3 - Hemodynamic Edema
3 - Hemodynamic Edema
3 - Hemodynamic Edema
Dr. Mishaal
HAEMODYNAMIC
DISORDERS
LEARNING OBJECTIVES
The students should understand:
• 1. Edema. Etiopathogenetic Mechanism .Types and
Morphology of Edema. Subcutaneous Edema. Pulmonary
Edema. Edema of the Brain. Fluid Accumulation in Body
Cavities. Clinical Correlation.
• 2. Hyperemia. Active Hyperemia. Passive Hyperemia
(Congestion). Morphology. Acute and Chronic types.
Pathologic Changes in Lungs, Liver, Spleen and Brain.
• 3. Hemorrhage. Causes. Mechanisms. Types. Hematoma,
Petechia, Purpura. Ecchymoses. Large Accumulation of
blood in the body cavities.
LEARNING OBJECTIVES
• 4. Thrombosis. Pathogenesis (Virchov’s triad).
Morphology of Thrombi. Arterial system Thrombi.
Thrombosis in the Heart. Venous Thrombosis.
Phlebothrombosis. Migratory Thrombosis. (Trousseau’s
Syndrome). Fate of Thrombosis. Clinical Features.
Disseminated Intravascular Coagulation (DIC).
• 5. Embolism. Thromboembolism. Pulmonary Embolism.
Fate of Pulmonary Thromboemboli. Paradoxal Embolism.
Systemic Embolism. Arterial Emboli.Air Embolism.
Decompression Sickness. Amniotic Fluid Embolism. Fat
Embolism. Miscellaneous Emboli.
• 6. infarction : Pathogenesis. Types. Pathologic Changes in
Organs ( Heart, Kidney, Lung, Liver, Brain).
• 7. Shock: Pathogenesis.Types and Stages of Shock.
Pathologic Changes in Organs ( Heart, Kidney, Lung,
Liver, Brain).
NORMAL FLUID BALANCE
• Balance is achieved through physiologic
mechanisms that :
- Maintain vessel wall integrity, intravascular
pressure & osmolarity to keep values within
physiologic ranges
- Control coagulation process
• Imbalance can be :
- Primary: e.g. trauma, hypercoagulability disorders,
- Secondary: e.g. heart failure, sepsis,
HAEMODYNAMIC
DISORDERS:
• OEDEMA / EDEMA
• HYPEREMIA AND CONGESTION
• HAEMORRHAGE
• THROMBOSIS
• EMBOLISM
• INFARCTION
• SHOCK
Overview
• Edema (increased fluid in the ECF)
• Hyperemia (INCREASED flow)
• Congestion (INCREASED backup)
• Hemorrhage (extravasation)
• Hemostasis (keeping blood as a fluid)
• Thrombosis (clotting of blood)
• Embolism (downstream travel of a clot)
• Infarction (death of tissues /no enough blood)
• Shock (circulatory failure with collapse)
OEDEMA/
EDEMA
Normal body composition
• Water composes about 60% of total body
mass in men, 55% in women.
• 3 body compartments containing H2O:
• Intracellular fluid = 67%
• Plasma = 8%
Water distribution
• 60% body weight in men, 55% in women
• a man of average weight (70 kg), body water content is about
42 liters.
• 2 thirds of body water is intracellular, and 1 third is
extracellular. Interstitial
(25%)
Extracellular
(33%)
Vascular
Body water (8%)
Intracellular
(67%)
60%OF BODY WEIGHT IS WATER
blood
plasma
8%
Intra-
cellular Interstitial
(67%) fluid (25%)
Mechanisms control body fluids
• Generation of interstitial fluid is regulated by the
“Starling equation” {The rate of leakage of fluid
is determined by the difference between two
forces (hydro-static pressure and oncotic
pressure) and also by the permeability of the
vessel wall to water}.
Starling equation
• Arterial pressure, venous pressure, colloid oncotic
pressure, and competent lymphatic vessels are the main
factors of fluid filtration process and formation of edema.
• Jv = (kf[Pc − Pi] − σ[πc − πi])
Leads to oedema
Normal Micro-circulation
Pulmonary edema
Chest X-ray
Morphology of edema
Histology
Clinical manifestations of edema
Clinical Signs Most Likely Cause(s)
Unilateral edema of one arm in a Lymphatic obstruction
60-year-old female with a
mastectomy scar on that side
– swollen, erythematous breast extensive invasion and
)Peau d’ orange( obstruction of dermal
.lymphatics by tumor cells
Bilateral symmetrical edema of skin Increased hydrostatic
& subcutis of both legs below knees pressure in veins due to
in 57-year-old man whose only congestive heart failure
complaint is shortness of breath
Periorbital edema with slight edema Hypoproteinemia/
in all four extremities. Ascitis hypoalbuminemia. (kidney
and liver)
Unilateral edema of one
arm, after mastectomy
Peau d’orange
Inflammatory carcinoma with its classic peau
d’orange appearance.
Peau d’orange
Note the tiny little “pits” in the orange peel and the
skin here.
Clinical manifestations of edema
• Which 3 major vital organs their dysfuncrions are
main causes of edema?
- Heart / cardiac (congestive heart
failure / CHF)
- Liver/ hepatic
- Kidneys/ renal
CHF EDEMA
• TWO main reasons for edema due mainly to
cardiac causes:
- Increased venous hydrostatic pressure due to
heart failure
- Decreased renal perfusion due to heart failure
lead to triggering of RENIN-ANGIOTENSION-
ALDOSTERONE complex, resulting ultimately
in sodium retention followed by water retention
HEPATIC ASCITES
• TWO main reasons for edema due mainly to
hepatic causes: