DiseasesDB = 9148 |
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ICD-10 | R60.9 |
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ICD-9 | 782.3 |
MeSH | D004487 |
Edema (American English) or oedema (British English); both words from the Greek οἴδημα - oídēma, "swelling"[1]), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling. Generally, the amount of interstitial fluid is determined by the balance of fluid homeostasis, and increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.
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Cutaneous edema is referred to as "pitting" when, after pressure is applied to a small area, the indentation persists for some time after the release of the pressure. Peripheral pitting edema, as shown in the illustration, is the more common type, resulting from water retention. It can be caused by systemic diseases, pregnancy in some women, either directly or as a result of heart failure, or local conditions such as varicose veins, thrombophlebitis, insect bites, and dermatitis.
Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedema, lipoedema and myxedema.
Edema caused by malnutrition defines kwashiorkor.
A rise in hydrostatic pressure occurs in cardiac failure. A fall in osmotic pressure occurs in nephrotic syndrome and liver failure. It is commonly thought that these facts explain the occurrence of edema in these conditions. However, it has been known since the 1950s that the situation is more complex and it is still far from completely understood.[2]
Causes of edema which are generalized to the whole body can cause edema in multiple organs and peripherally. For example, severe heart failure can cause pulmonary edema, pleural effusions, ascites and peripheral edema.
Although a low plasma oncotic pressure is widely cited for the edema of nephrotic syndrome, most physicians note that the edema may occur before there is any significant protein in the urine (proteinuria) or fall in plasma protein level. Fortunately there is another explanation available. Most forms of nephrotic syndrome are due to biochemical and structural changes in the basement membrane of capillaries in the kidney glomeruli, and these changes occur, if to a lesser degree, in the vessels of most other tissues of the body. Thus the resulting increase in permeability that leads to protein in the urine can explain the edema if all other vessels are more permeable as well.
Edema will occur in specific organs as part of inflammations, tendonitis or pancreatitis, for instance. Certain organs develop edema through tissue specific mechanisms.
Examples of edema in specific organs:
Six factors can contribute to the formation of edema:
Generation of interstitial fluid is regulated by the forces of the Starling equation.[5] Hydrostatic pressure within blood vessels tends to cause water to filter out into the tissue. This leads to a difference in protein concentration between blood plasma and tissue. As a result the oncotic pressure of the higher level of protein in the plasma tends to suck water back into the blood vessels from the tissue. Starling's equation states that the rate of leakage of fluid is determined by the difference between the two forces and also by the permeability of the vessel wall to water, which determines the rate of flow for a given force imbalance. Most water leakage occurs in capillaries or post capillary venules, which have a semi-permeable membrane wall that allows water to pass more freely than protein. (The protein is said to be reflected and the efficiency of reflection is given by a reflection constant of up to 1.) If the gaps between the cells of the vessel wall open up then permeability to water is increased first, but as the gaps increase in size permeability to protein also increases with a fall in reflection coefficient.
Changes in the variables in Starling's equation can contribute to the formation of edema either by an increase in hydrostatic pressure within the blood vessel, a decrease in the oncotic pressure within the blood vessel or an increase in vessel wall permeability. The latter has two effects. It allows water to flow more freely and it reduces the oncotic pressure difference by allowing protein to leave the vessel more easily.
Edema in plants is the extended swelling in plant organs caused primarily by an excessive accumulation of water. This occurs since the cell walls are composed of flexible cellulose.
Media related to [//commons.wikimedia.org/wiki/Category:Edema Edema] at Wikimedia Commons
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