TAILIEUCHUNG - Chapter 036. Edema (Part 1)

Harrison's Internal Medicine Chapter 36. Edema Edema: Introduction Edema is defined as a clinically apparent increase in the interstitial fluid volume, which may expand by several liters before the abnormality is evident. Therefore, a weight gain of several kilograms usually precedes overt manifestations of edema, and a similar weight loss from diuresis can be induced in a slightly edematous patient before "dry weight" is achieved. Anasarca refers to gross, generalized edema. Ascites (Chap. 44) and hydrothorax refer to accumulation of excess fluid in the peritoneal and pleural cavities, respectively, and are considered to be special forms of edema. . | Chapter 036. Edema Part 1 Harrison s Internal Medicine Chapter 36. Edema Edema Introduction Edema is defined as a clinically apparent increase in the interstitial fluid volume which may expand by several liters before the abnormality is evident. Therefore a weight gain of several kilograms usually precedes overt manifestations of edema and a similar weight loss from diuresis can be induced in a slightly edematous patient before dry weight is achieved. Anasarca refers to gross generalized edema. Ascites Chap. 44 and hydrothorax refer to accumulation of excess fluid in the peritoneal and pleural cavities respectively and are considered to be special forms of edema. Depending on its cause and mechanism edema may be localized or have a generalized distribution it is recognized in its generalized form by puffiness of the face which is most readily apparent in the periorbital areas and by the persistence of an indentation of the skin following pressure this is known as pitting edema. In its more subtle form edema may be detected by noting that after the stethoscope is removed from the chest wall the rim of the bell leaves an indentation on the skin of the chest for a few minutes. When the ring on a finger fits more snugly than in the past or when a patient complains of difficulty in putting on shoes particularly in the evening edema may be present. Pathogenesis About one-third of total-body water is confined to the extracellular space. Approximately 75 of the latter in turn is interstitial fluid and the remainder is the plasma. Starling Forces The forces that regulate the disposition of fluid between these two components of the extracellular compartment are frequently referred to as the Starling forces. The hydrostatic pressure within the vascular system and the colloid oncotic pressure in the interstitial fluid tend to promote movement of fluid from the vascular to the extravascular space. On the other hand the colloid oncotic pressure contributed by plasma proteins and

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