EDEMA Fluid extravasation and accumulation in the interstitial

EDEMA Fluid extravasation and accumulation in the interstitial spaces

EDEMA • Localized ( a limb) or systemic • Inflammatory or non inflammatory • Massive edema is called Anasarca • Fluid may also accumulate in body cavities: l Hydrothorax l Hydro pericardium l Hydro peritoneum is also called Ascites

Edema Fluid • A TRANSUDATE is protein-poor (specific gravity <1. 012)(non inflammatory) • An EXUDATE is protein-rich (specific gravity >1. 020) (inflammatory edema)

Pathophysiologic Categories of Edema I. Increased Hydrostatic Pressure II. Reduced Plasma Oncotic Pressure III. Sodium retention IV. Lymphatic obstruction

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

Edema Morphology Edema of the subcutaneous tissue is most • easily detected Grossly (not microscopically) Push your finger into it • and a depression remains •

Compare between: Hyperemia & Congestion HYPEREMIA: • is an active process • resulting from increase blood inflow into tissue Congestion • is a passive process • resulting from • due to arteriolar dilation impaired outflows • (e. g. acute inflammation) from a tissue • Impaired venous return • (e. g. cardiac failure or venous obstruction)

Liver - Chronic Passive Congestion “Nutmeg” Liver Cross Section of a Nutmeg

Hemorrhage Extravasation of blood due to rupture of blood vessels

Hemorrhage Forms: Causes: – Rupture of a large vessel: – Trauma – Atherosclerosis – Inflammatory – Neoplastic Erosion – Rupture of small vessels: » hemorrhagic diathesis May be: – external – into a body cavity – into a tissue

Hemorrhage: into tissue 1) Haematoma: accumulation of blood ENCLOSED OR CONFINED WITHIN TISSUE e. g. - Bruise (insignificant) - retroperitoneal haematoma due to ruptured aortic aneurysm fatal

Hemorrhage 2) Petechiae: minute hemorrhages into skin, mucous membranes, or serosal • surfaces (1 -2 MM) Associated with: – Local increase hydrostatic – pressure Thrombocytopenia

Hemorrhage 3) Purpura: – Slightly larger hemorrhages than Petechiae (3 -5 MM) – Causes: • Causes as Petechiae • Trauma • Vasculitis • Increased vascular fragility

Hemorrhage 4) Ecchymoses: – Subcutaneous haematoma ‘bruise’ OVER 1 -2 CM Q: Why do bruises change color as they Resolve? • The RBC’s in a hemorrhage are broken down: – hemoglobin (red) – bilirubin (blue-green) – hemosiderin (golden-brown)

Hemorrhage: Accumulation of blood in a body cavity: – Hemothorax – Hemopericardium – Hemoperitoneum – Hemarthrosis

Hemorrhage Cerebral hemorrhage