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Leicester Warwick Medical School. Tissue Fluid Formation and Oedema Dr. Kevin West kpw2@le.ac.uk Department of Pathology. Tissue Fluid Formation - Objectives 1. Control of normal interstitial fluid formation Definition of oedema

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Leicester Warwick Medical School

Tissue Fluid Formation and Oedema

Dr. Kevin West

kpw2@le.ac.uk

Department of Pathology

tissue fluid formation objectives 1
Tissue Fluid Formation - Objectives 1
  • Control of normal interstitial fluid formation
  • Definition of oedema
  • Definition of pleural effusion, pericardial effusion and ascites
  • Distinction between transudate and exudate
tissue fluid formation objectives 2
Tissue Fluid Formation - Objectives 2
  • Common causes and mechanisms of development of oedema
  • Pulmonary oedema - causes and effects
  • Cerebral oedema - causes and effects
water
Water
  • Major body component
  • 60% male 50% female
  • 3 compartments
    • intracellular
    • extracellular interstitial
    • extracellular intravascular
osmolality
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
Control of Interstitial Fluid
  • Hydrostatic pressure
  • Oncotic pressure
  • Endothelial integrity
  • Lymphatic system
interstitial fluid
Interstitial Fluid
  • Fluid between cells
  • Derived from capillaries
  • Solutes similar to plasma except for protein content
movement of fluid across capillaries
Movement Of Fluid Across Capillaries
  • Capillary (hydrostatic) pressure
  • Interstitial fluid (hydrostatic) pressure
  • Plasma oncotic pressure
  • Interstitial fluid oncotic pressure
capillary pressure
Capillary Pressure
  • Forces fluid from capillary to interstitium
  • Arterial end higher than venous end
  • Arterial approx. 30 mmHg
  • Venous approx. 10 mm Hg
interstitial fluid pressure
Interstitial Fluid Pressure
  • Maybe positive or negative
  • Negative - forces fluid into interstitium
  • Positive - forces fluid into capillary
  • Approx. minus 3 mm Hg in loose connective tissue
  • Higher in denser connective tissue
plasma oncotic pressure
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
Interstitial Oncotic Pressure
  • A small amount of protein is present in the interstitium
  • Tends to force fluid out of capillary
  • Concentration is approx 40 % of that in plasma
  • Approx 8 mm Hg
balance sheet arterial
Outward

Cap. pressure 30

Negative interstitial

fluid pressure 3

Interstitial oncotic

pressure 8

Total 41

Inward

Plasma oncotic

pressure 28

Net out 13

(Filtration pressure)

Balance Sheet - Arterial
balance sheet venous
Outward

Cap. pressure 10

Negative interstitial

fluid pressure 3

Interstitial fluid

oncotic presure 8

Total 21

Inward

Plasma oncotic

pressure 28

Net inward 7

(Reabsorption

pressure)

Balance Sheet - Venous
lymphatic system
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
Oedema
  • Hydrostatic pressure
  • Oncotic pressure
  • Endothelial integrity
  • Lymphatic integrity
oedema1
Oedema
  • Definition

An increased volume of interstitial fluid in a tissue or organ

May be localised or generalised (systemic)

causes of oedema
Causes of Oedema
  • Raised capillary pressure
  • Reduced oncotic pressure
  • Endothelial damage (inflammation)
  • Impaired lymphatic drainage
raised capillary pressure
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
Reduced Oncotic Pressure
  • Renal disease
    • loss of albumin across glomerulus
  • Hepatic disease
    • inadequate albumin synthesis
  • Malnutrition
    • inadequate albumin synthesis
lymphatic obstruction
Lymphatic Obstruction
  • Tumours
  • Fibrosis
  • Inflammation
  • Surgery
  • Congenital abnormality
generalised oedema
Generalised Oedema
  • Congestive cardiac failure
  • Right ventricular failure
  • Renal disease
  • Liver disease
generalised oedema1
Generalised Oedema
  • Commonly causes swelling of ankles
  • Swelling may extend higher
  • Sacral oedema in recumbent patients
right ventricular failure
Right Ventricular Failure
  • Raised jugular venous pressure also seen
  • Enlarged liver also common due to congestion (nutmeg liver)
pulmonary oedema
Pulmonary Oedema
  • Usually caused by LVF
  • Raised pressure across pulmonary capillaries
  • Causes shortness of breath
  • Due to ischaemic heart disease or hypertension
congestive cardiac failure
Congestive Cardiac Failure
  • Combination of left and right ventricular failure
  • Common in ischaemic heart disease
  • Causes systemic and pulmonary oedema
cerebral 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
Fluid in Body Cavities
  • Pleural effusion
    • heart failure, inflammation, tumour
  • Pericardial effusion
    • inflammation, tumour
  • Ascites (peritoneal effusion)
    • cirrhosis, heart failure, tumour
ascites
Ascites
  • Most severe cases associated with
    • cirrhosis of the liver
    • intra-abdominal malignancy