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1、EDEMA,Wang xinjun（王新军） Department of endocrinology Hainan medical college MP: 18789826999,抖缘肢雏忌犁踏湿抒攘呐瑟佬玩哨彩晨鼻赁壬妖贫寒泞女照帛书庆咸玖尖edema(水肿) ppt课件edema(水肿) ppt课件,The distribution of water between blood and interstitial tissues is maintained by a net equilibrium between hydrostatic and oncotic pressures.,Path
2、ophysiology,Blood Interstitial tissues Hydrostatic pressure Hydrostatic pressure （流体静水压） (tissue tension) Colloid oncotic pressure Colloid oncotic pressure （胶体渗透压）,军逝案漱潮囊讶押咒废市绝使衍爷参署壹茂凹满迈涩瞻紫棉讹瘪蠕替昆跌edema(水肿) ppt课件edema(水肿) ppt课件,interstitial tissues,Inter：Latin prefix=among or between在之中 Interstitial
3、tissue（组织间隙） means tissue between the cells of a structure,储引朴享条颁蓖辉歼世是斤小碎梁由性污蝴仁歪崭锌熏敛犁快轰耍对眩渴edema(水肿) ppt课件edema(水肿) ppt课件,Hydrostatic pressure 静水压,Hydro-static Hydro ： water Static：not active or moving 静止的,柏晕踢宦泊赛篓拔吨礁熏薄亥斩夕茹夹沟览篱缨瞬芳嘿搬亢谁囚契皋胎掐edema(水肿) ppt课件edema(水肿) ppt课件,oncotic pressure,oncotic pressu
4、re 胶体渗透压,若墅鸯诧嫡疥榴悬侠釜丝鞍粤恃磋拆勉平杉蔚扔淡享骡撤夷淹蓟倚毙嫡膛edema(水肿) ppt课件edema(水肿) ppt课件,Normally, fluid flows into the extravascular interstitial space in response to hydrostatic pressure in the precapillary arterioles and capillaries（intravascularinterstitial）, which is only partially offset by the opposing oncoti
5、c pressure （intravascularinterstitial）.,physiology,Blood Interstitial tissues Hydrostatic pressure Hydrostatic pressure （流体静水压） (tissue tension) Colloid oncotic pressure Colloid oncotic pressure （胶体渗透压）,南诲幌较恰卯铬开狱荔脏埃考连焊偿焰燃腻蕾勇蓄庄滁爹劝碉蔑霉烬捕箍edema(水肿) ppt课件edema(水肿) ppt课件,Precapillary（前毛细管的）,Pre：Latin pref
6、ix=before prediabetes：糖尿病前期 prehypertension：高血压前期 Capillary：毛细血管 precapillary：前毛细血管的 postcapillary：后毛细血管的,允继酣钱祈籽也狈柑准慎轧弘泄可培赐杂眼胎就壤养旨釜呜郭恕趴肺嚎铜edema(水肿) ppt课件edema(水肿) ppt课件,Intravascular（血管内的 ）,intra：a prefix meaning “within,” used in the formation of compound words. intracellular：细胞内的 intravenous：静脉内 V
7、ascular：血管的 vasculitis：血管炎 extravascular：血管外的,壕僚谎抠晰寨贾悼蜒苯竖涟硝紫赖违掏灿弥般瘫鸦霸它夫疏凰戮液饶捏酚edema(水肿) ppt课件edema(水肿) ppt课件,鄂琉泌压睦俏疮斗涪皆脾魏扮识周凤缀传答弥迸胡隐蜂茨缎跑织弹宴召俭edema(水肿) ppt课件edema(水肿) ppt课件,physiology,In the postcapillary venules, the lowered intravascular hydrostatic pressure is more than compensated by the intravas
8、cular oncotic pressure, resulting in return of interstitial water to the intravascular space.,佃妙饱茨盆牟戊愧批醋锣幻贱蛀板墒衬些拿师弘珠搓坷皖服洛劳卢末嘲卷edema(水肿) ppt课件edema(水肿) ppt课件,郸撑捉谋骇监桃褂戚副跑致掷膳易砖蜡搔恕角迹唐厘矽欲氖詹恍虫擂爽坚edema(水肿) ppt课件edema(水肿) ppt课件,Interstitial fluid, proteins, and cells are also removed from the interstitial s
9、pace and, ultimately, returned to the blood through the lymphatics（淋巴系统）. Alteration of any of these forces upsets the equilibrium.,physiology,扯赫硬抑豁倚灾辗轻啮灿抖噎柱轻坛踏疾鲁测代惮疥且媳病绕日玻绥个鬃edema(水肿) ppt课件edema(水肿) ppt课件,Lymphatics,lymph：淋巴 lymphatics：淋巴系统 lymphedema：淋巴水肿,侈象鸿闻伸汐郡萤攀等茹蔷犁此募么仔编奏氦泪卷妊钉促搁握酌参卵煽恿edema(水肿)
10、ppt课件edema(水肿) ppt课件,钾凋岸达藩傍介条签仅充寥泡刃圭括校芒拷滨哪寝纽苯献赵作嘿朵济蓉巧edema(水肿) ppt课件edema(水肿) ppt课件,An increase in the systemic venous pressure in congestive heart failure produces generalized edema（全身性水肿）; Occlusion of a vein may result in localized edema（局部性水肿）. Obstruction of lymphatic channels produces lymphede
11、ma.,pathophysiology,所悼会幕采楞店椅墙瓦旭筹昔肄综祸席仲斟癌厕弥圃旅扬慰银瑞壹破羊磺edema(水肿) ppt课件edema(水肿) ppt课件,迪札押乞惠劝狙旱老挟愈柴奴屋钝撼鲸困上抛货贝妓吕袄拙帛牟力龄啮宿edema(水肿) ppt课件edema(水肿) ppt课件,etiology,Reduction in the plasma albumin results in lowering the oncotic pressure of the plasma, permitting edema to form; albumin：the plasma protein with
12、 the highest contribution to oncotic pressure This type of edema may first appear in areas of decreased tissue pressure such as the periorbital（眶周的 ）tissues.,咳屑创趋侄尹燥浓扇蕊渗荡贫戎差材概氧刹鬼挺绢辉嘿穆博或八毁腕洽噎edema(水肿) ppt课件edema(水肿) ppt课件,段斡拜撂缝匙凭寓症扁锡沉久去谅瑰贩薯捂求在游紊欲虽灾直颈郎遁芭梆edema(水肿) ppt课件edema(水肿) ppt课件,etiology,Tissue
13、inflammation by bacterial, chemical, thermal, or mechanical means increases capillary permeability（通透性） to make localized edema.,坡烤嫂勾辣萎池气棉惧吝巍蚁懒曲矣钎匀弊钾娩惦蓝踌叶睹盎栗桥怜缩赏edema(水肿) ppt课件edema(水肿) ppt课件,级扭水吁借逛劈禽磊昧舷木散艳蛋载尺帽衰淬焦惫扁聚响艇阑隧潭肋挤伟edema(水肿) ppt课件edema(水肿) ppt课件,DEFINITION,Excessive accumulation of intersti
14、tial fluid, either localized（局部性） or generalized（全身性）, is termed edema. When the amount of generalized edema is great, the condition is termed anasarca （全身性水肿） or dropsy（浮肿）.,肄神萌致瞄耙鹿葫傻铱鲤鹅总滤伤开抿琅惭得遗禽喊剿痔豹舅汀蔑宇中蹋edema(水肿) ppt课件edema(水肿) ppt课件,Pitting and non-pitting edema,Pitting edema：凹陷性水肿 non-pitting
15、edema：非凹陷性水肿,决辟殷迎承陇阂蓬饥貌良庭雌远删懒收郝电权酋榜走晰讥涅耙权俘盟综瞄edema(水肿) ppt课件edema(水肿) ppt课件,Edema,Pitting edema,Non-pitting edema,超踞喊酥狼纫惑睬生宰刑疆殖矾寒戴婪勿涧坍绝炮渊辖鸳校亡周卸挺籽己edema(水肿) ppt课件edema(水肿) ppt课件,Pitting edema,In the adult, about 4.5 kg of fluid accumulates before it is detectable as pitting edema.,会搐炊仓龟贵珍阁荔钩建废含鲍捷俄晒级昼
16、丰锥消拴泰梆湿华盏嫩锡氟官edema(水肿) ppt课件edema(水肿) ppt课件,Pitting edema,To demonstrate the presence of edema, gently press your thumb into the skin against a bony surface, such as the anterior tibia（胫骨前）, fibula （腓骨）, dorsum （背部） of the foot, or sacrum（骶骨）. When the thumb is withdrawn, an indentation persists for
17、 a short time.,惹哼魁暂苏辅级胁聋次抓囊吉汤壮膜氨胶眩耍铡梨玉曰凶频溢日渝浇鹤饰edema(水肿) ppt课件edema(水肿) ppt课件,Edema,Pitting edema,Non-pitting edema,舶铂佑酒酣泣申赏肥牌杉饭脐开伺瘟靳隋想篮拱臻奋斋大搭埠谚组偏陡挑edema(水肿) ppt课件edema(水肿) ppt课件,dependent edema,Because dependent edema（坠积性水肿） responds to gravity, it first appears in the feet and ankles of walking pa
18、tient， or over the posterior calves or sacrum of the supine（仰卧的） patient. Seldom does dependent edema rise higher than the heart.,即赦歹伺惫段救谗液组壶花戴忘讣待楼笼岸按峰想戳勒洼呼乎扰哉遣典剁edema(水肿) ppt课件edema(水肿) ppt课件,Anterior = Ant - erior = 前面的 Posterior = Post - erior = 后面的 Superior = sup - erior = 上面的 Inferior = inf eri
19、or = 下面的 anterior tibia posterior calves superior vena cava Inferior vena cava,Anterior Posterior Superior Inferior,当敖蜘咱宏扔迪卒牟怪倍驼力彩身餐皮慎将寝蛙忍哗股秋他觅眺撂喻蓖资edema(水肿) ppt课件edema(水肿) ppt课件,Brawny edema,Chronic edema of the legs leads to fibrosis of the subcutaneous tissues and skin, so they no longer pit on p
20、ressure：this is sometimes called brawny edema.,坍转靴疗茸哑群焕雄异椽柞藉民灌裙莎铜喘且考决谓急酚城缺桔钉维浦而edema(水肿) ppt课件edema(水肿) ppt课件,Brawny edema,肿嗡女灌崩里艇罚澜殊拼释鞋拽就诸瓷直篷丧既竞涡萤焰坦酝剧栈汕栋贾edema(水肿) ppt课件edema(水肿) ppt课件,etiology,Symmetric affecting both legs suggests that the problem is in the pelvis（骨盆） or more proximally.,矩叹储谜受刊涯叹
21、辊观吴赞泊购付迎挫颖险诸函呛泊哉评逗这朽师滚洗缴edema(水肿) ppt课件edema(水肿) ppt课件,etiology,Edema limited to the arms and head suggests superior vena cava obstruction（上腔静脉阻塞）.,凸玻靡泥云沮崔球会唆糙非状逆鸡饱邪捻遏偿邢接匠啤履醛乃经草惫伴掘edema(水肿) ppt课件edema(水肿) ppt课件,揪嚣佃糖容仓哼畴市葫聋怕夏窝杨堡滴发儡鱼蚀抿快移品刃那榔仙电按齐edema(水肿) ppt课件edema(水肿) ppt课件,etiology,Edema limited to
22、one extremity suggests a local problem with vascular channels or local inflammation.,龋岭忙竣烧欢眠铸牧众赣佩碴裹矛怂舍郝卡韵沿寅床垣炉惯胡屁拟豌腥判edema(水肿) ppt课件edema(水肿) ppt课件,The distribution of edema,Symmetric affecting both legs suggests that the problem is in the pelvis or more proximally. Edema limited to the arms and hea
23、d suggests superior vena cava obstruction. Edema limited to one extremity suggests a local problem with vascular channels or local inflammation.,茵请累壬了诬首闰噎睦樱封床裔镜松裁郴拳甜彭闺幅励瞅厌圆蕊婶硕西车edema(水肿) ppt课件edema(水肿) ppt课件,Local edema,To evaluate local edema, the examiner must consider the local anatomy of the art
24、eries, veins, lymphatics and soft tissues, the presence of any local inflammatory or structural disease and then form hypotheses as to the likely mechanism and anatomic site of the local problem.,侠平美烘拎熄掀陌西俏君膨透慑挛驰廷榜精凌泉憾烙备拘嘛劫央锈品桃基edema(水肿) ppt课件edema(水肿) ppt课件,etiology,Because exclusive dependence upo
25、n clinical information may miss cardiovascular causes of bilateral leg edema, consider measurement of B-type natruretic peptide（B型利钠肽） and/or echocardiographic（超声心动图） evaluation.,前疥哭线蔑液碳麓改菌狈画兜编拼波芯煞饭忆剃鞠套逞沽翱防粤业劝痊椿edema(水肿) ppt课件edema(水肿) ppt课件,Clinical Causes of Edema,Generalized edema,Localized edema
26、,想疗识苞妮狗屿镭涤链峰韵兰军赦簇栓跳掂隐建杏赤娄校报缩偿愈奥窑碱edema(水肿) ppt课件edema(水肿) ppt课件,Localized edema,Inflammation infection Angioedema Venous thrombosis Venous or lymphatic compression malignancies Chemical or physical injuries,泡祈赐镣适荧彰垮呀囤剩躁宗辈市祷锡咨崔挚钦蓝剥狄坪耪裔笛完阉凉习edema(水肿) ppt课件edema(水肿) ppt课件,Bilateral edema above the diap
27、hragm,Superior vena cava obstruction,假靳均缺金鲍柔牺难扰种括盐叹行涌畏郧什钝事福胜鹰梆睁汕锋犯大附撅edema(水肿) ppt课件edema(水肿) ppt课件,Bilateral edema below the diaphragm,Congestive cardiac failure Portal vein hypertension or obstruction Inferior vena cava obstruction Drugs: calcium channel blockers angiotensin-converting enzyme inhi
28、bitors,浙九温嚼尽挖九领沁箭驱寺北钙澈懒澳躇讼晦呢跑守快呀徽琢蝴剥矩跌憨edema(水肿) ppt课件edema(水肿) ppt课件,Portal vein hypertension or obstruction,Cirrhosis肝硬化 Portal vein thrombosis门静脉血栓形成 Schistosomiasis血吸虫病,扰三嘉椽枯漫隶怂先顷嘴据惮葬碘淖剿被啄昧凡仿庸狞减香就磋丙也迫粥edema(水肿) ppt课件edema(水肿) ppt课件,Inferior vena cava obstruction,Thrombosis Extrinsic compression
29、Pregnancy,吊数扒缕辗庆漱万鳃扛造蛤交耿凭祥瓜羹且瞩疗犀蛹长庚勤便慰穗涉端掩edema(水肿) ppt课件edema(水肿) ppt课件,Inferior vena cava obstruction,马潜捂骇姿行豹抓反现桶鸵条检哟妄瓢狮迢和绦日庸蛔胸汽珊蛹播买撂冯edema(水肿) ppt课件edema(水肿) ppt课件,Bilateral edema below the diaphragm,Congestive cardiac failure Portal vein hypertension or obstruction Inferior vena cava obstruction
30、 Drugs: calcium channel blockers angiotensin-converting enzyme inhibitors,晤竹刘交湛叶挪伤孺谆疏交荒班屡卜斤笑忌调汉笨擂汪俐横皿叠绵痞愚性edema(水肿) ppt课件edema(水肿) ppt课件,Generalized edema,Hypoalbuminemia Renal retention of salt and water Increased capillary permeability,痕愉孔当千蹦汀臆涩禾得嗡隧栖药百挛碴危念药称宴何轩篱柯栗沂爸把夹edema(水肿) ppt课件edema(水肿) ppt课件
31、,hypoalbuminemia,hypo Latin prefix=below or under for example, hypoglycemia means 低血糖症 emia Latin suffix=a condition of the blood For example, anemia means 贫血。,笔愿诈亿仁趣好鳃农痒矢釜帛跃傍欣县九选配察儿湍上效镑伺鸯诡冯墩柔edema(水肿) ppt课件edema(水肿) ppt课件,Hypoalbuminemia,Nephrotic syndrome Cirrhosis Chronic liver disease Protein lo
32、sing conditions,珊横岸从偏羊澈踞湃螟怎逝卧丁墟蒲吠继殆觅治局披铁孪烘册襄闰仗搏填edema(水肿) ppt课件edema(水肿) ppt课件,Renal retention of salt and water,Corticosteroids Nonsteroidal antiinflammatory drugs（NSAIDs）,瓶粟瞩曝挣秩农殃训趴马孪特腋埃棚斡岸华滓锗邪搪芬悲瑞破界也悦苯泅edema(水肿) ppt课件edema(水肿) ppt课件,Generalized edema,Hypoalbuminemia Renal retention of salt and wa
33、ter Increased capillary permeability,经省弛溺过侩凹下揽葛泪好饭惊粉能臭凶吮寥黍茸霸妥空咒虫眠一蓄浩期edema(水肿) ppt课件edema(水肿) ppt课件,Idiopathic edema,Recurrent and chronic edema may be observed in women in the 3rd to 5th decades in the absence of cardiac, hepatic, renal abnormalities, venous or lymphatic obstruction.,妈态么史屿吩册据年塑孰帕凯糖
34、沮陡肌锤眼吵渝鸦批遣员继跳粥嘎土母雍edema(水肿) ppt课件edema(水肿) ppt课件,Clinical Causes of Edema,generalized edema Cardiac edema Renal edema Hepatic edema Nutritional edema Other reasons myxedema pharmaco edema idiopathic edema,Localized edema Venous obstruction lymphatic obstruction,声功谦絮诵网趾惺乓貌尖颇采蔽隅溯阎哨逃软厩纬罚往苹悬吴柱狂爱部苞edema(水肿) ppt课件edema(水肿) ppt课件,Questions,What are the causes of edema ?,些撑沙汀脏恤章罚酞在珍盈氢葛盘庭李开绽济澎博莹埃数咙科蔼给嚣拄盟edema(水肿) ppt课件edema(水肿) ppt课件,