Edema
Zhao Mingyao.ZZU
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