水肿EDEMA-仁济临床医学院诊断学课件.pptVIP

EDEMA Leyi Gu Renal Division, Renji Hospital DEFINITION Expansion of the interstitial （间质）fluid volume. Weight gain precedes overt edema Massive and generalized edema is called anasarca（全身性水肿） Pitting (压凹性) and non-pitting (非压凹性) edema Edema Anatomy and pathophysilolgy 1/3 of total body water is extracellular space, and 2/3 is intracellular space; Extracellular space is composed of the intravascular plasma volume (25%) and the extravascular interstitial spaces (75%); Anatomy and pathophysilolgy Starling’s law: Extravascular and intravascular hydrostatic pressurs; Differences in oncotic pressures within the interstitial space and plasma; The permeability of the blood vessel wall. Reduced Plasma Osmotic Pressure Albumin is the serum protein MOST responsible for the maintenance of colloid osmotic pressure A decrease in osmotic pressure can result from increased protein loss or decreased protein synthesis Capillary Damage Damage to the capillary endothelium Increase its permeability and permits the transfer of protein into interstitial compartment Injury agents Drugs Viral/bacterial agents Thermal/mechanical trauma Immune Responsible for inflammatory edema Nonpitting localized redness and tenderness Clinical Causes of Edema Systemic edema Congestive heart failure Cirrhosis Nephrotic syndrome/other hypoalbuminemia Drug-induced Idiopathic Localized edema Venous/lymphatic obstruction Congestive heart failure Left-sided heart failure: shortness of breath with exertion and when lying down at night (orthophea,端坐呼吸)－－pulmonary edema Right-sided heart failure: swelling in the legs and feet－－peripheral edema The physician examining a patient who has congestive heart failure with fluid retention looks for certain signs: pitting edema; rales in the lungs, a gallop rhythm and distended neck veins. Nephrotic Syndrome/Hypoalbuminemic states The primary alteration: decreased colloid on