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Edema

Not to be confused with Adema.


Dropsy redirects here. For other uses, see Dropsy
(disambiguation).
Edema (also oedema, dropsy, and hydropsy) (/dim/;
Greek odma, swelling)
[1]
is an abnormal ac-
cumulation of uid in the interstitium, located beneath
the skin and in the cavities of the body. Clinically, edema
is manifest as swelling; the amount of interstitial uid is
determined by the balance of uid homeostasis, and the
increased secretion of uid into the interstitium, or the
impaired removal of the uid can cause edema.
1 Classications
Cutaneous edema is referred to as pitting when, after
pressure is applied to a small area, the indentation per-
sists after the release of the pressure. Peripheral pitting
edema, as shown in the illustration, is the more common
type, resulting from water retention. It can be caused by
systemic diseases, pregnancy in some women, either di-
rectly or as a result of heart failure, or local conditions
such as varicose veins, thrombophlebitis, insect bites, and
dermatitis.
Non-pitting edema is observed when the indentation does
not persist. It is associated with such conditions as
lymphedema, lipedema, and myxedema.
Edema caused by malnutrition denes kwashiorkor, an
acute form of childhood protein-energy malnutrition
characterized by edema, irritability, anorexia, ulcerating
dermatoses, and an enlarged liver with fatty inltrates.
The insucient protein consumption, but with sucient
calorie intake, distinguishes it from marasmus. Kwash-
iorkor cases occur in areas of famine or poor food supply.
Cases in the developed world are rare.
1.1 Generalized
A rise in hydrostatic pressure occurs in cardiac failure. A
fall in osmotic pressure occurs in nephrotic syndrome and
liver failure.
[3]
Causes of edema which are generalized to the whole body
can cause edema in multiple organs and peripherally.
For example, severe heart failure can cause pulmonary
edema, pleural eusions, ascites and peripheral edema.
In rare cases, a Parvovirus B19 infection may cause gen-
eralized edemas.
[4]
Although a lowplasma oncotic pressure is widely cited for
the edema of nephrotic syndrome, most physicians note
that the edema may occur before there is any signicant
protein in the urine (proteinuria) or fall in plasma protein
level. Most forms of nephrotic syndrome are due to bio-
chemical and structural changes in the basement mem-
brane of capillaries in the kidney glomeruli, and these
changes occur, if to a lesser degree, in the vessels of most
other tissues of the body. Thus the resulting increase
in permeability that leads to protein in the urine can ex-
plain the edema if all other vessels are more permeable
as well.
[5]
As well as the previously mentioned conditions, edemas
often occur during the late stages of pregnancy in some
women. This is more common with those of a history
of pulmonary problems or poor circulation also being
intensied if arthritis is already present in that particu-
lar woman. Women that already have arthritic problems
most often have to seek medical help for pain caused from
over-reactive swelling. Edemas that occur during preg-
nancy are usually found in the lower part of the leg, usu-
ally from the calf down.
1.2 Organ-specic
An edema will occur in specic organs as part of in-
ammations, tendinitis or pancreatitis, for instance. Cer-
tain organs develop edema through tissue specic mech-
anisms.
Examples of edema in specic organs:
Cerebral edema is extracellular uid ac-
cumulation in the brain. It can occur in
toxic or abnormal metabolic states and
conditions such as systemic lupus or re-
duced oxygen at high altitudes. It causes
drowsiness or loss of consciousness.
Pulmonary edema occurs when the pres-
sure in blood vessels in the lung is raised
because of obstruction to the removal of
blood via the pulmonary veins. This is
usually due to failure of the left ventricle
of the heart. It can also occur in altitude
sickness or on inhalation of toxic chem-
icals. Pulmonary edema produces short-
ness of breath. Pleural eusions may oc-
1
2 2 MECHANISM
cur when uid also accumulates in the
pleural cavity.
Edema may also be found in the cornea of
the eye with glaucoma, severe conjunc-
tivitis or keratitis or after surgery. Suer-
ers may perceive coloured haloes around
bright lights.
Edema surrounding the eyes is called pe-
riorbital edema or eye puness. The
periorbital tissues are most noticeably
swollen immediately after waking, per-
haps as a result of the gravitational redis-
tribution of uid in the horizontal posi-
tion.
Common appearances of cutaneous
edema are observed with mosquito bites,
spider bites, bee stings (wheal and are),
and skin contact with certain plants such
as Poison Ivy or Western Poison Oak,
[6]
the latter of which are termed contact
dermatitis.
Another cutaneous form of edema is
myxedema, which is caused by increased
deposition of connective tissue. In
myxedema (and a variety of other rarer
conditions) edema is caused by an in-
creased tendency of the tissue to hold
water within its extracellular space. In
myxedema this is because of an in-
crease in hydrophilic carbohydrate-rich
molecules (perhaps mostly hyaluronan)
deposited in the tissue matrix. Edema
forms more easily in dependent areas in
the elderly (sitting in chairs at home or
on aeroplanes) and this is not well un-
derstood. Estrogens alter body weight in
part through changes in tissue water con-
tent. There may be a variety of poorly
understood situations in which transfer of
water from tissue matrix to lymphatics is
impaired because of changes in the hy-
drophilicity of the tissue or failure of the
'wicking' function of terminal lymphatic
capillaries.
In lymphedema abnormal removal of in-
terstitial uid is caused by failure of
the lymphatic system. This may be
due to obstruction from, for exam-
ple, pressure from a cancer or enlarged
lymph nodes, destruction of lymph ves-
sels by radiotherapy, or inltration of
the lymphatics by infection (such as
elephantiasis). It is most commonly due
to a failure of the pumping action of
muscles due to immobility, most strik-
ingly in conditions such as multiple scle-
rosis, or paraplegia. It has been suggested
that the edema that occurs in some peo-
ple following use of aspirin-like cyclo-
oxygenase inhibitors such as ibuprofen or
indomethacin may be due to inhibition of
lymph heart action.
Hydrops fetalis is a condition of the fe-
tus characterized by an accumulation of
uid, or edema, in at least two fetal com-
partments.
2 Mechanism
Six factors can contribute to the formation of edema:
1. increased hydrostatic pressure;
2. reduced oncotic pressure within blood vessels;
3. increased tissue oncotic pressure;
4. increased blood vessel wall permeability e.g.
inammation;
5. obstruction of uid clearance in the lymphatic sys-
tem;
6. changes in the water retaining properties of the tis-
sues themselves. Raised hydrostatic pressure of-
ten reects retention of water and sodium by the
kidney.
[7]
Generation of interstitial uid is regulated by the forces
of the Starling equation.
[8]
Hydrostatic pressure within
blood vessels tends to cause water to lter out into the
tissue. This leads to a dierence in protein concentration
between blood plasma and tissue. As a result the oncotic
pressure of the higher level of protein in the plasma tends
to draw water back into the blood vessels from the tissue.
Starlings equation states that the rate of leakage of uid is
determined by the dierence between the two forces and
also by the permeability of the vessel wall to water, which
determines the rate of ow for a given force imbalance.
Most water leakage occurs in capillaries or post capillary
venules, which have a semi-permeable membrane wall
that allows water to pass more freely than protein. (The
protein is said to be reected and the eciency of re-
ection is given by a reection constant of up to 1.) If
the gaps between the cells of the vessel wall open up then
permeability to water is increased rst, but as the gaps in-
crease in size permeability to protein also increases with
a fall in reection coecient.
3
Changes in the variables in Starlings equation can con-
tribute to the formation of edemas either by an increase in
hydrostatic pressure within the blood vessel, a decrease in
the oncotic pressure within the blood vessel or an increase
in vessel wall permeability. The latter has two eects. It
allows water to owmore freely and it reduces the oncotic
pressure dierence by allowing protein to leave the vessel
more easily.
3 Edema safety factors
Three major safety factors prevent excessive uid accu-
mulation in the interstitium:
1. low compliance of the interstitium when interstitial
uid pressure is negative
2. increased lymph ow
3. washdown of interstitial uid proteins, which re-
duces interstitial uid colloid osmotic pressure as
capillary ltration increases.
4 Treatment
Vein obstruction caused facial edema while lying down.
After sitting upright all day, the swelling had disappeared.
When possible, treatment involves resolving the underly-
ing cause.
Treatment may also involve positioning the aected body
parts to improve drainage. For example, swelling in
feet or ankles may be reduced by having the person lie
down in bed or sit with the feet propped up on cushions.
Intermittent pneumatic compression can be used to pres-
surize tissue in a limb, forcing uids to ow out of pres-
surized area.
5 In plants
Edema in plants is the extended swelling in plant organs
caused primarily by an excessive accumulation of water,
a condition most damaging in Cacti, Fuchsias, Pelargo-
nium and Succulents. The excess absorption of water can
cause cells to rupture, partly due to the cell walls being
composed of exible cellulose.
6 Gallery
Foot, c. 2 weeks post surgery because of
compartment syndrome
Left and right ring ngers of the same individual.
The distal phalanx of the nger on the right exhibits
edema due to acute paronychia.
7 References
[1] , Henry George Liddell, Robert Scott, A Greek-
English Lexicon, on Perseus
[2] Nutrition in Emergencies > Measuring dema. Erin
Boyd, reviewed by Diane Holland, Nutrition in Emergen-
cies Unit, UNICEF. Retrieved Nov 2012
[3] Renkin EM (1994). Cellular aspects of transvascular
exchange: a 40-year perspective. Microcirculation 1
(3): 15767. doi:10.3109/10739689409148270. PMID
8790586.
[4] Wiggli B, Imhof E, Meier CA, Laifer G (2013). Wa-
ter, water, everywhere. Acute parvovirus B19 infec-
tion. Lancet 381 (9868): 776. doi:10.1016/S0140-
6736(12)61894-7. PMID 23472922.
[5] Palmer BF, Alpern RJ (1997). Pathogenesis of edema
formation in the nephrotic syndrome. Kidney Int. Suppl.
59: S217. PMID 9185099.
[6] C.Michael Hogan (2008) Western poison-oak: Toxi-
codendron diversilobum, GlobalTwitcher, ed. Nicklas
Strmberg
[7] Kumar, Abbas, Fausto (1999). Pathologic Basis of Dis-
ease, 7th edition. China: Elsevier Saunders. p. 122. ISBN
0-7216-0187-1.
[8] Walter F., PhD. Boron. Medical Physiology: A Cellular
And Molecular Approaoch, Elsevier/Saunders. ISBN 1-
4160-2328-3.
4 8 EXTERNAL LINKS
8 External links
5
9 Text and image sources, contributors, and licenses
9.1 Text
Edema Source: http://en.wikipedia.org/wiki/Edema?oldid=631657877 Contributors: AxelBoldt, Kpjas, Bryan Derksen, The Anome,
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9.2 Images
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