TAILIEUCHUNG - Chapter 036. 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. | Chapter 036. 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 the hydrostatic pressure within the interstitial fluid referred to as the tissue tension promote the movement of fluid into the vascular compartment. As a consequence of these forces there is a movement of water and diffusible solutes from the vascular space at the arteriolar end of the capillaries. Fluid is returned from the interstitial space into the vascular system at the venous end of the capillaries and by way of the lymphatics. Unless these channels are obstructed lymph flow rises with increases in net movement of fluid from the vascular compartment to the interstitium. These flows are usually balanced so that a steady state exists in .

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