15. Hemodynamic Disorders 1 (Edema, Hyperemia, Hemorrhage)
Acute inflammatory edema produces swelling and can be recognized by the cardinal signs of acute inflammation: ____, ____, ____ and ____. Inflammatory edema is an ____ The pitting phenomenon is (absent of present). The mechanism of inflammatory edema is the increased ____vascular ____
Acute inflammatory edema produces swelling and can be recognized by the cardinal signs of acute inflammation: redness, heat, pain and swelling. Inflammatory edema is an exudate The pitting phenomenon is absent. The mechanism of inflammatory edema is the increased microvascular permeability
What is the most common form of generalized edema?
Cardiogenic Edema
Cardiogenic Edema 2) Forward failure (____ dysfunction, low cardiac ____); • Congestive heart failure is associated with reduced cardiac ____ and therefore, with reduced renal ____ . • Reduced renal ____ means reduced renal blood ____ and decreased ____ ____ • The kidney respond by secreting ____. • The ____-angiotensin-____ axis kicks in: the secretion of more ____ leads to further ____ retention and thus increased ____vascular ____ and improved cardiac ____ (via the Frank-Starling law). • The extra fluid load results only in increased ____ pressure and eventually edema.
Cardiogenic Edema 2) Forward failure (systolic dysfunction, low cardiac output); • Congestive heart failure is associated with reduced cardiac output and therefore, with reduced renal perfusion. • Reduced renal perfusion means reduced renal blood flow and decreased glomerular filtration. • The kidney respond by secreting renin. • The renin-angiotensin-aldosterone axis kicks in: the secretion of more aldosterone leads to further sodium retention and thus increased intravascular volume and improved cardiac output (via the Frank-Starling law). • The extra fluid load results only in increased venous pressure and eventually edema.
Chronic Pulmonary Congestion ('Brown Induration of Lung') Definition: The effects of ____-sided heart failure on the structure and function of the lung. Etiology: ____-sided heart failure due to (a) chronic myocardial ____; (b) stenosis of the ____ valve. Both cause a persistent backing up of blood in the lungs.
Chronic Pulmonary Congestion ('Brown Induration of Lung') Definition: The effects of left-sided heart failure on the structure and function of the lung. Etiology: Left-sided heart failure due to (a) chronic myocardial infarct; (b) stenosis of the mitral valve. Both cause a persistent backing up of blood in the lungs.
Chronic Pulmonary Congestion ('Brown Induration of Lung') Gross changes: - At autopsy lungs appear ____ and ____ - They are clinically less compliant (____) because of the increased interstitial diffuse ____. Functional changes: - Chronic ____ congestion is associated with impairment of ____ exchange across the alveolar capillary wall.
Chronic Pulmonary Congestion ('Brown Induration of Lung') Gross changes: - At autopsy lungs appear firm and brown ("brown induration of the lung"). - They are clinically less compliant (stiffer) because of the increased interstitial diffuse fibrosis. Functional changes: - Chronic passive congestion is associated with impairment of gas exchange across the alveolar capillary wall.
Chronic Pulmonary Congestion ('Brown Induration of Lung') Histopathology: Stage 1: ____ escapes into the connective tissue spaces and alveoli (pulmonary ____). Stage 2: Congested ____ bulge into the alveoli. Later they burst and flood the alveoli with blood. Spilled red blood cells are picked up by the alveolar ____ , which digest ____ and become loaded with ____ (rusty) colored granules of ____. ____-laden ____ accumulate within the alveolar ____. They are known as "____ ____ cells". Staining with Perl's will demonstrate a positive (Prussian ____) reaction for ____ . Eventually ____ ____ cells may be coughed out by the patient who will notice a ____-colored ____. Stage 3. Long-standing pulmonary congestion leads eventually to septal ____.
Chronic Pulmonary Congestion ('Brown Induration of Lung') Histopathology: Stage 1: Transudate escapes into the connective tissue spaces and alveoli (pulmonary edema). Stage 2: Congested capillaries bulge into the alveoli. Later they burst and flood the alveoli with blood. Spilled red blood cells are picked up by the alveolar macrophages, which digest hemoglobin and become loaded with brown (rusty) colored granules of hemosiderin. Hemosiderin-laden macrophages accumulate within the alveolar lumen. They are known as "heart failure cells". Staining with Perl's will demonstrate a positive (Prussian blue) reaction for iron. Eventually heart failure cells may be coughed out by the patient who will notice a rusty-colored sputum. Stage 3. Long-standing pulmonary congestion leads eventually to septal fibrosis.
Clinical manifestations of right-sided heart failure: • Signs of heart failure on physical examination • Edema in the ____ extremities and dependent regions • Elevated ____ ____ pressure with ____ of neck ____ • Enlarged and firm ____
Clinical manifestations of right-sided heart failure: • Signs of heart failure on physical examination • Edema in the lower extremities and dependent regions • Elevated jugular venous pressure with distention of neck veins • Enlarged and firm liver
Reduced plasma osmotic pressure leads to a net movement of fluid into the ____ ____ and a resultant plasma volume ____. Can occur when plasma ____ concentration drops from the normal 3.5-5.0 g/dL to 2.5 g/dL Can result in ____ ____ edema forms.
Reduced plasma osmotic pressure leads to a net movement of fluid into the interstitial tissues and a resultant plasma volume contraction. Can occur when plasma albumin concentration drops from the normal 3.5-5.0 g/dL to 2.5 g/dL Can result in less pitting edema forms. Examples: • Malnutrition with decreased protein intake • Cirrhosis with decreased synthesis of albumin • Nephrotic syndrome with increased loss of protein in urine (>3.5 g/24 hours) • Protein-losing enteropathies
Arterial end of capillary: fluid ____ the capillary since capillary ____ pressure (35 mmHg) is greater than the blood colloidal ____ pressure (25 mmHg) --> this is know as ____ Venous end of capillary: fluid ____ the capillary since capillary ____ pressure (18 mmHg) is less than the blood colloidal ____ pressure (25 mmHg) --> this is know as ____
Arterial end of capillary: fluid exits the capillary since capillary hydrostatic pressure (35 mmHg) is greater than the blood colloidal osmotic pressure (25 mmHg) --> this is know as filtration Mid capillary: no net movement of fluid since capillary hydrostatic pressure (25 mmHg) = blood colloidal osmotic pressure Venous end of capillary: fluid re-enters the capillary since capillary hydrostatic pressure (18 mmHg) is less than the blood colloidal osmotic pressure (25 mmHg) --> this is know as absorption
Cardiogenic Edema Pathophysiology: 1) Backward failure (____ dysfunction, ____ congestion): • Failure of the left side due to an ____ of the left ____ causes ____ edema • Failure of the right side causes ____ edema in ____ tissues in the "dependent" parts of the body and in body cavities: - Hydroperitoneum: a collection of edema fluid in the ____ cavity - Hydrothorax: a collection of edema fluid in the ____ cavity - Hydropericardium: a collection of edema fluid in the ____ cavity
Cardiogenic Edema Pathophysiology: Backward failure (systolic dysfunction, venous congestion): • Failure of the left side due to an infarct of the left ventricle causes pulmonary edema • Failure of the right side causes generalized edema in subcutaneous tissues in the "dependent" parts of the body and in body cavities: - Hydroperitoneum: a collection of edema fluid in the peritoneal cavity - Hydrothorax: a collection of edema fluid in the pleural cavity - Hydropericardium: a collection of edema fluid in the pericardial cavity Examples: - Dry cough or cough that produces frothy or bloody sputum--pulmonary edema - Swelling of the ankles and feet in walking patients—right sided heart failure - Swelling in the lower back if the patient is bedridden—right sided heart failure - Rapid weight gain due to fluid retention—right sided heart failure
Given the following types of edema, classify it as either local or generalized edema: - Cardiogenic edema, Nephrogenic edema, and/or Edema associated with liver cirrhosis - Inflammatory edema, venous obstruction (deep venous thrombosis), and/or lymphatic obstruction
Cardiogenic edema, Nephrogenic edema, and/or Edema associated with liver cirrhosis = generalized edema Inflammatory edema, venous obstruction (deep venous thrombosis), and/or lymphatic obstruction = localized edema
Chronic Liver Congestion ('nutmeg liver') Definition: The effects of chronic congestion on the structure and function of the liver. Etiology: ____ failure (____ ____ failure or ____-sided ____ failure).
Chronic Liver Congestion ('nutmeg liver') Definition: The effects of chronic congestion on the structure and function of the liver. Etiology: heart failure (global heart failure or right-sided heart failure).
Chronic Liver Congestion ('nutmeg liver') Laboratory findings: Modest elevations in AST, ALT, alkaline phosphatase, and total bilirubin, as well as mild decreases in albumin. Pathology: Liver lobule function like a funnel: blood flows from the ____ ____ toward the ____ ____ passing through zones 1 , 2 and 3. In normal conditions, zone 1 (____ zone) is the ____ oxygenation, and zone 3 (____ zone) has the ____ oxygenation
Chronic Liver Congestion ('nutmeg liver') Laboratory findings: Modest elevations in AST, ALT, alkaline phosphatase, and total bilirubin, as well as mild decreases in albumin. Pathology: Liver lobule function like a funnel: blood flows from the portal triads toward the central vein passing through zones 1 , 2 and 3. In normal conditions, zone 1 (perilobular zone) is the most oxygenation, and zone 3 (centrilobular zone) has the poorest oxygenation
Chronic Liver Congestion ('nutmeg liver') Pathogenesis: - Decompensated right ____ causes transmission of elevated central ____ pressures directly to the liver via the ____ ____ ____ and hepatic ____. - ____ congestion impedes efficient drainage of sinusoidal blood flow into terminal hepatic ____ . - Sinusoidal stasis results in accumulation of ____ blood in the ____ areas, liver cell ____ , ____ deposition, and, ultimately, ____
Chronic Liver Congestion ('nutmeg liver') Pathogenesis: - Decompensated right ventricle causes transmission of elevated central venous pressures directly to the liver via the inferior vena cava and hepatic veins. - Venous congestion impedes efficient drainage of sinusoidal blood flow into terminal hepatic venules. - Sinusoidal stasis results in accumulation of deoxygenated blood in the centrilobular areas, liver cell necrosis, collagen deposition, and, ultimately, fibrosis.
Chronic Liver Congestion ('nutmeg liver') The liver is grossly ____ On cut surface displays a yellowish background punctuated by red dots. Red dots represent ____ regions, accentuated against the yellowish (____) lobular periphery. Hence the name of "nutmeg liver".
Chronic Liver Congestion ('nutmeg liver') The liver is grossly enlarged, it can swell up to 3 kg (normal liver is 1.5 kg). On cut surface displays a yellowish background punctuated by red dots. Red dots represent centrolobular regions, accentuated against the yellowish (steatotic) lobular periphery. Hence the name of "nutmeg liver".
Chronic Liver Congestion ('nutmeg liver') Zone 1 (perilobular): in chronic liver congestion, only perilobular hepatocytes receive adequate ____ and ____ . These cells show ____ changes Zone 2 (middle third of the lobule): hepatocytes will be ____ , and therefore will show ____ change --> resulting in ____. Mechanism: insufficient ____ to burn down ____ coming to from the ____ tissue. Zone 3: centrilobular hepatocytes die from ____ congestion and lack of ____ and disappear leaving space to a pool of ____ under ____. In the long run, ____ fibers accumulate in zone 3 --> resulting in cardiac ____
Chronic Liver Congestion ('nutmeg liver') Zone 1 (perilobular): in chronic liver congestion, only perilobular hepatocytes receive adequate oxygen and nutrients. These cells show no changes Zone 2 (middle third of the lobule): hepatocytes will be hypoxic, and therefore will show fatty change --> resulting in steatosis. Mechanism: insufficient oxygen to burn down triglycerides coming to from the adipose tissue. Zone 3: centrilobular hepatocytes die from venous congestion and lack of oxygen and disappear leaving space to a pool of blood under pressure. In the long run, collagen fibers accumulate in zone 3 --> resulting in cardiac cirrhosis
Congestion: • It is a (active or passive) process. • It is accumulation of ____ stagnant blood resulting from impaired ____ from a tissue. • It may occur systemically as in global ____ failure, or it may be local resulting from an isolated ____ obstruction. • Congested organs ____ due to ____ with blood. • The color of congested organ is ____ (1) or ____ (cyanosis) in color rather than bright ____ • The ____ (1) is due to a change in color of the blood. Sluggish flow leads to greater oxygen ____ and thus a decrease in the ratio of bright red ____ to dusky red ____ ____.
Congestion: • It is a passive process. • It is accumulation of venous stagnant blood resulting from impaired outflow from a tissue. • It may occur systemically as in global cardiac failure, or it may be local resulting from an isolated venous obstruction. • Congested organs enlarge due to overfilling with blood. • The color of congested organ is bluish or purple (cyanosis) rather than bright red. • The blueness is due to a change in color of the blood. Sluggish flow leads to greater oxygen extraction and thus a decrease in the ratio of bright red hemoglobin to dusky red unoxygenated hemoglobin
Edema Definition: Edema is an excess of ____ fluid. Fluid compartments in the normal body: • Two thirds of this water is ____ fluid • One third is ____ fluid • Only 5% is in ____ ____ Extracellular fluid (ECF) is divided into two subcompartments: • ____ ____ • ____ fluid Ions or molecules representing each compartment: - ____ is the major ECF cation. - ____ is the major ICF cation - ____ is limited to ECF
Edema Definition: Edema is an excess of extracellular fluid. Fluid compartments in the normal body: • Two thirds of this water is intracellular fluid (IFC) • One third is extracellular fluid (EFC) • Only 5% is in blood plasma Extracellular fluid (ECF) is divided into two subcompartments: • Blood plasma • Interstitial fluid Ions or molecules representing each compartment: - Sodium (Na+) is the major ECF cation. - Potassium (K+) is the major ICF cation - Glucose is limited to ECF
Edema -- Transudate is a result of decreased ____ pressure OR increased ____ pressure Edema -- Exudate is a result of increased vascular ____ --> this ultimately leads to an increased ____ pressure and a decreased ____ pressure
Edema -- Transudate is a result of decreased oncotic pressure OR increased hydrostatic pressure Edema -- Exudate is a result of increased vascular permeability --> this ultimately leads to an increased hydrostatic pressure and a decreased oncotic pressure
Edema Associated with Liver Cirrhosis During liver cirrhosis, the fluid weeps from the cirrhotic liver surface and accumulates in the peritoneal cavity (ascites). Ascites is a combination of local and generalized factors: 1. The roots of the ____ ____ are strangled. There is a backup of ____ blood flow due to an obstacle in the liver (backward mechanism). 2. Insufficient ____ is produced by the liver. 3. ____ is inadequately inactivated by the liver cells which normally conjugate it.
Edema Associated with Liver Cirrhosis During liver cirrhosis, the fluid weeps from the cirrhotic liver surface and accumulates in the peritoneal cavity (ascites). Ascites is a combination of local and generalized factors: 1. The roots of the portal vein are strangled. There is a backup of portal blood flow due to an obstacle in the liver (backward mechanism). 2. Insufficient albumin is produced by the liver. 3. Aldosterone is inadequately inactivated by the liver cells which normally conjugate it.
Edema Associated with Liver Cirrhosis During liver cirrhosis, the fluid weeps from the cirrhotic liver surface and accumulates in the ____ cavity --> causing ____
Edema Associated with Liver Cirrhosis During liver cirrhosis, the fluid weeps from the cirrhotic liver surface and accumulates in the peritoneal cavity --> causing ascites
____: Extravasation of water i.e. movement of water across the vascular wall into the interstitial spaces due to abnormalities of vascular permeability. Hyperemia: An increased ____ of blood in a particular tissue. _____: Extravasation of blood due to rupture of vessel or diseased vascular wall. _____: Blood clotting at inappropriate sites, e.g. within the vascular lumen. ____: Migration of blood clots which are carried by the blood to a distant site obstructing blood flow. Infarction: Development of ____ in an area ____ to the obstruction of an end-artery.
Edema: Extravasation of water i.e. movement of water across the vascular wall into the interstitial spaces due to abnormalities of vascular permeability. Hyperemia: An increased volume of blood in a particular tissue. Hemorrhage: Extravasation of blood due to rupture of vessel or diseased vascular wall. Thrombosis: Blood clotting at inappropriate sites, e.g. within the vascular lumen. Embolism: Migration of blood clots which are carried by the blood to a distant site obstructing blood flow. Infarction: Development of necrosis in an area distal to the obstruction of an end-artery.
Hemorrhage Definition: Hemorrhage is extravasation of blood due to vessel rupture. Etiology: (a) Rupture of a large ____ or ____ due to trauma, atherosclerosis, aneurysm, vasculitis, erosion of vessels from tuberculosis, peptic ulcer or tumor. (b) ____ bleeding due to hemorrhagic diatheses. Classification: the patient may have an internal hemorrhage that is invisible or an external hemorrhage that is visible on the outside of the body. Bleeding into the spleen or liver is internal hemorrhage. Bleeding from a cut on the face is an external hemorrhage
Hemorrhage Definition: Hemorrhage is extravasation of blood due to vessel rupture. Etiology: (a) Rupture of a large artery or vein due to trauma, atherosclerosis, aneurysm, vasculitis, erosion of vessels from tuberculosis, peptic ulcer or tumor. (b) Capillary bleeding due to hemorrhagic diatheses. Classification: the patient may have an internal hemorrhage that is invisible or an external hemorrhage that is visible on the outside of the body. Bleeding into the spleen or liver is internal hemorrhage. Bleeding from a cut on the face is an external hemorrhage
Hemorrhages from Body Cavities Hematuria: Appearance of blood in the ____. It is a sign of ____ or ____ tract disease. Hematemesis: ____ blood. It is a sign of ____ or ____ hemorrhage. Melena: Coffee-ground material in the ____. It is a sign of upper ____ bleeding. Such blood is partially digested by the ____ of the ____ juice and transformed into a black pigment called ____. Hematochesia: Bleeding through the ____. It is caused by diseases of the ____ intestine. Epistaxis: Bleeding from ____. Hemoptysis: Bleeding from the ____. Menorrhagia: Heavy ____bleeding. Metrorrhagia: Hemorrhage from ____that occurs at any time and is not related to menstrual bleeding.
Hemorrhages from Body Cavities Hematuria: Appearance of blood in the urine. It is a sign of kidney or urinary tract disease. Hematemesis: Vomiting blood. It is a sign of esophageal or gastric hemorrhage. Melena: Coffee-ground material in the stool. It is a sign of upper GI bleeding. Such blood is partially digested by the HCl of the gastric juice and transformed into a black pigment called hematein. Hematochesia: Bleeding through the rectum. It is caused by diseases of the large intestine. Epistaxis: Bleeding from nose. Hemoptysis: Bleeding from the lungs. Menorrhagia: Heavy menstrual bleeding. Metrorrhagia: Hemorrhage from uterus that occurs at any time and is not related to menstrual bleeding.
Hemorrhages into skin and mucosae: this classification is arbitrary and has survived only by tradition. • ____: pinpoint hemorrhages smaller than 1 mm. • ____: hemorrhages measuring 1 mm to 1 cm in diameter. • ____: hemorrhages larger than 1 cm
Hemorrhages into skin and mucosae: this classification is arbitrary and has survived only by tradition. • Petechiae: pinpoint hemorrhages smaller than 1 mm. or ecchymoses. • Purpura: hemorrhages measuring 1 mm to 1 cm in diameter. • Ecchymoses: hemorrhages larger than 1 cm Note: Petechiae may become confluent and become purpura
Hyperemia and Congestion Definition: Excess of ____ in an ____; both terms are used to mean that the vessels of the micro_____ contain more ____ than normal.
Hyperemia and Congestion Definition: Excess of blood in an organ; both terms are used to mean that the vessels of the microcirculation contain more blood than normal.
Hyperemia: • It is an augmented supply of blood in an organ. • It is an (active or passive) process. • It is a ____ response to increased ____ demands. • Example: ____ and ____ muscle during ____. • Example: ____; the temperature of the skin is abnormally warm, because the blood flow is increased.
Hyperemia: • It is an augmented supply of blood in an organ. • It is an active process. • It is a physiologic response to increased functional demands. • Example: heart and skeletal muscle during exercise. • Example: blushing; during blushing, the temperature of the skin is abnormally warm, because the blood flow is increased.
Increases in vascular hydrostatic pressure result in greater ____ of fluid into the ____ ____ and its retention as ____ edema.
Increases in vascular hydrostatic pressure result in greater filtration of fluid into the interstitial space and its retention as pitting edema.
Internal hemorrhage: • Hematoma: accumulation of blood within ____ ____. Example: rupture of aortic aneurysm leads to massive retroperitoneal hematoma. • Hemothorax: hemorrhage into ____ cavity • Hemopericardium: hemorrhage into ____ cavity • Hemoperitoneum: hemorrhage into ____ cavity • Hemarthrosis: hemorrhage into ____ cavity.
Internal hemorrhage: • Hematoma: accumulation of blood within soft tissues. Example: rupture of aortic aneurysm leads to massive retroperitoneal hematoma. • Hemothorax: hemorrhage into pleural cavity • Hemopericardium: hemorrhage into pericardial cavity • Hemoperitoneum: hemorrhage into peritoneal cavity • Hemarthrosis: hemorrhage into synovial cavity.
Pathophysiology of Edema Normal formation and retention of ____ fluid depends on filtration and reabsorption of plasma fluids at the level of the ____ (Starling equilibrium). In this equilibrium, ____ pressures are opposed by ____ pressures
Pathophysiology of Edema Normal formation and retention of interstitial fluid depends on filtration and reabsorption of plasma fluids at the level of the capillaries (Starling equilibrium). In this equilibrium, hydrostatic pressures are opposed by oncotic pressures
Nephrogenic Edema The kidney diseases can induce edema in several ways depending on the underlying disease: 1. By a glomerular mechanism: During the inflammatory diseases of the glomeruli (glomerulonephritis) glomeruli become ____, ____ is lost from plasma into urine, thereby reducing the ____ pressure of the plasma. 2. By secreting renin: This causes adrenals to secrete more ____which increases the reabsorbtion of ____. The retained ____ produces edema by ____ the blood volume. 3. By failing to secrete ____ and ____. In acute renal failure, the daily volume of urine production decreases to a minimum. As fluid intake continues, the blood volume ____.
Nephrogenic Edema The kidney diseases can induce edema in several ways depending on the underlying disease: 1. By a glomerular mechanism: During the inflammatory diseases of the glomeruli (glomerulonephritis) glomeruli become leaky, albumin is lost from plasma into urine, thereby reducing the oncotic pressure of the plasma. 2. By secreting renin: This causes adrenals to secrete more aldosterone which increases the reabsorbtion of sodium. The retained sodium produces edema by expanding the blood volume. 3. By failing to secrete sodium and water. In acute renal failure, the daily volume of urine production decreases to a minimum. As fluid intake continues, the blood volume expands.
Pitting describes an ____ that remains in the edematous area after ____ is applied. ◦ This occurs when fluid in the interstitial space has a low concentration of ____. ◦ Pitting edema is associated with ____ hydrostatic pressure and ____ plasma oncotic pressure.
Pitting describes an indentation that remains in the edematous area after pressure is applied. ◦ This occurs when fluid in the interstitial space has a low concentration of protein. ◦ Pitting edema is associated with increased hydrostatic pressure and decreased plasma oncotic pressure. Examples: • Deep venous thrombosis in the lower extremities • Congestive heart failure: ◦ Pulmonary edema in left-sided heart failure ◦ Leg pitting edema in right-sided heart failure • Portal hypertension in liver cirrhosis producing ascites.
The portal triad is made up of the ____ ____ , the ____ ____, and the ____ ____
The portal triad is made up of the portal vein, the hepatic artery, and the hepatic duct
Types of Edema Fluid pt. 1 Transudate: • ____-poor fluid (< 3g/dL) with specific gravity <1.012 • Results from ____ of plasma across the capillary wall (from increased ____ pressure) • Produces dependent ____ edema and body ____ effusion Exudate: • ____-rich fluid (>3 g/dL) with specific gravity > 1.020. • Results from increased endothelial ____ (during _____) • Produces swelling of ____ but no ____ edema
Types of Edema Fluid pt. 1 Transudate: • Protein-poor fluid (< 3g/dL) with specific gravity <1.012 • Results from ultrafiltration of plasma across the capillary wall (from increased hydrostatic pressure) • Produces dependent pitting edema and body cavity effusion Exudate: • Protein-rich fluid (>3 g/dL) with specific gravity > 1.020. • Results from increased endothelial permeability (during inflammation) • Produces swelling of tissue but no pitting edema
Types of Edema Fluid pt. 2 Lymphedema: • ____-rich fluid • Results from obstacles along the ____ pathway • Produces massive swelling of ____ but no ____ edema. Myxedema: • Accumulation of ____ (____ acid and ____ acid) in the _____ (hint: layer of skin) • These compounds attract ____ , which lead to ____ nonpitting edema. • Results from both ____ and ____ conditions.
Types of Edema Fluid pt. 2 Lymphedema: • Protein-rich fluid • Results from obstacles along the lymphatic pathway • Produces massive swelling of extremities but no pitting edema. Myxedema: • Accumulation of glycosaminoglycans (hyaluronic acid and chondroitin acid) in the dermis • These compounds attract water, which lead to cutaneous nonpitting edema. • Results from both hypothyroid and hyperthyroid conditions.
Under normal circumstances, more fluid is filtered into the interstitial spaces than is reabsorbed into the vascular bed. This excess interstitial fluid is removed by ____.
Under normal circumstances, more fluid is filtered into the interstitial spaces than is reabsorbed into the vascular bed. This excess interstitial fluid is removed by lymphatics.
When lymphatic outflow is completely occluded, the ____ fluid volume increases because a fluid with relatively high ____ content accumulates due to decreased tissue washout of extravasated plasma proteins. In fact, the ____ ____ pressure rises until it equals ____ ____ pressure leading to local ____ edema.
When lymphatic outflow is completely occluded, the interstitial fluid volume increases because a fluid with relatively high protein content accumulates due to decreased tissue washout of extravasated plasma proteins. In fact, the interstitial oncotic pressure rises until it equals plasma oncotic pressure leading to local nonpitting edema. Examples: • Lymphedema following radical mastectomy for breast cancer due to removal of axillary lymph nodes and lymphatics; • Filariasis caused by the nematode Wuchereria bancrofti; • Lymphogranuloma venereum, a venereal disease caused by Chlamydia trachomatis;
