Increase Hydrostatic Pressure

can result from

Ascities(liver cirrhosis), constrictive pericardidtis

Regional increases from impairment in venous return: DVT

Generalized increases in venous pressure from CHF: compromised right ventricular function

Reduced Plasma osmotic pressure(hyperproteinemia)

Caused by:

Protein-losing glomerulopathies(nephritic syndrome)

 Glolerular capillaries  become leaky

Malnutrition

Decreased intravascular volume(from ↓Albumin) → decreased renal perfusion, activates rennin-angiotensin

More edema.

Edema

Lymphatic Obstruction

causes:

Chronic inflammation with fibrosis

Tumors

Radiation

Infections: Filariasis(parasite) causes inguinal lymphatic and lymph node fibrosis → external genitalia and lower limb swelling (elephantiasis)

Surgical removal of breast and axillary lymph nodes in breast  cancer, also increases risk of angiosarcoma(stewart-treves syndrome)

Sodium Retention & Edema

How does it  cause it?

Excessive salt intake → increase in retained fluid → increase in venous pressure

SOdium retention causes increase in hydrostatic pressure, and decreases colloid osmotic pressure(dilution from water retention)

Renin / Angiotensin system

Activation and effects

Renin(kidney, from ↓arterial pressure) converts angiotensinogen → angiotensin I

angiotensin I → Angiotensin II via ACE(lung/renal endothelium)

Angiotensin II increases Na+, Cl-, H₂O retention

 via aldosterone from adrenal cortex

Angiotensiin II: vasoconstriction

Angiotensin II: Stimulates ADH release from posterior pituatery. H₂O absorption in collecting ducts

Left sided heart failure

causes & resulting edema

Causes:

 Ischemic heart disease

 Hypertension

 Mitral valve disease

 Myocardial disease

Edema:

 Pulmonary congestion → interstitial edema(interlobar septa - Kerley B lines)

 Fluid in alveoli

 Left chamber blood statis

 Left ventricular hypertrophy

 Tissue hypoperfusion

Right sided heart failure

Causes & pathology/edema

Causes:

 Most commonly by left sided heart failure

 Hypertension

 Ischemic heart disease

Pathology:

 Congestion of hepatic and portal vessels: hepatomegaly, nutmeg liver, splenomegaly

Venous congestion → effusions in pleural pericardial and peritoneal spaces

Anasarca, pitting edema

Subcutaenous is normally dependent edema: legs when standing

Pitting edema is a sign of dependent edema

Signals underlying cardiac or renal disease

Renal dysfunction can efffect all parts of body

(renin/angiotensin)

Periorbital edema in severe renal disease

Normally result of Left ventricular failure

Edema fluid in lungs creates ideal environment for microbes(infetion)

Hyperemia

vs

Congestion

Hyperemia

 active process(exercise/inflammation) in which arteriolar dilation results in increased blood flow(erythemia)

Congestion

 Passive process from reduced outflow of blood from a tissue(cyanosis)

Chronic congestion can cause capillary rupture → clusters of hemosiderin-laden macrophages

Acute pulmonary congestion

 engorged alveolar capillaries

Chrnoic pulmonary  congestion

 septa are thickened and fibrotic(kerley b lines)

 Hemosiderin laden macrophages

Petechia

What are they?

Causes?

minute 1 to 2 mm Hemorrhage

Causes:

 thrombocytopenia(low platelet  counts)

 Defective platelet function(uremia)

Purpura

what are they?

Causes?

Purpura

>3 mm hemorrhage, similar to petechiae but larger

Causes:

 Thrombocytopenia, uremia, trauma

 Vasculitis

 Increased vascular fragility(amyloidosis, accumulation of misfolded protein)

Ecchymoses

What are they?

What causes colors?

Ecchymoses(bruises)

1 to 2 cm subcutaenous hematomas

Causes:

 Trauma

 RBCs degraded → hemoglobin(red/blue)

 hemoglobin → billirubin(blue-green)

 billirubin

 hemosiderin(gold-brown)

DIC

how do you treat?

Antibiotics, if septic shock

Intensive insulin therapy for hyperglycemia

FLuid resuscitation to main system pressures

COrticosteroids to correct adrenal insufficiency