上海交通大学：《诊断学》课程PPT教学课件（英语版）Chapter 9 Edema

Edema

Edema

Definition Clinically apparent increase in the interstitial 可质) fluid volume Weight gain precedes overt edema Weight loss in edematous patients before dry weight Massive edema is called anasarca

Definition • Clinically apparent increase in the interstitial (间质) fluid volume • Weight gain precedes overt edema • Weight loss in edematous patients before “dry weight” • Massive edema is called Anasarca

Edema Localized or generalized Generalized form puffiness(浮肿) of the face edema of periorbital areas Indentation of the skin"pitting edema 凹陷性水肿 Fluid may also accumulate in body cavities ascite(腹水) hydrothorax(胸水)

Edema • Localized or generalized • Generalized form: puffiness（浮肿） of the face edema of periorbital areas Indentation of the skin “pitting edema” 凹陷性水肿 • Fluid may also accumulate in body cavities ascite（腹水） hydrothorax (胸水）

Edema Pitting edema

Edema Pitting edema

Pathogenesis Reduced plasma osmotic pressure Capillary damage Reduction of effective arterial volume Reduced cardiac output Renal factors Renin-Angiotension-Aldosterone

Pathogenesis Reduced plasma osmotic pressure Capillary damage Reduction of effective arterial volume Reduced cardiac output Renal factors Renin-Angiotension-Aldosterone

Starling forces 1/3 body water: extracellular space plasma volume(25%) interstitial space(75%) Regulating the disposition of fluid between two compartment (Law of Capillaries) Vascular system Interstitial space Hydrostatic pressure (流体静水压) Hydrostatic pressure Colloid oncotic pressure (tissue tension) (胶体渗透压) Colloid oncotic pressure

Starling forces • 1/3 body water: extracellular space plasma volume (25% ) interstitial space (75% ) • Regulating the disposition of fluid between two compartment (Law of Capillaries) Vascular system Interstitial space Hydrostatic pressure （流体静水压） Hydrostatic pressure Colloid oncotic pressure (tissue tension) （胶体渗透压） Colloid oncotic pressure

To thoracic duct and eventually Homeostasis is to left subclavian vein maintained by the opposIng eftects of vascular hydrostatic pressure and pl asmi Increased interstitial colloid osmotic Hydrostatic pressure Huid oressure pressure Plasma coloid osmotic pressure Arterial end CAPILLARY BED Venous end Ficure 4-1

Reduced plasma Osmotic pressure Vascular system Interstitial space Hydrostatic pressure Hydrostatic pressure Colloid oncotic pressure tissue tension Colloid oncotic pressure

Reduced Plasma Osmotic Pressure Vascular system Interstitial space Hydrostatic pressure Hydrostatic pressure Colloid oncotic pressure (tissue tension) Colloid oncotic pressure

Reduced plasma Osmotic pressure Albumin is the serum protein MOst responsible for the maintenance of colloid osmotic pressure (胶体渗透压) a decrease in osmotic pressure can result from increased protein loss or decreased protein synthesis Increase in capillary pressure may be due to congestive heart failure

Reduced Plasma Osmotic Pressure Albumin is the serum protein MOST responsible for the maintenance of colloid osmotic pressure (胶体渗透压） A decrease in osmotic pressure can result from increased protein loss or decreased protein synthesis Increase in capillary pressure may be due to congestive heart failure

Capillary damage Damage to the capillary endothelium(内皮) ncrease its permeability and permits the transfer of protein into interstitial compartment ° Injury agents D Viral/bacterial agents Thermal/mechanical trauma Immune Responsible for inflammatory edema Nonpitting localized redness and tenderness

Capillary Damage • Damage to the capillary endothelium(内皮) • Increase its permeability and permits the transfer of protein into interstitial compartment • Injury agents Drugs Viral/bacterial agents Thermal/mechanical trauma Immune • Responsible for inflammatory edema • Nonpitting localized redness and tenderness