EDEMA

PWM Olly Indrajani

2012
 Edema

= Increased fluid in the interstitial tissue

spaces

 Anasarca:
Generalized edema + profound subcutaneous
swelling
 Anatomy and pathophysiology

• 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 pathophysiology
Starling’s law:
• Extravascular and intravascular hydrostatic pressures;
• Differences in oncotic pressures within the interstitial
space and plasma;
• The permeability of the blood vessel wall.
• Hydrostatic Pressure (capillary - tissue) - Oncotic
pressure (capillary - tissue) = net fluid movement out
of capillary into interstitium.
 Pathophysiology
1. Increased Hydrostatic Pressure
Most common cause - Congestive heart failure,
others - DVT

2. Decreased oncotic or osmotic Pressure

Nephrotic syndrome, Cirrhosis

3. Sodium retention
Renal failure, Renin- Angiotensin – Aldosterone

4. Inflammation
Acute or chronic,
Edema - Pathogenesis
Type of edema 
exudate in inflammatory and
transudate in non inflamatory.
conditions

Morphology 
Mostly involve - Subcutaneous
tissues
- Lung, Brain
Subcutaneous
– can be pitting (Cardiac or renal disorders) or
non – pitting ( Thyroid disorders)
Pitting edema can be
-independent parts (at ankles in ambulatory and
Back or sacrum in bedridden patients- cardiac
disorders)
-nondependent area ( periorbital in renal disorders)
Lung or Pulmonary edema –
Most common in Left Heart failure, lungs are wet and
heavy, pink frothy fluid in alveoli
Cerebral edema
– localized ( Abscess, Neoplasms) /
- Generalized ( Encephalitis), narrowed sulci and
distended gyri, fatal if edema develops rapidly
(due to cerebellar or Tonsillar
 Edema

Pitting edema Non-pitting edema

 Clinical Causes of Edema
Systemic edema Localized edema

• Congestive heart failure • Venous/lymphatic

• Cirrhosis Obstruction (lymphedema)
• Nephrotic syndrome/other • myxedema
hypoalbuminemia
• Drug-induced
• Idiopathic
 Systemic Edema
Congestive heart failure
 Congestive heart failure
• Left-sided heart failure: shortness of breath with exertion and
when lying down at night (orthophea)－－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.
Systemic Edema
 Nephrotic Syndrome /Hypoalbuminemic states

• The primary alteration: decreased colloid

oncotic pressure
protein loss in the urine
severe nutritional deficiency
protein loss enteropathy
congenital hypoalbuminemia
liver cirrhosis

• Promotes fluid move into the interstitium

• Causes hypovolemia
salt/water retention activation RAA axis etc
 Idiopathic Edema

• Diurnal alterations in weight occurring

with orthostatic retention of sodium and
water
• Increase in capillary permeability
fluctuate in severity aggravated by hot
weather
• Reduction in plasma volume in this
condition with secondary activation of
the RAA system
 Drug-induced edema
Nonsteroidal anti-inflammatory drugs
Antihypertensive agents
Direct arterial/arteriolar vasodilators
Calcium channel antagonists
α-Adrenergic antagonists
Steroid hormones
Glucocorticoids Anabolic steroids
Estrogens Progestines
Cyclosporine
Growth hormone
Immunotherapies
Interleukin 2 OKT3 monoclonal antibody
 Localized edema

• Inflammation
• Venous/lymphatic obstruction
• Chronic lymphangitis
• Resection of regional lymph
nodes
• Filariasis
 Clinical significance

In Almost disorders causing edema,

excess sodium re-absorption ( via
Renin Angiotensin-Aldosterone
pathway) is key factor

Treatment 
salt intake,
Diuretics (↑sodium Excretion),
Aldosterone antagonists