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oedema
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2oed definition
Increased fluid in interstitial spaces
Anasarca -- severe generalized
oedema with profound subcutaneoustissue swellingFluid collection in various cavities is named
HydrothoraxHydroperitonium (ascities)
hydropericardium
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3oed classification
Increase hydrostatic pressure
Reduced plasma osmotic pressure
(hypoproteinemia)
Lymphatic obstruction
Sodium retention
inflammation
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4oedincreased hydrostatic pressure
Impaired venous return Congestive heart failure
Constrictive pricarditis
Ascities (liver cirrhosis)Venous obstruction Thrombosis
External pressure (mass)
Inactivity with prolonged dependency
Arteriolar dilation heart
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5oed hyoproteinemia
Reduced plasma osmotic pressure
Protein loosing glomerulopathies
(nephrotic syndrome)Liver cirrhoses (ascities)
malnutrition
protein loosing gastro-entero pathy
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7oed sodium retention
Excessive salt intake ,with renal
insufficiency
Increase tubular reabsorption of sodium
Renal hyoperfusion
Increased renin-angiotensin-aldosteron
secretion
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8oed inflammation
Acute inflammation
Chronic inflammationangiogenesis
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9oed variables of pressures
Affecting fluid transit across capillary wall
Capillary hydrostatic & osmatic forces are
balanced
No net loss or gain of fluid across capillary bed
Increase hydrostatic pressure or decreased
plasma osmotic pressure leads to
net accumulation of extra vascular fluid (oedema) As the interstitial fluid pressure increases
tissue lymphatics remove much of the excess fluid
Eventually returning it to circulation via thoracic duct
Oth ff i
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pathways leading
To systemic
oedema
Heart failure
Cardiac output
Effective arterial
Blood volume
rennin
aldosteron
Renal sodium
reabsorption
Rena retention
Of Na+, H2O
Plasmavolumetransudation oedema
MALNUTRITION
Hepatic SYNTHEIS
NEPHROTIC SYNDROM
PLASMA
Osmotic pressure
Blood volume
Other effusions
Renal
vasoconstriction
Tubular reabsorption
Na+, H2O
GFR
CVP capillarypressure
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11oed clinical presentation
Ranges from annoying to fatal
Signals the underlying disease
Impairs wound healing & clearance ofinfection
Pulmonary oedema interferes with
ventilation & can cause deathBrain oedema is serious and can be fatal
by herniation or pressure ischemia
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MORPHOLOGY
SUBCUTANEOUS EDEMA Dependent, site of higher osmotic pressure
Prominent feature of right heart failure
NEPHROTIC EDEMA PERIORBITAL EDEMA
PULMONARY EDEMA
Frothy blood tinged fluid, with air
BRAIN EDEMASwollen brain,narrow sulci distended gyri
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12hyp
Hyperaemia
and congestion
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13hyp definition
Both indicate a local increased volume of bloodin particular tissue
Hyperemia is an active process
augmented tissue inflow
arteriolar dilatation
skeletal muscle in exercise
place of inflammation
Congestion is passive process
impaired outflow
cardiac failure
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14hyp hyperemia versus congestive
In both cases there is
Increased volume
and pressure of bloodin a given tissue with
associated capillary dilatation and
potential for fluid extravasations
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15hyphyperemia versus congestion
hyperemiaIncreased inflow leads to
Engorgement with oxygenated blood
Resulting in erythemaCongestionDiminished out flow leads to
Capillary be swollenWith deoxygenated venous blood
Resulting in cyanosis
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MORPHOLOGY
Cut surfacewet and hemorrhagic
Alveolar capillaries engorged with blood
Focal intra alveolar hemorrhage
HEPATIC CONGESTION
Hepatocyte degeneration
Chronic congestion.nutmeg liver
Centrilobular necrosis
Hepatic fibrosisin severe cases
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