By: Dr. Pamela Fabie

1. By: Dr. Pamela Josefina T. Fabie

2.  The abnormal accumulation of fluid in
the intercellular tissue of body cavities.
 It may be localized or systemic

3. • ANASARCA – when edema is
sever and generalized; with
diffused swelling of all tissues and
organs in the body
• ASCITES – collection of
edema fluid in the
peritoneal cavity

4. • HYDROTHORAX – collection of
edema fluid in the thoracic
(pleural cavity)
• PERICARDIAL EFFUSION –
collection of edema fluid in
the pericardial sac

5. FACTORS CONTRIBUTING TO EDEMA
FORMATION
I. Arteriolar Dilatation –
inflammation, heat, toxins, neurohumoral excess
or deficit
II. Reduced Effective Osmotic Pressure
I. Hypoproteinemia – malnutrition, cirrhosis, nephrotic
syndrome, protein-osing gastroenteropathy
II. Leaky Vascular Endothelium –
inflammation, burns, trauma, allergy
III. Lymphatic Obstruction

6. III. Increased Venous Pressure – congestive heart
failure, thrombophlebitis, liver cirrhosis
IV. Sodium Retention – excessive salt intake,
increased tubular reabsorption of sodium

7. MORPHOLOGY OF EDEMA
A. In Cardiac Failure – edema is most
severe in the dependent parts of
the body (“dependent edema”)
B. In Renal Failure – generalized, most
manifested in loose tissues like the
face, particularly the eyelids

8. “Pitting Edema” – finger
pressure over the edematous
subcutaneous tissue displace the
interstitial fluid from the skin to
leave pitted depressions
Edema of the brain and the lungs
are most life-threatening forms;
edema of the brain is encountered
with trauma, infections (meningitis,
brain abscess, encephalitis)
hypertensive crises, etc.

9. Pulmonary Edema – major manifestation of left
ventricular failure; also found in renal disease, shock, infection
within the lungs, hypersensitivity states

11. • HYPEREMIA – occurs when arterial and
arteriolar dilatation produces an increased flow of blood
into capillary beds, with opening of inactive capillaries
• Causes redness in the affected part;
• Active hyperemia of the skin is seen whenever excess body
heat must be dissipated like in muscular exercise and high
fever. “Blushing”

12. • CONGESTION (Passive Hyperemia)
• Results from impaired venous drainage
• Causes an intensified blue-red colored, accentuated
when there is an increase of deoxygenated blood –
“Cyanosis”
• Closely related with edema

13. Indicates exravasation of blood due to
rupture of blood vessels

14. • HEMATOMA – significant
amount of released blood
accumulating within a tissue
forming a massive clot; it may
be relatively insignificant (as in
bruise)or life-threatening

15. PETECHIAE – Minute (1-2mm), typically assoc. with
localized intravascualr pressure, low platelet
counts(thrombocytopenia), defective platelet function, or
clotting factor deficiencies
PURPURA – Slightly larger (3-
5mm), typically assoc. with many of
the same disorders that cause
petechiae, as well in
trauma, vascular inflammation
(vasculitis) or increased vascular
fragility

16. ECCHYMOSES – Larger (1-2cm), these
are subcutaneous hematomas (bruises)
The erythrocytes in these local hemorrhages are
degraded and phagocytosed by macrophages; the
Hemoglobin (red-blue color) is then enzymatically
converted to Bilirunin (blue-green) and eventually into
Hemosidirin (golden-brown) accounting for a
charateristic color changes in a hematoma

17. Formation of a solid mass in living blood
vessels or in the heart from the
constituents of the blood; resultant mass
is called “Thrombus”. A blood clot is
formed by coagulation of extravascular
blood

18. DANGERS OF THROMBOSIS
1. Diminished or obstructed blood flow
 ischemia to tissue/organ
2. Becomes dislodged  Embolus
EMBOLUS – intravascular solid, liquid, or gaseous
mass carried in the bloodstream to some site
removed from its origin, or from its point of entry in
the CVS

19. INFARCTS – ischemic necrosis of tissues
Arterial Thrombi – dry, friable grey masses
composed of almost regularly arranged
alternating layers of fibrin and platelets with scant
amount of darker red coagulated blood resulting
to laminations known as “Lines of Zhan”.

20. Venous Thrombi – more gelatinous moist
appearance; called “Stasis or Red Coagulation” or
“Phlebothrombosis” (90% in in veins)
Post-Mortem Clot – cyanotic dark red “Currant
Jelly” or with supernatant portion of coagulated
clear plasma “chicken fat” overlying a portion of
darker hue where the red cells have settled

21. Detached intravascular solid, liquid or
gaseous mass that is carried by the blood
to a site distant from its point of origin

22. SYSTEMIC EMBOLISM – travel through the arterial
circulation; thrombi from the left side of the heart;
affects the heart, lower extremity. Kidneys and spleen.
Almost always cause infarction of the affected parts
PULMONARY EMBOLISM – most common form
and one of the most lethal; 95% arise from the thrombi
withing the veins of the legs
– SADDLE EMBOLUS – large thrombus lodged in the
bifurcation of the main pulmonary artery

23. • AIR OR GAS EMBOLISM– sometimes happen
after delivery or abortion when it is forced into
ruptured uterine venous sinuses by the powerful
contractions of the uterus
– “Caisson Disease” or decompression
sickness, bends, chokes – occurs in sudden
changes in atmospheric pressure and deep-sea
divers

24. • FAT EMBOLISM (Circulating fat Microglobules) –
caused by severe trauma to fat-laden tissues such as
fractures of bone containing fatty marrows or fat
depots
• AMNIOTIC EMBOLISM (Amniotic Fluid Infusion)
– fatal maternal obstetric complication; trauma in
Labor

25. A localized area of ischemic
necrosis in an organ or tissue
resulting from occlusion of either
its arterial supply or venous
drainage, either by thrombosis
and/or embolism

26. TYPES OF INFARCT
1. ANEMIC (white) – encountered with
arterial occlusion and in solid tissues;
common in heart. Spleen and kidneys
2. HEMORRHAGIC (red) – with venous
occlusions in loose tissues, in tissues with
double circulation and in tissue with
previously congested; common in
lungs, ovarian pedicles, intestine and brain

27. Infarcts may either be “Septic” or “Bland”
• Presence or absence of bacterial infection In the
area of necrosis
Ischemic Coagulative Necrosis – characteristic
cytologic change in all infarcts

28. A constellation of syndromes, all characterized
by low-perfusion circulatory insufficiency
leading to imbalance in the metabolic needs of
vital organs and the available blood flow; as a
result, oxygen and nutrient delivery to cells and
removal of waste products are decreased

29. Signs and Symptoms:
Hypotension, weak thready pulses, cool clammy
skin, tachycardia, alterations in
respiration, sensorium, peripheral cyanosis and
oliguria

30. CLASSIFICATION OF SHOCK
1. HYPOVOLEMIC – reduction of blood
volume from external loss of blood plasma or
water; reduction in blood volume from internal
loss (internal haemorrhage); heart unable to
pump enough blood to the body
2. CARDIOGENIC – inadequate circulation of blood due
to primary failure of the ventricles of the heart to function
effectively

31. 3. SEPTIC– overwhelming gram-
negatve infections (endotoxemia);
overwhelming gram-positive infections
(endotoxic shock)
4. NEUROGENIC – occurs in anaesthetic accident
or spinal cord injury due to vascular tone and
peripheral pooling of blood

32. 5. ANAPHYLACTIC – initiated by a generalized
immunoglobulin E-mediated hypersensitivity
response; associated with systemic vasodilation and
increased vascular permeability

33. 3 Most Causes of Shock
1. Loss of blood volume – hypovolemic shock
2. Pump Failure – cardiogenic shock
3. Action of Toxins on peripheral vessels – Septic
and neurogenic shock