【诊断学课件】症状学部分：水肿.pptVIP

Section III Common Symptoms(edema) Dr. Zhuoren Lu First Hospital Xian Jiaotong University B. Edema1. Definition: Edema is an excessive collection of fluid in the interstitial space. anasarca (dropsy): body edema; ascites: fluid located to peritoneal cavity; hydrothorax (pleural fluid or effusion): fluid located to the pleural space.2. Etiology: Edema results when increased hydrostatic pressure, decreased oncotic pressure or disrupted capillary permeability allows fluid to shift from the intravascular to the extravascular space. Interstitium _______ tissure pressure↓ oncotic pressure↑ _______ Lymphatics ――――――――――――――――――――――――― Capillary hydrostatic pressure↑ oncotic pressure↓ ――――――――――――――――――――――――― (1) Generalized edema: Commonly results from increased capillary hydrostatic pressure in congestive heart failure (cardiac edema), renal failure (renal edema) with excess sodium and water retention, expansion of intravascular volume by large volumes of fluid at a rate faster than kidney can excrete. (2) Localized edema: It is often due to increased capillary hydrostatic pressure in chronic venous insufficiency (deep vein thrombophlebitis). Less commonly, localized edema results from chronic lymphangitis, because the fluid return from the interstistium to the intravascular space is impaired by disrupted or obstructed lymphotics, or after lymph node resection. (3) Decreased oncotic pressure: When serum proteins are reduced (malnutrition, protein loss via kidney, liver dysfunction), there is insufficient oncotic pressure within the intravascular space to hold the fluid there. (4) Disruption of capillary endothelium: increased vessel permeability and leakage of protein and fluid from the intravascular space to the extravascular space, for example immunologic injury with hypersensitivity (generalized edema), infection, burn injury, trauma (localized edema). 3. Charac