Edema Zhao Mingyao.ZZU. Dayu Nuo Ya square boat 1.Concept A large amount of body fluid accumulates...

Edema

Zhao Mingyao.ZZU

Dayu

Nuo Ya square boat

1.Concept A large amount of body fluid accumulates in

the interstitial space (interstitial fluid↑)

interstitial space Cell 60% of

body weight)

fluidbloodvessel

Soft tissue swelling due to expansion of the interstitial volume

A large amount of body fluid accumulates in the interstitial space

(interstitial fluid↑)

Edema

Distinguish concepts

• Edema

• Hydrops

• Cellular edema

Cause, site, type, formation, feature, impact, treatment

Edema

Does the body weight certainly increase in all type of edema?

2.Pathogenesis

(1) Disturbance of Transcapillary Fluid Exchange

(2) Sodium and Water Retention

Formation of interstitial fluid

back-flowreview

Formation > back-flow (for interstitial fluid )

1. Capillary blood pressure↑

2. Plasma colloid osmotic pressure↓

3. Capillary wall permeability↑

4. Obstruction of lymphatic flow

(1) Disturbance of Transcapillary Fluid Exchange

Filariasis Filariasis

↑Capillary Hydrostatic Pressure

Reabsorption of salt

(2) Sodium and Water Retention

① GFR↓

② Reabsorption↑

of renal tubule

① Glomerular filtration rate (GFR) ↓

afferentarteriole

efferentarteriole

Renal glomerulu

proximal tubule

Bowman's space

Primary ↓: renal failure

Second ↓: ECBV ↓

② Reabsorption↑of Na+ and H2O

ⅰ. ADS ↑& ADH ↑ ⅱ. ANF 、 kinin 、 PGE ↓ ⅲ. Redistribution of renal blood flowⅳ. Filtration fraction↑

Atrial natriuretic factor

Cortical nephrons

proximal medullary nephrons

Redistribution of renal blood flow

Collectingtubules

sympathetic nerve excitation ↑↑

Reabsorption ↑↑

Filtration fraction↑

FF = GFR/ renal plasma flow

efferent arteriole contraction > afferent arteriole contraction

afferentarteriole

efferentarteriole

Renal glomerulu

proximal tubule

Bowman's space

3. Treatment of edema

① First, treat the underlying disease

②Decrease Na+ intake, either dietary or intravenous

③Increase excretion of sodium and water

a. Diuretics - remember, these are palliative, not curative.

b. Bed rest, local pressure

neither begin nor end with the administration of diuretics.

• Why , sometimes, can`t we get satisfied effects when treat some systemic edema (anasarca) with diuretics, but use albumin to get well result?

Question

Thanks