MBBS Block 2: Edema
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Questions and Answers

What percentage of body weight is made up of water?

  • 80%
  • 50%
  • 70%
  • 60% (correct)

    • Where is the majority of extracellular fluid located?

  • Bloodstream
  • Interstitium (correct)
  • Lymphatic vessels
  • Plasma

    • What is one of the causes of edema?

  • Decrease in lymphatic flow
  • Increase in plasma osmotic pressure
  • Increase in intravascular hydrostatic pressure (correct)
  • Decrease in salt and water retention

    • What is the normal balance between hydrostatic and osmotic forces in vessels?

    <p>They are nearly balanced</p> Signup and view all the answers

    What is the result of an imbalance between hydrostatic and osmotic forces?

    <p>Extravasation of fluid into tissues</p> Signup and view all the answers

    What is the consequence of a decrease in plasma osmotic pressure?

    <p>Edema formation</p> Signup and view all the answers

    What is the role of lymphatics in the body?

    <p>Regulation of fluid balance</p> Signup and view all the answers

    What is the consequence of an impairment in lymph flow?

    <p>Edema formation</p> Signup and view all the answers

    What is the consequence of renal retention of salt and water?

    <p>Edema formation</p> Signup and view all the answers

    What happens when the capacity for lymphatic drainage is exceeded?

    <p>Tissue edema results</p> Signup and view all the answers

    Which of the following is a cause of increased hydrostatic pressure?

    <p>Congestive heart failure</p> Signup and view all the answers

    What is a cause of reduced plasma osmotic pressure?

    <p>Protein-losing glomerulopathies</p> Signup and view all the answers

    Which of the following is a cause of lymphatic obstruction?

    <p>Neoplastic lymphatic obstruction</p> Signup and view all the answers

    What is a consequence of excessive sodium retention?

    <p>Tissue edema</p> Signup and view all the answers

    Which of the following is a cause of edema?

    <p>Increased renin-angiotensin-aldosterone secretion</p> Signup and view all the answers

    What is a consequence of impaired venous return?

    <p>Increased hydrostatic pressure</p> Signup and view all the answers

    Which of the following is a cause of increased hydrostatic pressure?

    <p>Constrictive pericarditis</p> Signup and view all the answers

    What is a consequence of lymphatic obstruction?

    <p>Tissue edema</p> Signup and view all the answers

    What is the definition of edema?

    <p>Abnormal accumulation of fluid in the tissue spaces or body cavities</p> Signup and view all the answers

    What type of edema is caused by venous obstruction?

    <p>Edema of venous obstruction</p> Signup and view all the answers

    What is cardiac edema an example of?

    <p>Generalized edema</p> Signup and view all the answers

    Which of the following is not a type of generalized edema?

    <p>Acute inflammatory edema</p> Signup and view all the answers

    What is myxoedema an example of?

    <p>Generalized edema</p> Signup and view all the answers

    What is the main difference between transudate and exudate?

    <p>The protein content</p> Signup and view all the answers

    Which of the following is a serious complication of edema?

    <p>All of the above</p> Signup and view all the answers

    What is the term for fluid accumulation in body cavities?

    <p>Effusion</p> Signup and view all the answers

    What is the classification of edema caused by protein losing enteropathy?

    <p>Nutritional edema</p> Signup and view all the answers

    What is the term for generalized edema producing marked swelling of subcutaneous tissue?

    <p>Anasarca</p> Signup and view all the answers

    What is the primary cause of cardiac edema?

    <p>Congestive cardiac failure</p> Signup and view all the answers

    What is the term for the abnormal accumulation of fluid in the pericardial cavity?

    <p>Hydropericardium</p> Signup and view all the answers

    What is the characteristic of pulmonary edema on gross examination?

    <p>Lungs are 2-3 times larger than normal</p> Signup and view all the answers

    What is the term for the swelling of the part of the optic nerve inside the eye?

    <p>Papilloedema</p> Signup and view all the answers

    What is the effect of brain edema on the brain substance?

    <p>All of the above</p> Signup and view all the answers

    What is the significance of papilloedema in clinical practice?

    <p>It is a sign of increased intracranial pressure</p> Signup and view all the answers

    What is the effect of pulmonary edema on normal ventilatory function?

    <p>It impairs oxygen diffusion</p> Signup and view all the answers

    What is the significance of subcutaneous edema in cardiac and renal failure?

    <p>It is a sign of underlying disease</p> Signup and view all the answers

    What may be the initial vision problems in certain individuals?

    <p>Short flickers of gray vision</p> Signup and view all the answers

    What is the main characteristic of exudate?

    <p>High protein content</p> Signup and view all the answers

    What is the definition of transudate?

    <p>Filtrate of blood or plasma with no increased vascular permeability</p> Signup and view all the answers

    What is the nature of exudate?

    <p>Inflammatory edema</p> Signup and view all the answers

    What is the protein content of transudate?

    <p>Low (less than 3 g/dl)</p> Signup and view all the answers

    What is the fluid LDH/serum LDH ratio in exudate?

    <p>&gt;0.6</p> Signup and view all the answers

    What is the specific gravity of exudate?

    <p>More than 1.018</p> Signup and view all the answers

    What is the characteristic of exudate in terms of fibrinogen?

    <p>High fibrinogen</p> Signup and view all the answers

    What is the LDH level in transudate?

    <p>Low</p> Signup and view all the answers

    What is the main cause of edema in cardiac failure?

    <p>Renal retention of salt and water</p> Signup and view all the answers

    What is the primary mechanism of edema formation in renal disease?

    <p>Renal retention of salt and water</p> Signup and view all the answers

    What is the underlying cause of edema in lymphatic obstruction?

    <p>Impairment in lymph flow</p> Signup and view all the answers

    What is the result of an imbalance between hydrostatic and osmotic forces in vessels?

    <p>Extravasation of fluid into tissues</p> Signup and view all the answers

    What is the consequence of a decrease in plasma osmotic pressure?

    <p>Extravasation of fluid into tissues</p> Signup and view all the answers

    What is the role of lymphatics in edema formation?

    <p>To drain excess fluid from tissues</p> Signup and view all the answers

    What is the consequence of an impairment in lymph flow?

    <p>Edema formation</p> Signup and view all the answers

    What is the underlying cause of edema in hepatic disease?

    <p>Decreased plasma oncotic pressure</p> Signup and view all the answers

    What is the primary cause of cardiac edema?

    <p>Impaired venous return</p> Signup and view all the answers

    What is the primary mechanism of edema formation in hypersensitivity reactions?

    <p>Increased capillary permeability</p> Signup and view all the answers

    Which of the following can cause renal edema?

    <p>All of the above</p> Signup and view all the answers

    What is the underlying mechanism of hepatic edema?

    <p>Reduced plasma osmotic pressure</p> Signup and view all the answers

    Which of the following is a characteristic of lymphatic edema?

    <p>Impaired lymphatic drainage</p> Signup and view all the answers

    What is a common cause of edema in patients with liver cirrhosis?

    <p>Reduced plasma osmotic pressure</p> Signup and view all the answers

    Which of the following can cause hypersensitivity edema?

    <p>Allergic reaction</p> Signup and view all the answers

    What is the consequence of an imbalance between hydrostatic and osmotic forces in vessels?

    <p>Edema</p> Signup and view all the answers

    What is the role of lymphatic vessels in the body?

    <p>To remove excess fluid</p> Signup and view all the answers

    Which of the following can cause edema in patients with cardiac disease?

    <p>All of the above</p> Signup and view all the answers

    What is the main characteristic of vision problems in certain individuals?

    <p>All of the above</p> Signup and view all the answers

    What is the nature of transudate?

    <p>Non-inflammatory edema</p> Signup and view all the answers

    What is the protein content of exudate?

    <p>More than 4g/dl</p> Signup and view all the answers

    What is the specific gravity of transudate?

    <p>Less than 1.015</p> Signup and view all the answers

    What is the fluid LDH/serum LDH ratio in exudate?

    <p>More than 0.6</p> Signup and view all the answers

    What is the characteristic of exudate in terms of fibrinogen?

    <p>High fibrinogen</p> Signup and view all the answers

    What is the definition of transudate?

    <p>Filtrate of blood or plasma; no increased in permeability</p> Signup and view all the answers

    What is the nature of exudate?

    <p>Inflammatory edema</p> Signup and view all the answers

    What is the LDH level in exudate?

    <p>High</p> Signup and view all the answers

    What is the main cause of cardiac edema?

    <p>Increased hydrostatic pressure</p> Signup and view all the answers

    Which type of edema is associated with allergic reactions?

    <p>Hypersensitivity edema</p> Signup and view all the answers

    What is the main characteristic of renal edema?

    <p>Sodium and water retention</p> Signup and view all the answers

    Which type of edema is caused by impaired lymphatic drainage?

    <p>Lymphatic edema</p> Signup and view all the answers

    What is the main cause of hepatic edema?

    <p>Liver cirrhosis</p> Signup and view all the answers

    Which type of edema is associated with protein-losing enteropathy?

    <p>Nutritional edema</p> Signup and view all the answers

    What is the main difference between cardiac edema and renal edema?

    <p>Cause of edema</p> Signup and view all the answers

    Which type of edema is more likely to cause respiratory distress?

    <p>Cardiac edema</p> Signup and view all the answers

    What is the common characteristic of cardiac edema, renal edema, and hepatic edema?

    <p>Generalized edema</p> Signup and view all the answers

    What is the main cause of cardiac edema?

    <p>Congestive cardiac failure</p> Signup and view all the answers

    Which type of edema is characterized by periorbital edema and pitting edema?

    <p>Renal edema</p> Signup and view all the answers

    What is the term for the abnormal accumulation of fluid in the pleural cavity?

    <p>Hydrothorax</p> Signup and view all the answers

    What is the effect of pulmonary edema on normal ventilatory function?

    <p>Impaired oxygen diffusion</p> Signup and view all the answers

    What is the characteristic of brain edema?

    <p>Generalized swelling of the brain</p> Signup and view all the answers

    What is the term for the swelling of the part of the optic nerve inside the eye?

    <p>Papilloedema</p> Signup and view all the answers

    What is the clinical significance of papilloedema?

    <p>Precious clinical sign of increased intracranial pressure</p> Signup and view all the answers

    What is the effect of subcutaneous edema in cardiac and renal failure?

    <p>Impairs wound healing and clearance of infection</p> Signup and view all the answers

    What is the gross characteristic of pulmonary edema?

    <p>The lungs are 2-3 times larger</p> Signup and view all the answers

    What is a type of generalized edema that is caused by liver disease?

    <p>Hepatic edema</p> Signup and view all the answers

    Which of the following types of edema is caused by obstruction of the lymphatic vessels?

    <p>Lymphatic edema</p> Signup and view all the answers

    What is the cause of hypersensitivity edema?

    <p>Allergic reaction</p> Signup and view all the answers

    Which of the following types of edema is caused by kidney disease?

    <p>Renal edema</p> Signup and view all the answers

    What is the primary cause of cardiac edema?

    <p>Increased hydrostatic pressure</p> Signup and view all the answers

    What type of edema is caused by protein losing enteropathy?

    <p>Generalized edema</p> Signup and view all the answers

    What is the characteristic of edema caused by hypersensitivity?

    <p>Allergic reaction</p> Signup and view all the answers

    Which of the following types of edema is caused by venous obstruction?

    <p>Edema of venous obstruction</p> Signup and view all the answers

    What is the classification of edema caused by liver disease?

    <p>Generalized edema</p> Signup and view all the answers

    What is the primary cause of edema in cardiac failure?

    <p>Increased hydrostatic pressure</p> Signup and view all the answers

    What is the underlying cause of edema in lymphatic obstruction?

    <p>Impaired lymphatic flow</p> Signup and view all the answers

    What is the primary mechanism of edema formation in renal disease?

    <p>Renal retention of salt and water</p> Signup and view all the answers

    What is the term for the abnormal accumulation of fluid in the pleural cavity?

    <p>Hydrothorax</p> Signup and view all the answers

    What is the consequence of an increase in capillary hydrostatic pressure?

    <p>Increased fluid movement out of vessels</p> Signup and view all the answers

    What is the primary cause of cardiac edema?

    <p>Congestive cardiac failure</p> Signup and view all the answers

    What is the result of a decrease in plasma osmotic pressure?

    <p>Increased fluid movement out of vessels</p> Signup and view all the answers

    What is the characteristic of Renal edema?

    <p>Periorbital edema and pitting edema</p> Signup and view all the answers

    What is the primary mechanism of edema formation in hepatic disease?

    <p>Decreased plasma osmotic pressure</p> Signup and view all the answers

    What is the consequence of an impairment in lymphatic flow?

    <p>Accumulation of fluid in the interstitium</p> Signup and view all the answers

    What is the term for the swelling of the part of the optic nerve inside the eye?

    <p>Papilloedema</p> Signup and view all the answers

    What is the result of an imbalance between hydrostatic and osmotic forces in vessels?

    <p>Increased fluid movement out of vessels</p> Signup and view all the answers

    What is the effect of pulmonary edema on normal ventilatory function?

    <p>Impairs normal ventilatory function</p> Signup and view all the answers

    What is the significance of subcutaneous edema in cardiac and renal failure?

    <p>Signals the underlying disease</p> Signup and view all the answers

    What is the primary cause of edema in hypersensitivity reactions?

    <p>Increased capillary permeability</p> Signup and view all the answers

    What is the characteristic of edema fluid in alveolar spaces in pulmonary edema?

    <p>Frothy and serosanguinous</p> Signup and view all the answers

    What is the effect of brain edema on the brain substance?

    <p>Herniates through the foramen magnum</p> Signup and view all the answers

    What is the significance of papilloedema in clinical practice?

    <p>It is a sign of increased intracranial pressure</p> Signup and view all the answers

    What is the consequence of impaired venous return in the body?

    <p>Edema</p> Signup and view all the answers

    Which of the following is a cause of reduced plasma osmotic pressure?

    <p>Protein-losing glomerulopathies</p> Signup and view all the answers

    What is the result of lymphatic obstruction?

    <p>Edema</p> Signup and view all the answers

    Which of the following is a cause of renal edema?

    <p>Excessive salt intake with renal insufficiency</p> Signup and view all the answers

    What is the consequence of cardiac failure?

    <p>Edema</p> Signup and view all the answers

    Which of the following is a cause of hepatic edema?

    <p>Liver cirrhosis</p> Signup and view all the answers

    What is the result of excessive sodium retention?

    <p>Edema</p> Signup and view all the answers

    Which of the following is a cause of lymphatic edema?

    <p>Lymphatic obstruction</p> Signup and view all the answers

    What is the consequence of increased hydrostatic pressure?

    <p>Edema</p> Signup and view all the answers

    What is the characteristic of exudate in terms of protein content?

    <p>High (more than 4g/dl)</p> Signup and view all the answers

    What is the main difference between transudate and exudate?

    <p>Nature of edema (inflammatory or non-inflammatory)</p> Signup and view all the answers

    What is the characteristic of transudate in terms of specific gravity?

    <p>Low (less than 1.015)</p> Signup and view all the answers

    What is the fluid LDH/serum LDH ratio in exudate?

    <p>More than 0.6</p> Signup and view all the answers

    What is the characteristic of transudate in terms of fibrinogen?

    <p>Low fibrinogen content</p> Signup and view all the answers

    What is the initial vision problem in certain individuals?

    <p>Short flickers of gray vision</p> Signup and view all the answers

    What is the nature of exudate?

    <p>Inflammatory edema</p> Signup and view all the answers

    What is the definition of transudate?

    <p>Filtrate of blood or plasma; no increased permeability</p> Signup and view all the answers

    What is the protein content of exudate?

    <p>High (more than 4g/dl)</p> Signup and view all the answers

    Study Notes

    Edema

    • Edema is an abnormal accumulation of fluid in tissue spaces or body cavities (effusion).

    Classification

    • Edema can be classified into two types: Generalized edema and Local edema
    • Generalized edema includes:
      • Cardiac edema
      • Renal edema
      • Nutritional edema
      • Protein-losing enteropathy
      • Hepatic edema
      • Myxoedema
      • Unexplained edema
    • Local edema includes:
      • Acute inflammatory edema
      • Hypersensitivity (allergic) edema
      • Edema of venous obstruction
      • Lymphatic edema

    Pathogenesis

    • Edema occurs due to:
      • Increase in intravascular hydrostatic pressure
      • A fall in colloid oncotic pressure in plasma
      • An impairment in the flow of lymph
      • Renal retention of salt and water

    Pathogenesis of Different Types of Edema

    • Increased hydrostatic pressure:
      • Impaired venous return
      • Arteriolar dilation
    • Reduced plasma osmotic pressure (hypoproteinemia):
      • Protein-losing glomerulopathies (nephrotic syndrome)
      • Liver cirrhosis (ascites)
      • Malnutrition
      • Protein-losing gastroenteropathy
    • Lymphatic obstruction:
      • Inflammatory
      • Neoplastic
      • Postsurgical
      • Post-irradiation
    • Sodium retention:
      • Excessive salt intake with renal insufficiency
      • Increased tubular reabsorption of sodium
      • Renal hypoperfusion
      • Increased renin-angiotensin-aldosterone secretion
    • Inflammation:
      • Acute inflammation
      • Chronic inflammation
      • Angiogenesis

    Terminology

    • Anasarca: generalized edema producing marked swelling of subcutaneous tissue
    • Hydrothorax: abnormal accumulation of fluid in pleural cavity (pleural effusion)
    • Hydropericardium: abnormal accumulation of fluid in pericardial cavity (pericardial effusion)
    • Hydroperitoneum: abnormal accumulation of fluid in peritoneal cavity (ascites)

    Morphology of Edema

    • Cardiac edema:
      • Mainly due to congestive cardiac failure
      • Dependent edema: subcutaneous edema of lower parts of the body or sacral edema
    • Renal edema:
      • Acute glomerulonephritis
      • Nephrotic syndrome
      • Chronic glomerulonephritis
      • Periorbital edema and pitting edema

    Clinical Significance of Serious Complications of Edema

    • Pulmonary edema:
      • Causes: left ventricular failure, renal failure, adult respiratory distress syndrome, pulmonary infections, hypersensitivity reactions
      • Gross: lungs are 2-3 times larger, edema is confined to lower lobes, all lobes may be involved in advanced cases
      • Histology: edema fluid first accumulates about septal arteries with widening of septa, then proteinaceous fluid escapes into alveolar spaces
    • Papilloedema:
      • Swelling of the part of the optic nerve inside the eye (optic disc) due to raised intracranial pressure
      • Typically presents as bilateral disc edema
    • Brain edema (Cerebral edema):
      • Localized: at sites of injury, abscess, or neoplasm
      • Generalized: encephalitis, hypertensive crisis, obstruction to venous flow
      • Gross: brain is swollen with narrowing of sulci and flattening of gyri, white matter may appear soft and gelatinous
      • Clinical significance: impaired normal ventilatory function, increased ICP, vision problems

    Transudate and Exudate

    • Transudate:
      • Filtrate of blood or plasma
      • No increased permeability
      • Low protein content (less than 3g/dl)
      • Low specific gravity (less than 1.015)
      • Low LDH
    • Exudate:
      • Oedema associated with increased vascular permeability
      • High protein content (more than 4g/dl)
      • High specific gravity (more than 1.018)
      • High LDH

    Edema

    • Definition: Abnormal accumulation of fluid in the tissue spaces (edema) or body cavities (effusion)
    • Classification:
      • Generalized edema
      • Local edema
      • Types of edema:
        • Cardiac edema
        • Renal edema
        • Nutritional edema
        • Edema of venous obstruction
        • Lymphatic edema
        • Hepatic edema
        • Myxoedema

    Body Composition

    • 60% of body weight is water
    • 2/3 of water is intracellular
    • Remainder is in extracellular compartments, mostly in the interstitium

    Pathogenesis of Edema

    • Increase in intravascular hydrostatic pressure
    • Fall in colloid oncotic pressure in plasma
    • Impairment in the flow of lymph
    • Renal retention of salt and water

    Lymphatics

    • Lymphatic vessels remove excess fluid from tissues
    • If lymphatic capacity is exceeded, tissue edema results

    Causes of Edema

    • Increased hydrostatic pressure:
      • Impaired venous return
      • Arteriolar dilation
    • Reduced plasma osmotic pressure (hypoproteinemia):
      • Protein-losing glomerulopathies
      • Liver cirrhosis
      • Malnutrition
      • Protein-losing gastroenteropathy
    • Lymphatic obstruction:
      • Inflammatory
      • Neoplastic
      • Postsurgical
      • Post-irradiation
    • Sodium retention:
      • Excessive salt intake with renal insufficiency
      • Increased tubular reabsorption of sodium
      • Renal hypoperfusion
      • Increased renin-angiotensin-aldosterone secretion
    • Inflammation:
      • Acute inflammation
      • Chronic inflammation
      • Angiogenesis

    Types of Edema

    • Anasarca: generalized edema producing marked swelling of subcutaneous tissue
    • Hydrothorax: abnormal accumulation of fluid in the pleural cavity
    • Hydropericardium: abnormal accumulation of fluid in the pericardial cavity
    • Hydroperitoneum: abnormal accumulation of fluid in the peritoneal cavity

    Morphology of Edema

    • Cardiac edema: mainly due to congestive cardiac failure
    • Renal edema:
      • Periorbital edema and pitting edema
      • Acute glomerulonephritis
      • Nephrotic syndrome
      • Chronic glomerulonephritis

    Clinical Significance of Edema

    • Pulmonary edema:
      • Causes: left ventricular failure, renal failure, adult respiratory distress syndrome, pulmonary infections, hypersensitivity reactions
      • Gross: lungs are 2-3 times larger, edema is confined to lower lobes
      • Histology: edema fluid first accumulates about septal arteries, then escapes into alveolar spaces
    • Papilloedema:
      • Swelling of the optic nerve inside the eye due to raised intracranial pressure
      • Bilateral disc edema
      • Optic nerve is typically swollen and hyperemic
    • Brain edema:
      • Localized: at sites of injury, abscess, or neoplasm
      • Generalized: encephalitis, hypertensive crisis, obstruction to venous flow
      • Gross: brain is swollen with narrowing of sulci and flattening of gyri
      • Histology: white matter may appear soft and gelatinous, peripheral gray matter is widened, ventricles are compressed

    Effects of Edema

    • Subcutaneous edema:
      • Impairs wound healing and clearance of infection
      • Signals underlying disease in cardiac and renal failure
    • Pulmonary edema:
      • Impaired normal ventilatory function
      • Fluid collects in alveolar septa around capillaries, impeding oxygen diffusion
      • Edema fluid in alveolar spaces creates a favorable environment for bacterial infections
    • Edema of brain:
      • Increased intracranial pressure, leading to headache, projectile vomiting, and convulsive seizure
      • Serious and rapidly fatal, brain substance can herniate through the foramen magnum, brain stem vascular supply can be compressed, and can injure medullary centers and death

    Differences between Transudate and Exudate

    • Definition:
      • Exudate: oedema associated with increased vascular permeability
      • Transudate: filtrate of blood or plasma; no increased permeability
    • Nature:
      • Exudate: inflammatory edema
      • Transudate: non-inflammatory edema
    • Protein content:
      • Exudate: high (> 4g/dl)
      • Transudate: low (< 3g/dl)
    • Specific gravity:
      • Exudate: high (> 1.018)
      • Transudate: low (< 1.015)
    • LDH:
      • Exudate: high
      • Transudate: low
      • Fluid LDH/serum LDH ratio:
        • Exudate: > 0.6
        • Transudate: < 0.6

    Inflammation

    • Inflammation can be acute or chronic
    • Angiogenesis is a process related to inflammation

    Edema

    • Definition: Abnormal accumulation of fluid in tissue spaces or body cavities
    • Classification:
      • Generalized edema
      • Local edema
      • Types of edema:
        • Cardiac edema
        • Renal edema
        • Nutritional edema
        • Protein losing enteropathy
        • Hepatic edema
        • Myxoedema
        • Unexplained edema

    Pathogenesis of Edema

    • Edema occurs due to:
      • Increase in intravascular hydrostatic pressure
      • A fall in colloid oncotic pressure in plasma
      • An impairment in the flow of lymph
      • Renal retention of salt and water

    Factors Affecting Edema

    • Increased hydrostatic pressure:
      • Impaired venous return
      • Congestive heart failure
      • Constrictive pericarditis
      • Ascites (liver cirrhosis)
      • Venous obstruction or compression
      • Arteriolar dilation
      • Heat
      • Neurohumoral dysregulation
    • Reduced plasma osmotic pressure (hypoproteinemia):
      • Protein-losing glomerulopathies (nephrotic syndrome)
      • Liver cirrhosis (ascites)
      • Malnutrition
      • Protein-losing gastroenteropathy
    • Lymphatic obstruction:
      • Inflammatory
      • Neoplastic
      • Postsurgical
      • Post-irradiation
    • Sodium retention:
      • Excessive salt intake with renal insufficiency
      • Increased tubular reabsorption of sodium
      • Renal hypoperfusion
      • Increased renin-angiotensin-aldosterone secretion

    Types of Edema

    • Anasarca: generalized edema producing marked swelling of subcutaneous tissue
    • Hydrothorax: abnormal accumulation of fluid in pleural cavity
    • Hydropericardium: abnormal accumulation of fluid in pericardial cavity
    • Hydroperitoneum: abnormal accumulation of fluid in peritoneal cavity (ascites)

    Morphology of Edema

    • Cardiac edema:
      • Mainly due to congestive cardiac failure
      • Dependent edema: subcutaneous edema of lower parts of the body or sacral edema
    • Renal edema:
      • Acute glomerulonephritis
      • Nephrotic syndrome
      • Chronic glomerulonephritis
      • Periorbital edema and pitting edema

    Pulmonary Edema

    • Causes:
      • Left ventricular failure
      • Renal failure
      • Adult respiratory distress syndrome
      • Pulmonary infections
      • Hypersensitivity reactions
    • Gross:
      • Lungs are 2-3 times larger
      • Edema is confined to lower lobes
      • For advanced cases, all lobes may be involved
      • On section, free escape of frothy serosanguinous fluid presenting a mixture of air, edema fluid, and extravasated red cells
    • Histology:
      • Edema fluid first accumulates about septal arteries with widening of septa
      • Then, proteinaceous fluid escapes into alveolar spaces, marked by a granular pink coagulate within spaces

    Papilloedema

    • Swelling of the part of the optic nerve inside the eye (optic disc) due to raised intracranial pressure
    • Typically in bilateral disc edema
    • Optic nerve is typically swollen and hyperemic

    Brain Edema (Cerebral Edema)

    • Localized: at sites of injury, abscess, or neoplasm
    • Generalized: encephalitis, hypertensive crisis, obstruction to venous flow
    • Gross:
      • Brain is swollen with narrowing of sulci and flattening of gyri
      • On section, white matter may appear soft and gelatinous
      • Peripheral gray matter is widened
      • Ventricles are compressed

    Clinical Significance of Edema

    • Subcutaneous edema:
      • Signals underlying disease
      • Impairs wound healing
      • Impairs clearance of infection
    • Pulmonary edema:
      • Impairs normal ventilatory function
      • Fluid collects in alveolar septa around capillaries and impedes oxygen diffusion
      • Edema fluid in alveolar spaces creates a favorable environment for bacterial infections
    • Edema of brain:
      • Increased ICP: headache, projectile vomiting, and convulsive seizure
      • Serious and rapidly fatal, brain substance can herniate through the foramen magnum, brain stem vascular supply can be compressed, can injure the medullary centers and death

    Differences between Transudate and Exudate

    • Features:
      • Exudate:
        • Oedema associated with increased vascular permeability
        • High protein content (more than 4g/dl)
        • High fibrinogen
        • Specific gravity: high (more than 1.018)
        • LDH: high
      • Transudate:
        • Filtrate of blood or plasma; no increased in permeability
        • Low protein content (less than 3g/dl)
        • Mainly albumin, low fibrinogen
        • Specific gravity: low (less than 1.015)
        • LDH: low

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    Edema - MBBS Block 2 PDF

    Description

    This quiz covers the definition, classification, and pathogenesis of edema, as well as its clinical significance and complications, including pulmonary, papilloedema, and cerebral edema.

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