资源描述
单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Edema,Zhou Yun,The Affiliated Hospital of Medical College of Ningbo University,Emergency Department,EdemaZhou Yun,1,Objective,Definition,Classification,Etiology and pathogenesis,Differential diagnosis,ObjectiveDefinition,2,Definition,The excessive accumulation of intestitial fluid,A pathologic process caused by diseases,Not accompanied with cellular edema,DefinitionThe excessive accumu,3,Classification,According to the range that edema fluid spreads to:,Generalized edema,Localized edema,According to the cause of edema:,Renal edema,Hepatic edema,Cardiac edema,Malnutritional edema,lymphedema,ClassificationAccording to the,4,Classification,Generalized edema:,Puffiness of the face,Indentation of the skin“,pitting edema,”,Ascites&Hydrothorax,Localized edeme,ClassificationGeneralized edem,5,Edema,Pitting edema,EdemaPitting edema,6,Ascites,Ascites,7,Etiology and pathogenesis,Imbalance of fluid exchange between plasma and interstitial compartment,Imbalance of fluid exchange between extra-and intra-body,Etiology and pathogenesis Imb,8,Imbalance of fluid exchange between plasma and interstitial compartment,Imbalance of fluid exchange be,9,Capillaries,Capillaries,10,Figure 7-7,Total Pressure Differences Inside and Outside Capillary,permeability,obstruction,Figure 7-7Total Pressure Diffe,11,1.Increased capillary blood pressure,Causes,:,Elevated plasma volume,Increased venous pressure,General venous pressure,i.e.congestive heart failure,Local venous pressure,i.e.venous thrombosis,Arteriolar dilation i.e.acute imflammation,Capillary blood pressure,Force driving fluid into interstitium,Formation of interstitial fluid,Edema,When greater than lymphatic compensatory return,1.Increased capillary blood p,12,2.Decreased plasma colloid osmotic pressure,Causes:,Plasma albumin content decrease,Decrease of protein production i.e.hepatic cirrhosis,malnutrition,Excessive loss of protein i.e.nephrosis,Elevated catabolism of protein i.e.chronic debilitating diseases,such as malignant tumor,Plasma colloid osmotic pressure,Force drawing water back into capillary from interstitium,Formation of interstitial fluid,Edema,When greater than lymphatic compensatory return,2.Decreased plasma colloid os,13,3.Obstruction of lymphtic,Causes,:,Blockage by cancer,Blockage by infection,especially with filarial,3.Obstruction of lymphticCaus,14,4.Increased capillary permeability,Capillary permeability,Filtration of more protein from capillary to interstitium,formation of interstitial fluid,Edema,When greater than lymphatic compensatory return,Plasma colloid osmotic pressure,Causes:,Inflammation,Infection,Burn,Allergic response,Trauma,Anoxia,Acidosis,4.Increased capillary permeab,15,Imbalance of fluid exchange between extra-and intra-body,-Renal retention of sodium and water,Imbalance of fluid exchange be,16,In normal condition,99-99.5%of total volume of sodium and water filtrated via glomeruli are reabsorbed by tubules.,60-70%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),In normal condition,99-99.5%,17,Retention of sodium and water,GFR(glomerular filtration rate)decreases,while tubular reabsorption does not decrease accordingly;,Tubular reabsorption increases,while GRF does not increased.,GFR,Reabsorption of proximal tubule,Reabsorption of distal tubule and collection tubule,G-T imbalance,Retention of sodium and waterG,18,Factors determining the GFR:,Filtration area and membrane permeability,Filtration pressure,Effective circulating blood volume or renal blood volume,1.Decreased glomerular filtration rate(GFR),Factors determining the GFR:1.,19,1.GFR,Causes,Extensive glomerular damage,Acute or chronic glomerulonephritis,Decrease of effective circulating blood volume,Congestive heart failure,nephrotic syndrome,Renal blood volume,Renin-angiotensin system,Sympathetic-adrenal medullary system,GFR,1.GFRCausesRenal blood volum,20,-,Increased reabsorption in proximal tubule,Increased filtration fraction(FF),2.,glomerular filtration rate(GFR),renal plasma flow(RPF),=,FF,GFR:amount of plasma filtered at glomerulus into Bowmans capsule,FF is the fraction of renal plasma flow that is filtered at the glomerulus,In normal condition:FF:20%,-Increased reabsorption in p,21,The protein concentration in the plasma entering the peritubular capillaries increases,The peritubular capillary oncotic pressure increases,Enhancing fluid reabsorption from the renal interstitial space to the capillary,Decreases renal interstitial pressure,favoring reabsorption across the tubular epithelium and minimizing back flux from the renal interstitial space to the tubule lumen.,Reabsorption in proximal tubule,Increased FF,Increased FF make elevated reabsorption of proximal tubule,The protein concentration in t,22,Causes of FF increasing,Congestive heart failure
展开阅读全文