseverebloodloss
•Oftenhardtocontrol
VENOUS
•Darkerred
•Steadyandcopiousflow
•Colorbecomesfurtherdarkerwithoxygendesaturation
•Usuallyeasytocontrol
CAPILLARY
•Brightred
•Rapidandoozing
•Bloodlossbecomesseriousifcontinuesforhours
•Generallyminor&easytocontrol
TIMING OF
HAEMORRHAGE
PRIMARY REACTIONARY SECONDARY
PRIMARY
•Occursatthetimeofsurgery
•Causeisinjurytovessels
•Maybearterial,venousorcapillary
•Morecommoninsurgeryonmalignancies
REACTIONARY
•Bleedingwithin24hours(usually4-6hrs.)ofsurgery
•Causeisslippingofligature,dislodgementofclotorcessation
ofreflexvasospasm
•Bleedstartswhenthereisariseinthearterialorvenous
pressure.
SECONDARY
•Occursafter7-14daysofsurgery
•Causeissloughingofvesselduetoinfection,pressurenecrosis
ormalignancy.
•1stawarningstainfollowedbyasuddenseverebleed
•Commonafterhemorrhoidssurgery,GIsurgery&
amputations.
EFFECTS
Theeffectsofbloodlossdependsuponthreemainfactors:
• Amountofbloodloss
• Thespeedofbloodloss
• Thesiteofbloodloss
Theofbloodupto20%haslittleclinicaleffects.
Thesuddenlossof33%ofbloodvolumemayleadtodeath.
CAUSES OF HAEMORRHAGE
• Bleedingariseseitherduetotraumaticinjuryorduetosomemedicalconditions.
• Traumaticbleedingiscausedbysometypeofinjury.Therearedifferenttypes
ofwoundswhichmaycausetraumaticbleeding.Theseinclude:
Abrasion(Transverseactionofforeignobjectsontheskin)
Excoriation(Mechanicaldestructiontotheskin)
Hematoma(Damagetothebloodvessels)
Incision(Cutintobodytissueororgan)
Puncturewound(Causedbyanobjectthatpenetratedtheskinandunderlyinglayers)
MEDICAL CONDITION
• Medicalbleeding'denoteshaemorrhageasaresultofanunderlyingmedicalcondition.Blood
canescapefrombloodvesselsasaresultof3basicpatternsofinjury.Theyare:
1. Intravascularchanges-changesofthebloodwithinvessels(e.g. bloodpressure,clotting
factors)
2. Intramuscularchanges–changesarisingwithinthewallsofbloodvessels
(e.g.dissections,AVMs)
3. Extravascularchanges-changesarisingoutsidebloodvessels(e.g. Brainabscess,brain
tumour)
Thank You!

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