Term
Define "edema"
Describe the distribution of fluid in body compartments |
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Definition
Excessive fluid in the interstitial space (extravascular space) or body cavity (pleural, peritoneal, pericardial) due to:
-changes in Starling forces
-impaired vascular permeability
-lymphatic blockage
Intracellular
Extracellular
-interstitial
-vascular (intravascular; plasma volume)
Starling forces maintain balances across barriers |
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Term
| The general names for different types of edema |
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Definition
Hydrothorax
Hydropericardium
Hydroperitoneum (ascites)
-usually result of i/c hydrostatic pressure in the portal-systemic blood vessels or d/c oncotic pressure from low albumin
-ultrafiltrate of the plasma seeps across capillary walls and peritoneal surfaces, driven by hydrostatic pressure in portal system and low albumin and oncotic pressure
-i/c resistance to blood flow in portal HTN may be pre-, intra-, or post-hepatic, pts with cirrhosis develop portal htn b/c of i/c vascular resistance in the liver and i/c splanchnic/portal blood flow
Anasarca (extravascular space)
-generalized edema with accumulation of serum in connective tissue |
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Term
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Definition
Transudate: cell poor, protein poor (<2 g/dl)
-i/c hydrostatic pressure: forces fluid out of vessels
-d/c oncotic pressure: less fluid enters vascular space from interstitial space
-specific gravity <1.015
-glucose conc is normal
-LDH usually normal
Exudate: cell rich (PNMs) and protein rich (>3 g/dl)
-inflammatory: i/c vascular permeability (rather than hydrodynamic)
-bacterial infxn esp if pus forming, suppurative, purulent, pyogenic bacteria
-specific gravity >1.018
-glucose conc is d/c, in proportion to leukocyte count
-lactic dehydrogenase is i/c in exudates from damaged tissue and dead leukocytes |
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Term
Explain the pathogenesis of
-inflammatory edema
-hydrostatic edema (HTN, heart failure)
-oncotic edema (nephrotic syndrome)
-obstructive edema (lymphatic obstruction)
-hypervolemic edema
give clinical ex of each |
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Definition
Hydrostatic pressure (Starling forces)
-increased intravascular
-forces fluid out of vascular space
Oncotic pressure
-d/c intravascular (hypoproteinemia): movement of fluid out of vascular space into interstitium
-i/c interstitial (sodium retention): mvmt of fluid into the interstitium |
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Term
| Describe the pathways that lead to systemic (generalized) edema due to primary heart failure (CHF) |
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Definition
Generalized pitting edema of anasarca may follow leg edema late in heart failure
-dyspnea, orthopnea, tachycardia, fatigue typify left-sided HF
-jugular vein distention, enlarged liver, peripheral edema typify right-sided HF |
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Term
| Describe how nephrotic syndrome and malnutrition lead to edema |
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Definition
Nephrotic syndrome results from i/c loss of protein through the glomerular capillaries --> proteinuria
the degree of proteinuria leads to hypoalbuminemia, d/c intravascular oncotic pressure, and edema
-periorbital edema
-dx: proteinuria, generalized edema, hypoalbuminemia, hyperlipidemia (with hypercholesterolemia)
Kwashiorkor: edema from hypoalbuminemia; severe def more of protein than of calories
-retain fluid, look puffy and swollen
-abdomen may protrude if severe |
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Term
Review the analysis of lab findings of fluid from body cavities
-pleural
-ascites
-pericardial |
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Definition
Abnormal:
-turbidity indicates high leukocyte count and thus an exudate, pus-like
-high viscosity indicates clotting and/or much hydrolyzed debris
-red or pink color indicates the presence of blood, if no trauma hx suggests malignancy
Pleural fluid analysis
-collect by pleural tap (thoracentesis)
-transudate: usually bilateral b/c systemic, leads to dyspnea, respiratory distress, dull pain, coughing
-caused by CHF, hypoalbuminemia, nephrosis, hepatic cirrhosis, iatrogenic
-exudate: caused by bacterial lung infections, lung tumors, pulmonary embolism and lung infarction
Ascites
-N: yellow, transparent
-chylous: milky, cloudy, turbid - cirrhosis, portal HTN
-chylous ascites can be caused by lymphatic blockage - high triglyceride levels |
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