-0Passion Batch 2015

Body fluid edema

In the previous lecture : We mention the bulk of the osmolarity in the
extra cellular fluid related to sodium chloride concentration .
If we major sodium chloride concentration outside for example plasma
140 millimolar >>>> normal
140 = 280 milliosmole
Over all the osmolarity of the extra cellular fluid is
300 miliosmo

90% of the osmolarity of the ECF is related to sodium chloride

In the intercellular fluid : is the same but it related to potassium
concentration not sodium concentration .
Now we said when we change the osmolarity of out side the cell that will
shift the water either inside the cell or outside the cell.
**Large change in pressure will cause small change in volume
If we have isotonic outside we will start to push water inside until they
accomplished and treat the equilibrium.
Hypertonic
Hypotonic
more sodium concentration outside Less sodium concentration inside
the cell
the cell
suck the water from the cell and
the cell will shrink

Cell absorb the water and the cell

will be swelling

**change fluid to hypertonic and that will > it will shrink to the revant if
you reach hyper tonicity equal outside and the inside which (the first part
of the lopper ship in our body)
Capillary: allow the water to leave outside or get back inside
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The common force between the period and the veins part: osmotic
oncotic pressure related to the plasma protein and the volume for that
are 25
interstitial pressure

filtration pressure

reabsorption pressure

The pressure between cell

and its negative its
normally about.

The pressure pushing the

water outside the capillary.

The pressure that suck

the water back.

-2 to -3 mmHg

11 mmHg

8 mmHg

The different between 8 and 11 is little bit of pressure helping filtration or

in other ways every time the plasma leaves capillary it will leave the
capillary give the food and oxygen washing the toxic material and
go back to the capillary but there is a small portion of water remaining
outside the capillary. Because the force of filtration is higher than the
force of reabsorption. Because of that we have less lymphatic vessel is
here all over the body.
** Function of lymphatic vessels: always taking that extra amount of
the water remaining in the interstitial compartment.

Leave the
capillary

Give food , oxygen and

washing toxic material

Back to capillary

Different
force

Less lymphatic
vessels

*so if we look to this equation:

the amount of water leaving (filtration)= the amount of water reabsorb
(reabsorption) + the amount of water going inside the lymphatic vessel
(lymphatic flow )

**Filtration = Kf x (Pc -Pif - c + if ) > in the slides

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The abnormalities: which lead either to gain the water or to lose the
water

Gaining water :
EX: if the hydrostatic pressure instead of 37 is 40 and this hydrostatic
pressure remain normal 17 and the oncotic pressure still 25
that means: the filtration not 11 now it extreme 3 mmHg ( the extreme
come from the difference of 40 and 37, 40-37 ) so it will be 14
mmHg(11+3) pushing but the reabsorption still 8 and assume that the
lymphatic vessel has a fix capacity to suck the water

So by the end of that changes: we will have some of the water remain
in the interstitial compartment, that means if that happen in each
minute plus assume that 0.3 mil of water remaining outside the capillary
each minute (0.3 is not significant) so by end of the day 24 hours it will
be huge and if that happen we will transfer the person of situation called
edema.
Edema: increase amount of water in one of the compartment
So in general we have two types of edema:

Intracellular :it is very rare

*happen if the sodium potassium compound is defective

So if you inhibit the sodium potassium pump you will allow the
sodium to go from outside to inside the cell and the water will
follow the sodium and fill the cell with water.
The major cause of the intercellular edema is:
1.
2.
3.
4.
5.

defect in sodium potassium pump

depression of the metabolic system of the tissue
inflammation of the tissue
starvation
ischemia
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Extra cellular edema : causes of it :

If you increase hydrostatic pressure by 3 mmHg you will accumulate
water outside the capillary
1-hypertension: increase hydrostatic pressure by increase of
blood pressure
EX: normally the blood pressure is 100 mmHg if it increase to 150
hypertension that means this pressure will be higher and the other
one also because is the same increasing.
EX: If we have 40 mmHg instead of 37 and 20 increase here the
effect in the beginning
37 normal 25 normal the change is 40 (37+3) so the filtration rate will
increase by 3 mmHg (more water will leave the capillary)
Veins part:
Normally any force that tries to get water back is (-)
And any water pushing the water is (+)
So it will be +25, -1, -17 so the net result is -8 or -7by which second
part of the capillary sucking the water high under normal condition
-25 and -1, +25 will be -6 and that less water reabsorption which -8
will suck the water more than -6
So in the hypertension we will increase the water filtration and
decrease water reabsorption
Lymphatic
vessels

11 mmHg
ultrafiltration

Interstitial fluid

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9 mmHg
reabsorption

2-Starvation: is the diseases that causes by less protein

When it start they will lose the ability to synthesize the protein one of
these protein is plasma
So if you have starvation that will decrease the protein which decrease
the osmotic pressure instead of 25 it will be 20 or 15 depends on level of
starvation lets assume will be 20 and other pressure like hydrostatic will
be the same (-20 , -1 ,+17 now is -7 )
decrease

decrease

protein

osmotic pressure

**More filtration more water will will leave and accumulate in the
interstate **
**Any change in plasma protein concentration it will change the osmotic
pressure and lead to edema
**The huge updomain is not muscles but is water
3- The hole in the capillary
How much water go out or in so if we increase the number of pores that
will lead to increase the permeability so that will allow to more water to
go out. Which happen in allergy reaction.
4-lymphatic vessels: it take the extra water that not allow the
accumulation of water
The lymphatic vessels will be blocked (fail):

If we have cancer ( huge grow of the cell ) :

So when we have the tumour this will block the blood vessels
So when they blocked will block the function of the lymphatic vessels
which is to take the water from the Interstitial compart
So the water will start to accumulate that region

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***Lymphatic vessels is not cores its valvar cores > if it increase

hydrostatic pressure outside the cell it will open the valve and the water
will go on and if it increase inside the cell it will close the valve (the
function of the lymphatic is take the water to filter the water.

The second after surgery they cut the lymphatic vessels

abnormalities special parasite >> which is different type of

infection not from bacteria like elephantiasis that called elephant leg

There are safety factor that help us to avoid edema:

1- Interstitial low compliance :
Which mean is the attachment between two cell and we want to fill
water between two cells we need the force that overcome attachment
so more attachment more force.
EX: if the hydrostatic pressure increase into 2 or 3 unites it will not
filtration because in order to increase filtration and accumulate
between cells we have to overcome this negative pressure but
equilibrium to this pressure the water then start to accumulate.
2- Related to the function of the lymphatic vessels
That able to suck the water but it has the sufficiency to increase the
suction power part by 50 times
If that lymphatic vessels is 1 or 2 >>> it will take it by the sufficiency of
suction
**When the sufficiency of the lymphatic increase it will wash water and
anything in the water.
**If we have particle protein outside the capillary this particle protein will
create osmotic pressure the water will suck up in opposite way.
Now if the lymphatic vessels is sufficient that will wash out this protein so
it will decrease the ability of filtration and not suck the water form
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capillary If any increase of net filtration by 17 mmHg you will have in the
same side .

Dehydration: causes:
The causes of edema and dehydration is inversely which mean any
cause of edema make it opposite will lead to dehydration
Dehydration
Decrease hydrostatic pressure
increase in plasma protein
increase the sufficiency more than
normal that will lead to it

edema
Increase hydrostatic pressure
Decrease in plasma protein
Decrease in the sufficiency

So at the end because of homeostasis we dont get edema and

dehydration.

**An extra information from slides:

Interstitial low compliance:
1-Compliance increases markedly, once interstitial pressure rises above
zero.
2-Protoglycan creates gel form of fluid prevents flowing no free fluid
spaces.
3-When + pressure= pitting edema

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