leicester warwick medical school tissue fluid formation and oedema dr. kevin west [email protected]...
TRANSCRIPT
![Page 1: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/1.jpg)
Leicester Warwick Medical School
Tissue Fluid Formation and Oedema
Dr. Kevin [email protected]
Department of Pathology
![Page 2: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/2.jpg)
![Page 3: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/3.jpg)
Tissue Fluid Formation - Objectives 1
Control of normal interstitial fluid formation
Definition of oedemaDefinition of pleural effusion, pericardial
effusion and ascitesDistinction between transudate and
exudate
![Page 4: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/4.jpg)
Tissue Fluid Formation - Objectives 2
Common causes and mechanisms of development of oedema
Pulmonary oedema - causes and effects
Cerebral oedema - causes and effects
![Page 5: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/5.jpg)
Water
Major body component60% male50% female3 compartments
intracellular extracellular interstitial extracellular intravascular
![Page 6: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/6.jpg)
Osmolality
Osmotic pressure related to number of particles of solute
Oncotic pressure describes osmotic pressure exerted by proteins
Effect of oncotic pressure small but significant across capillaries
![Page 7: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/7.jpg)
Control of Interstitial Fluid
Hydrostatic pressureOncotic pressureEndothelial integrityLymphatic system
![Page 8: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/8.jpg)
Interstitial Fluid
Fluid between cellsDerived from capillariesSolutes similar to plasma except for
protein content
![Page 9: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/9.jpg)
Movement Of Fluid Across Capillaries
Capillary (hydrostatic) pressure Interstitial fluid (hydrostatic) pressurePlasma oncotic pressure Interstitial fluid oncotic pressure
![Page 10: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/10.jpg)
Capillary Pressure
Forces fluid from capillary to interstitiumArterial end higher than venous endArterial approx. 30 mmHgVenous approx. 10 mm Hg
![Page 11: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/11.jpg)
Interstitial Fluid Pressure
Maybe positive or negativeNegative - forces fluid into interstitiumPositive - forces fluid into capillaryApprox. minus 3 mm Hg in loose
connective tissueHigher in denser connective tissue
![Page 12: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/12.jpg)
Plasma Oncotic Pressure
Proteins are the only solutes which do not pass freely between plasma and interstitium
Thus it is only proteins which exert a significant osmotic effect across capillary walls
Albumin is the most abundant plasma protein Approx 28 mm Hg (Albumin = 21.8)
![Page 13: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/13.jpg)
Interstitial Oncotic Pressure
A small amount of protein is present in the interstitium
Tends to force fluid out of capillaryConcentration is approx 40 % of that in
plasmaApprox 8 mm Hg
![Page 14: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/14.jpg)
Balance Sheet - Arterial
OutwardCap. pressure 30
Negative interstitial
fluid pressure 3
Interstitial oncotic
pressure 8
Total 41
InwardPlasma oncotic
pressure 28
Net out 13
(Filtration pressure)
![Page 15: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/15.jpg)
Balance Sheet - Venous
OutwardCap. pressure 10
Negative interstitial
fluid pressure 3
Interstitial fluid
oncotic presure 8
Total 21
InwardPlasma oncotic
pressure 28
Net inward 7
(Reabsorption
pressure)
![Page 16: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/16.jpg)
Lymphatic System
The lymphatic system provides a route for the transport of fluids and protein away from the interstitium
System of fine lymphatic channels throughout the body passing via lymph nodes to thoracic duct
Valves ensure one-way flow
![Page 17: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/17.jpg)
Oedema
Hydrostatic pressure Oncotic pressureEndothelial integrityLymphatic integrity
![Page 18: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/18.jpg)
Oedema
Definition
An increased volume of interstitial fluid in a tissue or organ
May be localised or generalised (systemic)
![Page 19: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/19.jpg)
Causes of Oedema
Raised capillary pressureReduced oncotic pressureEndothelial damage (inflammation) Impaired lymphatic drainage
![Page 20: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/20.jpg)
Raised Capillary Pressure
Cardiac failure right ventricular failure - systemic oedema left ventricular failure - pulmonary oedema congestive cardiac failure - both
Local venous obstruction deep vein thrombosis external compression SVC obstruction
![Page 21: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/21.jpg)
Reduced Oncotic Pressure
Renal disease loss of albumin across glomerulus
Hepatic disease inadequate albumin synthesis
Malnutrition inadequate albumin synthesis
![Page 22: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/22.jpg)
Lymphatic Obstruction
TumoursFibrosis InflammationSurgeryCongenital abnormality
![Page 23: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/23.jpg)
Generalised Oedema
Congestive cardiac failureRight ventricular failureRenal diseaseLiver disease
![Page 24: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/24.jpg)
Generalised Oedema
Commonly causes swelling of ankles
Swelling may extend higher
Sacral oedema in recumbent patients
![Page 25: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/25.jpg)
Right Ventricular Failure
Raised jugular venous pressure also seen
Enlarged liver also common due to congestion (nutmeg liver)
![Page 26: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/26.jpg)
Pulmonary Oedema
Usually caused by LVF Raised pressure across
pulmonary capillaries Causes shortness of
breath Due to ischaemic heart
disease or hypertension
![Page 27: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/27.jpg)
Pulmonary Oedema
![Page 28: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/28.jpg)
Congestive Cardiac Failure
Combination of left and right ventricular failure
Common in ischaemic heart diseaseCauses systemic and pulmonary
oedema
![Page 29: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/29.jpg)
Cerebral Oedema
Causes increased intracranial pressure
Fatal if left untreated Generalised in
hypoxia, injury Surrounding other
lesions eg tumour, abscess
![Page 30: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/30.jpg)
Fluid in Body Cavities
Pleural effusion heart failure, inflammation, tumour
Pericardial effusion inflammation, tumour
Ascites (peritoneal effusion) cirrhosis, heart failure, tumour
![Page 31: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/31.jpg)
Pleural Effusion
![Page 32: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/32.jpg)
Pericardial Effusion
![Page 33: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/33.jpg)
Ascites
Most severe cases associated with cirrhosis of the liver intra-abdominal
malignancy
![Page 34: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/34.jpg)
![Page 35: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/35.jpg)
Superior Vena Cava Obstruction
![Page 36: Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology](https://reader036.vdocument.in/reader036/viewer/2022062318/551ae4fc5503465e7d8b494f/html5/thumbnails/36.jpg)