Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West [email protected]...
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Transcript of Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West [email protected]...
Leicester Warwick Medical School
Tissue Fluid Formation and Oedema
Dr. Kevin [email protected]
Department of Pathology
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
Tissue Fluid Formation - Objectives 2
Common causes and mechanisms of development of oedema
Pulmonary oedema - causes and effects
Cerebral oedema - causes and effects
Water
Major body component60% male50% female3 compartments
intracellular extracellular interstitial extracellular intravascular
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
Control of Interstitial Fluid
Hydrostatic pressureOncotic pressureEndothelial integrityLymphatic system
Interstitial Fluid
Fluid between cellsDerived from capillariesSolutes similar to plasma except for
protein content
Movement Of Fluid Across Capillaries
Capillary (hydrostatic) pressure Interstitial fluid (hydrostatic) pressurePlasma oncotic pressure Interstitial fluid oncotic pressure
Capillary Pressure
Forces fluid from capillary to interstitiumArterial end higher than venous endArterial approx. 30 mmHgVenous approx. 10 mm Hg
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
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)
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
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)
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)
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
Oedema
Hydrostatic pressure Oncotic pressureEndothelial integrityLymphatic integrity
Oedema
Definition
An increased volume of interstitial fluid in a tissue or organ
May be localised or generalised (systemic)
Causes of Oedema
Raised capillary pressureReduced oncotic pressureEndothelial damage (inflammation) Impaired lymphatic drainage
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
Reduced Oncotic Pressure
Renal disease loss of albumin across glomerulus
Hepatic disease inadequate albumin synthesis
Malnutrition inadequate albumin synthesis
Lymphatic Obstruction
TumoursFibrosis InflammationSurgeryCongenital abnormality
Generalised Oedema
Congestive cardiac failureRight ventricular failureRenal diseaseLiver disease
Generalised Oedema
Commonly causes swelling of ankles
Swelling may extend higher
Sacral oedema in recumbent patients
Right Ventricular Failure
Raised jugular venous pressure also seen
Enlarged liver also common due to congestion (nutmeg liver)
Pulmonary Oedema
Usually caused by LVF Raised pressure across
pulmonary capillaries Causes shortness of
breath Due to ischaemic heart
disease or hypertension
Pulmonary Oedema
Congestive Cardiac Failure
Combination of left and right ventricular failure
Common in ischaemic heart diseaseCauses systemic and pulmonary
oedema
Cerebral Oedema
Causes increased intracranial pressure
Fatal if left untreated Generalised in
hypoxia, injury Surrounding other
lesions eg tumour, abscess
Fluid in Body Cavities
Pleural effusion heart failure, inflammation, tumour
Pericardial effusion inflammation, tumour
Ascites (peritoneal effusion) cirrhosis, heart failure, tumour
Pleural Effusion
Pericardial Effusion
Ascites
Most severe cases associated with cirrhosis of the liver intra-abdominal
malignancy
Superior Vena Cava Obstruction