Edema-水肿英语课件.ppt

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1、EdemaZhou YunThe Affiliated Hospital of Medical College of Ningbo UniversityEmergency DepartmentObjectiveDefinitionClassificationEtiology and pathogenesisDifferential diagnosisDefinitionThe excessive accumulation of intestitial fluidA pathologic process caused by diseases Not accompanied with cellul

2、ar edemaClassificationAccording to the range that edema fluid spreads to:Generalized edemaLocalized edemaAccording to the cause of edema:Renal edemaHepatic edemaCardiac edemaMalnutritional edemalymphedemaClassificationGeneralized edema:Puffiness of the face Indentation of the skin“pitting edema”Asci

3、tes&HydrothoraxLocalized edemeEdemaPitting edemaAscitesEtiology and pathogenesis Imbalance of fluid exchange between plasma and interstitial compartmentImbalance of fluid exchange between extra-and intra-bodyImbalance of fluid exchange between plasma and interstitial compartmentCapillariesFigure 7-7

4、Total Pressure Differences Inside and Outside Capillarypermeabilityobstruction1.Increased capillary blood pressure Causes:Elevated plasma volume Increased venous pressure General venous pressure,i.e.congestive heart failureLocal venous pressure,i.e.venous thrombosisArteriolar dilation i.e.acute imfl

5、ammationCapillary blood pressureForce driving fluid into interstitiumFormation of interstitial fluidEdemaWhen greater than lymphatic compensatory return2.Decreased plasma colloid osmotic pressureCauses:Plasma albumin content decreaseDecrease of protein production i.e.hepatic cirrhosis,malnutritionEx

6、cessive loss of protein i.e.nephrosisElevated catabolism of protein i.e.chronic debilitating diseases,such as malignant tumor Plasma colloid osmotic pressureForce drawing water back into capillary from interstitiumFormation of interstitial fluidEdemaWhen greater than lymphatic compensatory return3.O

7、bstruction of lymphticCauses:Blockage by cancerBlockage by infection,especially with filarial4.Increased capillary permeabilityCapillary permeabilityFiltration of more protein from capillary to interstitiumformation of interstitial fluidEdemaWhen greater than lymphatic compensatory returnPlasma coll

8、oid osmotic pressureCauses:InflammationInfectionBurnAllergic responseTraumaAnoxiaAcidosisImbalance of fluid exchange between extra-and intra-body-Renal retention of sodium and waterIn normal condition,99-99.5%of total volume of sodium and water filtrated via glomeruli are reabsorbed by tubules.60-70

9、%of filtrates are actively reabsorbed by proximal convoluted tubule.The reabsorptions of sodium and water at distal tubule and collection duct are regulated by hormone.Glomerular(filtration)and tubular(reabsorption)balance(G-T balance)Retention of sodium and waterGFR(glomerular filtration rate)decre

10、ases,while tubular reabsorption does not decrease accordingly;Tubular reabsorption increases,while GRF does not increased.GFRReabsorption of proximal tubuleReabsorption of distal tubule and collection tubuleG-T imbalanceFactors determining the GFR:Filtration area and membrane permeability Filtration

11、 pressure Effective circulating blood volume or renal blood volume1.Decreased glomerular filtration rate(GFR)1.GFRCausesExtensive glomerular damageAcute or chronic glomerulonephritisDecrease of effective circulating blood volumeCongestive heart failure,nephrotic syndromeRenal blood volumeRenin-angio

12、tensin systemSympathetic-adrenal medullary system GFR-Increased reabsorption in proximal tubuleIncreased filtration fraction(FF)2.glomerular filtration rate(GFR)renal plasma flow(RPF)=FFGFR:amount of plasma filtered at glomerulus into Bowmans capsuleFF is the fraction of renal plasma flow that is fi

13、ltered at the glomerulusIn normal condition:FF:20%The protein concentration in the plasma entering the peritubular capillaries increasesThe peritubular capillary oncotic pressure increasesEnhancing fluid reabsorption from the renal interstitial space to the capillaryDecreases renal interstitial pres

14、surefavoring reabsorption across the tubular epithelium and minimizing back flux from the renal interstitial space to the tubule lumen.Reabsorption in proximal tubuleIncreased FF Increased FF make elevated reabsorption of proximal tubuleCauses of FF increasingCongestive heart failure Nephrotic syndr

15、omeDecreased effective circulatory blood volumeSympathetic-adrenal medullary system excitingEfferent arteriole constricts stronger than afferent oneEfferent arteriole resistanceGFR is increased relative to renal plasma flowFFCongestive heart failureNephrotic syndromeEffective circulatory blood volum

16、eADH secretionRenal blood flowRenal perfusion pressureGFRsodium at macula densaSecretion of renin by Juxtaglomerular cell Sympathetic nerve excitationRenin-angiotensin-aldosterone system activation Retention of sodium and waterStimulation of volume-receptor in left atrium and thoracic vessel-Increas

17、ed reabsorption in distal tubule and collecting ductIncreased ADH(antidiuretic hormone)and ADS(aldosterone)secretion3.QuestionWhy does congestive heart failure cause edema?General venous pressurePlasma colloid osmotic pressur because of dilution of bloodDysfunction of lymphatic return because of inc

18、reased venous pressureGFRFFADH and ADSDifferential diagnosis Heart failure Renal diseases Cirrhosis Nutritional origin Idiopathic OthersDifferential diagnosisHeart FailureOccurs at lower part of the body(lower extremities)Symmetric location The presence of heart diseasesCardiac enlargementGallop rhy

19、thmDyspnea Basilar ralesVenous distentionHepatomegalyDifferential diagnosisRenal diseasesHypoalbuminemia&Retention of sodium and water Associated:HematuriaProteinuriaHypertention Impaired renal functional test Characteristic of edema Puffiness of the face Differential diagnosisCardiac/Renal disease

20、Renal CardiacLocation onset from the face,onset from the lower periobital areas part of the bodyProgression progress quickly progress slowlyIdentity soft and mobile relatively solid,less mobileOther signs proteinuria signs of heart failure:hypertension cardiac enlargement impaired renal venous diste

21、ntion functional test hepatomegaly Differential diagnosisLiver diseases(cirrhosis)Clinical evidence of hepatic diseaseJaundiceSpider angiomasAscites Ascites refractory to the treatmentcirrhosisDifferential diagnosisIdiopathic edema Exclusive in women Periodic episodes Accompanied by abdominal distentionDifferential diagnosisOther Causes of EdemaHypothyroidism PregnancyEstrogensAngioneuroticApproach to the patient GeneralizedLocalizedorHeartLiver KidneyVenous obstructionLymphatic obstruction