上海交通大学：《诊断学》课程PPT教学课件（英语版）Basic Course of Diagnosis

Basic Course of Diagnosis Edema 水肿 Xiaoqi XU Renal Divison, Renji Hospital, Shanghai second Med Univ

Basic Course of Diagnosis – Edema – -水肿 -Xiaoqi XU Renal Divison, Renji Hospital, Shanghai Second Med.Univ

Definition a clinical apparent increase in the interstitial fluid volume Distribution: local general Special form: ascites hydrothorax

Definition ◼ A clinical apparent increase in the interstitial fluid volume. ◼ Distribution: local general ◼ Special form: ascites hydrothorax

athogenesis Total body water(TBW): 2/3 body weight intracellular 2 3 BW interstitial 3/4 extracellular 1/3 starling orce intravascular 1/4 Starling force depends on: hydrostatic pressure(静水压) colloid oncotic pressure(胶体渗透压)

Pathogenesis Total body water(TBW): 2/3 body weight TBW intracellular 2/3 extracellular 1/3 Interstitial 3/4 intravascular 1/4 starling force Starling force depends on : hydrostatic pressure(静水压) colloid oncotic pressure（胶体渗透压）

Pathogenesis Disturbed starling forces(reduced effective circulating volume, edema formation systemic venous pressure Increase right-sided heart failure, constrictive pericarditis local venous pressure increase left-sided heart failure, vena cava obstruction, portal vein obstruction reduced oncotic pressure nephrotic syndrome, decreased albumin synthesis combined disorders cirrhosis

◼ Disturbed starling forces(reduced effective circulating volume,edema formation) systemic venous pressure increase right-sided heart failure,constrictive pericarditis local venous pressure increase left-sided heart failure,vena cava obstruction, portal vein obstruction reduced oncotic pressure nephrotic syndrome,decreased albumin synthesis combined disorders cirrhosis Pathogenesis

Primary hormone excess (increased effective circulating volume) primary aldosteronism Cushing 's syndrome SIADH Primary renal sodium retention (increased effective circulating volume) renal failure SIADH: syndrome of inappropriate antidiuretic hormone production

◼ Primary hormone excess (increased effective circulating volume) primary aldosteronism Cushing ‘s syndrome SIADH ◼ Primary renal sodium retention (increased effective circulating volume) renal failure SIADH: syndrome of inappropriate antidiuretic hormone production

Capillary damage inflammation due to the bacteria infection, allergic reaction immune reaction Lymphatic obstruction

◼ Capillary damage inflammation due to the bacteria infection,allergic reaction,immune reaction ◼ Lymphatic obstruction

t Effeceive arteral volume EFferent arteriolar vasoconstncton 會 Aortic BP 4 Aortic oncatc prassure + Filtration fraction ↑ Peritubular capillary hydrostatic pressure + Peritubular cap ary oncotic pressure t Interstitial 4 Interstitial hydrostatic pressure oncotic pressure tIght junction +volume 4 Active NaCl permeat ty absorption absorption onwectwe Nac absorption 4 Net NaCl t Net organic solute +Net NaHCO3 absorption absorpti。n

Clinical causes of edema General edema: Congestive Heart Failure Nephrotic Syndrome and other Hypoalbuminemic States Cirrhosis Drug-Induced Idiopathic Edema

Clinical causes of edema General edema: ◼ Congestive Heart Failure ◼ Nephrotic Syndrome and Other Hypoalbuminemic States ◼ Cirrhosis ◼ Drug-Induced ◼ Idiopathic Edema

Localized edema Obstruction of venous(and lymphatic)drainage of a limb

Localized edema: ◼ Obstruction of venous (and lymphatic) drainage of a limb

Heart Ascites, other effusions, Malnutrition, hepatio A-V 1° nous obstruction synthesis, nephrotic Fistula Renal syndrome, G.l. loss failure Central venous and atrial press t Blood volume +oncome pre +Transudation t Plasma volume Cardiac outpul Renal Effective arterial asoconstriction bood volume +RPF +GFR +4 Renin foration fraction +Angiotensin ll Proximal tubular +GFR/Nephi reabsorption volume tubular Na+H2o reabsorption of Na and H2o Distal tubular Distal H2o Na reabsorption retention Renal retent on of Na and H2o A Plasma volu Interstit a + Transudation -I volum Edema