Edema and haemorrhage were presented. Edema is the abnormal accumulation of fluid in tissues, and can be localized or generalized. It can be transudate or exudate depending on protein content. Haemorrhage is bleeding from blood vessels. Bleeding can be arterial, venous, or capillary. Arterial bleeding is bright red and emitted in a jet; venous bleeding is darker and steady; capillary bleeding is bright red and oozing. Bleeding can be primary, reactionary, or secondary depending on timing relative to injury or surgery. The causes, effects, and types of edema and haemorrhage were described.

1. HUMAN PATHOLOGY
EDEMA
AND
HAEMORRHAGE
PRESENTED BY:
GIRISH KUMAR. K

2. EDEMA
• EdemacomesfromGreekwordOIDEMAmeansSwelling.
• Edemaisusuallydefinedasabnormalandexcessiveaccumulationoffluidin
interstitialtissuespacesandserouscavities.
• Itisthenormalresponseofthebodytoinflammationorinjury.
E.g.:Twistedankle,beesting,skininfection.
• Insomecasesedemaisbeneficialsuchasaninfection.
Because,increasedfluidallowsmoreinfectionfightingWBCstoenter
theaffectedareas.

3. TYPES
1. Localised
2. Generalised
LOCALISED
Limitedtoanorganorlimb.
E.g.:Lymphaticedema
Inflammatoryedema.
GENERALISED
Systemicindistribution,particularly
noticeableinsubcutaneoustissue.
E.g.:Renaledema
Cardiacedema

4. EDEMA FLUID
•Dependinguponfluidcompositionedemafluidmaybeoffollowingtypes:
1.Transudate.(PROTEINPOOR)
2.Exudate.(PROTEINRICH)
TRANSUDATE EXUDATE
Filtrateofbloodplasmawithout
changesinendothelialpermeability.
E.g.:Cardiacedema
Edemaofinflamattedtissues
associatedwithincreased
vascularpermeability.
E.g.:Pus

5. 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.

6. PATHOGENESIS OF EDEMA
• Decreasedplasmaoncoticpressure
• Increasedplasmahydrostaticpressure
• Lymphaticobstruction
• Tissuefactor
• Increasedcapillarypermeability
• Sodiumandwaterretention

7. DECREASED PLASMA OSMOTIC PRESSURE
Reducedalbuminsynthesisinliver/proteinmalnutrition
↓
Fallinplasmaoncoticpressure
↓
Netmovementoffluidintointerstitialtissues
↓
EDEMA

8. INCREASED CAPILLARY HYDROSTATIC PRESSURE
Riseinhydrostaticpressureatthevenularendofcapillaries
toalevelmorethanplasmaoncoticpressure
↓
Minimal/Noreabsorptionoffluidatvenularend
↓
EDEMA

9. LYMPHATIC OBSTRUCTION
• Theinterstitialfluidinthetissuesspacesescapesbythewayoflymphatics.
Obstructionstooutflowofthesechannelscauseslocalisededemaknownas
LYMPHOEDEMA.

10. PULMONARY EDEMA
• Itisthefluidaccumulationintheairspacesandparenchymaoflungs.
• Causesimpairedgasexchangeandmaycauserespiratoryfailure.
• Itiseitherduetofailureofleftventricleofthehearttoadequatelyremoveblood
frompulmonarycirculation.
• ItcanresultfromeitherElevationofpulmonaryhydrostaticpressureorthe
increasedcapillarypermeability.

12. NUTRITIONAL EDEMA
•Theedemaduetonutritionaldeficiencyofprotein,vitaminsandchronic
alcoholismoccursonthelegs.
•Themaincontributionfactorsarehypoproteinaemiaandsodiumwater
retentionrelatedtometabolicabnormalities.
ProteinDeficiency–Kwashiorkor,Prolongedstarvation,Famine
Vitamins–beri-beri

13. KWASHIORKOR BERI-BERI

14. MYXOEDEMA
•Myxoedemafromhyperthyroidismisa
formofnon-pittingedemaoccurringon
skinoffaceandotherpartsofthebody
alsointheinternalorgansdueto
excessivedepositionof
glycosaminoglycanininterstitium.

15. CEREBRAL EDEMA
• Itistheswellingofbrainwithfluidaccumulation.Itisthemostthreateningexampleof
edema.
• Itisexcessaccumulationoffluidintheintracellularorextracellularspacesofthebrain.
• Cerebraledemacanresultfrombraintraumaorfromnon-traumaticcausessuchas
ischemicstroke,cancer,orbraininflammationduetomeningitisorencephalitis.
• Theareofthreetypes:
1.Vasogenicedema
2.Cytotoxicedema
3.Interstitialedema

17. HAEMORRHAGE
• BleedingistechnicallyknownasHAEMORRHAGE.
• Itistheescapeof bloodfromabloodvesselofthecirculatorysystem.
• Thebleedingmaybeexternalorinternal.
• External-Eitherthroughnaturalopeningsuchasmouth,nose,ear,urethra,vagina
oranusorthroughabreakintheskin.
• Internal-bloodleaksfrombloodvesselsinsidethebody

18. TYPES
ARTERIAL VENOUS CAPILLARY

20. ARTERIAL
•Brightred
•Emittedasspurtingjet
•Canleadtoseverebloodloss
•Oftenhardtocontrol

21. VENOUS
•Darkerred
•Steadyandcopiousflow
•Colorbecomesfurtherdarkerwithoxygendesaturation
•Usuallyeasytocontrol

22. CAPILLARY
•Brightred
•Rapidandoozing
•Bloodlossbecomesseriousifcontinuesforhours
•Generallyminor&easytocontrol

23. TIMING OF
HAEMORRHAGE
PRIMARY REACTIONARY SECONDARY

24. PRIMARY
•Occursatthetimeofsurgery
•Causeisinjurytovessels
•Maybearterial,venousorcapillary
•Morecommoninsurgeryonmalignancies

25. REACTIONARY
•Bleedingwithin24hours(usually4-6hrs.)ofsurgery
•Causeisslippingofligature,dislodgementofclotorcessation
ofreflexvasospasm
•Bleedstartswhenthereisariseinthearterialorvenous
pressure.

26. SECONDARY
•Occursafter7-14daysofsurgery
•Causeissloughingofvesselduetoinfection,pressurenecrosis
ormalignancy.
•1stawarningstainfollowedbyasuddenseverebleed
•Commonafterhemorrhoidssurgery,GIsurgery&
amputations.

27. EFFECTS
Theeffectsofbloodlossdependsuponthreemainfactors:
• Amountofbloodloss
• Thespeedofbloodloss
• Thesiteofbloodloss
Theofbloodupto20%haslittleclinicaleffects.
Thesuddenlossof33%ofbloodvolumemayleadtodeath.

28. CAUSES OF HAEMORRHAGE
• Bleedingariseseitherduetotraumaticinjuryorduetosomemedicalconditions.
• Traumaticbleedingiscausedbysometypeofinjury.Therearedifferenttypes
ofwoundswhichmaycausetraumaticbleeding.Theseinclude:
Abrasion(Transverseactionofforeignobjectsontheskin)
Excoriation(Mechanicaldestructiontotheskin)
Hematoma(Damagetothebloodvessels)
Incision(Cutintobodytissueororgan)
Puncturewound(Causedbyanobjectthatpenetratedtheskinandunderlyinglayers)

29. 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)

30. Thank You!