OEDEMA
OEDEMA
OEDEMA
PATHOGENESIS
Oedema is caused by mechanisms that interfere with normal fluid balance of plasma, interstitial
fluid and lymph flow. The following mechanisms may be operating singly or in combination to
produce oedema:
1. Decreased plasma oncotic pressure
2. Increased capillary hydrostatic pressure
3. Lymphatic obstruction
4. Tissue factors (increased oncotic pressure of interstitial fluid, and decreased tissue tension)
5. Increased capillary permeability
6. Sodium and water retention.
3. Lymphatic obstruction
Normally, the interstitial fluid in the tissue spaces escapes by way of lymphatics. Obstruction to
outflow of these channels causes localised oedema, known as lymphoedema
The examples of lymphoedema include the following:
i) Removal of axillary lymph nodes in radical mastectomy for carcinoma of the breast produces
lymphoedema of the affected arm.
ii) Inflammation of the lymphatics as seen in filariasis
4. Tissue factors
The two forces acting in the interstitial space—oncotic pressure of the interstitial space and
tissue tension, are normally quite small and insignificant to counteract the effects of plasma
oncotic pressure and capillary hydrostatic pressure respectively
2. Increased vascular permeability (Irritant oedema). The vascular endothelium as well as the
alveolar epithelial cells (alveolo-capillary membrane) may be damaged causing increased
vascular permeability so that excessive fluid and plasma proteins leak out, initially into the
interstitium and subsequently into the alveoli.
3. Acute high altitude oedema. Sudden ascent to high altitudes leads to severe circulatory and
respiratory issues. Problems typically start above 2500 meters.These changes include
appearance of oedema fluid in the lungs, congestion and widespread minute haemorrhages.
These changes can cause death within a few days. The underlying mechanism appears to be
anoxic damage to the pulmonary vessels.