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Hemodynamic Disorders, Thrombosis & Shock Edema Hyperemia and Congestion Hemorrhage Hemostasis & Thrombosis Embolism Infarction Shock Edema Edema.

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Presentation on theme: "Hemodynamic Disorders, Thrombosis & Shock Edema Hyperemia and Congestion Hemorrhage Hemostasis & Thrombosis Embolism Infarction Shock Edema Edema."— Presentation transcript:

1 Hemodynamic Disorders, Thrombosis & Shock Edema Hyperemia and Congestion Hemorrhage Hemostasis & Thrombosis Embolism Infarction Shock Edema Edema

2 EDEMA Fluid extravasations and accumulation in the interstitial spaces

3 EDEMA Increased fluid in the interstitial tissue spaces body cavities: Fluid may also accumulate in body cavities: 1. Hydrothorax 2. Hydropericardium 3. Hydroperitoneum is also called Ascites Massive generalized edema is called Anasarca Massive generalized edema is called Anasarca

4 Fluid Homeostasis Homeostasis is maintained by the opposing effects of: 1.Vascular Hydrostatic Pressure and 2.Plasma Colloid Osmotic Pressure Lymphatics

5 Edema Fluid = TRANSUDATE transudate A transudate is protein-poor (specific gravity <1.012) exudate (inflammatory edema) An exudate is protein-rich (specific gravity >1.020) = (inflammatory edema)

6 Pathophysiologic Categories of Edema I.Increased Hydrostatic Pressure II.Reduced Plasma Oncotic Pressure III.Inflammation IV.Others I.Increased Hydrostatic Pressure

7 Pathophysiologic Categories of Edema Increased Hydrostatic Pressure Increased Hydrostatic Pressure venous return 1. Due to impaired venous return A) Localized:  Venous Thrombosis B) Generalized:  Congestive Heart Failure arteriolar dilatation 2. Due o increased arteriolar dilatation

8 Increased Hydrostatic Pressure Congestive Heart Failure: “Generalized increase “Generalized increase in venous pressure, SYSTEMIC EDEMA with resultant SYSTEMIC EDEMA occurs MOST COMMONLY in CONGESTIVE HEART FAILURE” {*** Thus, Congestive Heart Failure is the most common cause of EDEMA due to Increased Hydrostatic Pressure}

9 Congestive Heart Failure Overall, there are TWO main effects Increased Central Venous Pressure 2. Decreased Renal Perfusion

10 Increased Hydrostatic Pressure: Congestive Heart Failure Mechanism: The Pump is FAILING!!!   Cardiac output Blood backs up, first into the lungs  then into the venous circulation  increasing Central Venous Pressure (CVP) increased capillary pressure (Hydrostatic Pressure)  increased capillary pressure (Hydrostatic Pressure) Edema Leading to Edema

11 Congestive Heart Failure: & Decreased Renal Perfusion Congestive heart failure  Decreased Cardiac Output Decreased Cardiac Output  Decreased ARTERIAL blood volume  “Less arterial blood…Less renal perfusion... The Kidney doesn’t see enough blood coming through …….

12 Congestive Heart Failure: & Decreased Renal Perfusion Decreased Renal Perfusion activates Renal Defense Mechanisms: the Renal Defense Mechanisms: 1. Renin-Angiotensin-Aldosterone axis   Na & H2O retention 2. Renal Vasoconstriction 3. Increased Renal Anti-diuretic Hormone (ADH)

13 Congestive Heart Failure - Summary Central Venous Pressure Renal Perfusion Renin Renal Vasoconstriction ADH

14 Pathophysiologic Categories of Edema I.Increased Hydrostatic Pressure II.Reduced Plasma Oncotic Pressure III.Inflammation IV.Other II. Reduced Plasma Oncotic Pressure

15 Reduced Plasma Osmotic Pressure “…Albumin: “…Albumin: is the serum protein MOST responsible for the maintenance of colloid osmotic pressure.” decrease in osmotic pressure A decrease in osmotic pressure can result from: 1.  Protein Lossor 2.  Protein Synthesis

16 Reduced Plasma Osmotic Pressure 1. Increased albumin loss: Nephrotic Syndrome Increased permeability of the glomerular capillary wall  loss of protein 2. Reduced albumin synthesis Cirrhosis Protein malnutrition

17 Pathophysiologic Categories of Edema I.Increased Hydrostatic Pressure II.Reduced Plasma Oncotic Pressure III.Inflammation IV.Other III. Inflammation

18 Pathophysiologic Categories of Edema I.Increased Hydrostatic Pressure II.Reduced Plasma Oncotic Pressure III.Inflammation IV.Others IV. Others : - Lymphatic Obstruction - Sodium & water retention

19 Lymphatic Obstruction lymphedema Impaired lymphatic drainage with resultant lymphedema usually localized usually due to: INFLAMMATION INFLAMMATION or NEOPLASTIC OBSTRUCTION NEOPLASTIC OBSTRUCTION

20 Lymphatic Obstruction Lymphatic Obstruction Filariasis Filariasis – A parasitic infection affecting inguinal lymphatics resulting in elephantiasis

21 Lymphatic Obstruction Neoplastic arm edema Resection and/or radiation to axillary lymphatics in breast cancer patients can lead to -- arm edema Carcinoma of breast with obstruction of superficial lymphatics can lead to edema of breast skin -- --with an unusual appearance: “peau d’orange” (orange peel)

22 EDEMA - Summary INCREASED HYDROSTATIC PRESSURE Congestive Heart Failure Ascites Venous Obstruction DECREASED ONCOTIC PRESSURE Nephrotic Syndrome Cirrhosis Protein Malnutrition INCREASED PERMEABILITY Inflammation LYMPHATIC OBSTRUCTION Inflammatory Neoplastic HEART LIVER KIDNEY

23 GENERALIZED EDEMA HEART LIVER KIDNEY

24 Edema Morphology Dependent Edema Dependent Edema is a prominent feature of Congestive Heart Failure Facial Edema Facial Edema is often the initial manifestation of Nephrotic Syndrome Subcutaneous Edema Grossly Edema of the subcutaneous tissue is most easily detected Grossly (not microscopically) Push your finger into it and a depression remains

25 Edema Clinical Correlation: Subcutaneous Edema Annoying but Points to Underlying Disease it can impair wound healing or clearance of Infection However, it can impair wound healing or clearance of Infection

26 Edema Morphology Pulmonary Edema Congestive Heart Failure is most frequently seen in Congestive Heart Failure May also be present in renal failure, adult respiratory distress syndrome (ARDS), pulmonary infections and hypersensitivity reactions

27 Pulmonary Edema Gross: The Lungs are typically 2-3 times the normal weight outpouring of frothy, Cross sectioning causes an outpouring of frothy, sometimes blood-tinged fluid

28 Pulmonary Edema Normal

29 Edema Clinical Correlation: Pulmonary Edema death May cause death by interfering with Oxygen and Carbon Dioxide exchange infection Creates a favorable environment for infection THINK it resembles “Culture Media”!!!

30 Edema of the Brain Trauma, Abscess, Neoplasm, Infection (Encephalitis due to say… West Nile Virus), etc

31 Clinical Correlation: Edema of the Brain The big problem is: There is no place for the fluid to go! Herniation into the foramen magnum will kill


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