Materiały źródłowe

• #1 Pathophysiology of Edema Formation – Capillary Fluid Exchange – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK53445/

  Edema occurs when an excessive volume of fluid accumulates in the tissues, either within cells (cellular edema) or within the collagen-mucopolysaccharide matrix distributed in the interstitial spaces (interstitial edema) […] Our focus is on swelling of the extracellular matrix or interstitial edema, which may occur as a result of aberrant changes in the pressures (hydrostatic and oncotic) acting across the microvascular walls, alterations in the molecular structures that comprise the barrier to fluid and solute flux in the endothelial wall that are manifest as changes in hydraulic conductivity and the osmotic reflection coefficient for plasma proteins, or alterations in the lymphatic outflow system, as predicted by examination of the Starling equation. […] Hydrostatic edema refers to accumulation of excess interstitial fluid which results from elevated capillary hydrostatic pressure while permeability edema results from disruption of the physical structure of the pores in the microvascular membrane such that the barrier is less able to restrict the movement of macromolecules from the blood to interstitium.

• #1 Pathophysiology of Edema Formation – Capillary Fluid Exchange – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK53445/

  Destruction of extracellular matrix proteins, as occurs in inflammation secondary to the formation of reactive oxygen and nitrogen species and release of hydrolytic enzymes from infiltrating leukocytes, resident immune cells, and cells comprising the tissue parenchyma, alters the compliance characteristics of interstitial gel matrix such that interstitial fluid pressure fails to increase and oppose the movement of fluid. […] Marked reductions in the circulating levels of proteins, especially albumin, is another cause of edema that relates to intravascular factors. Hypoproteinemia may result from rapid loss of proteins across a compromised glomerular barrier in diseased kidneys, impaired hepatic synthesis of plasma proteins in liver disease, severe malnutrition or protein-losing enteropathy (which limits the availability of substrate for protein synthesis), or from infusion of intravenous fluids lacking macromolecules.

• #1 Pathophysiology of Edema Formation – Capillary Fluid Exchange – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK53445/

  Disruption of the microvascular barrier is a pathologic sequela in a large number of disease states, commonly accompanies trauma, and can be induced by a wide variety of endogenously produced mediators and pharmacologic agents. […] Myxedema is caused by suction of plasma filtrate into the tissue spaces that occurs as a result of overproduction of interstitial collagen and mucopolysaccharides by fibroblasts. Increasing the density of these extracellular matrix components augments the elastic recoil of the interstitial gel matrix and thereby producing a highly negative interstitial fluid pressure. […] Because lymphatic drainage represents the major route for removal of interstitial fluid (and macromolecules) formed by capillary filtration, dysfunction of lymphatic vessels causes the development of edema and can exacerbate edema induced by other causes.

• #2 Physiology, Edema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537065/

  The definition of edema is a swelling due to the expansion of interstitial fluid volume in tissues or an organ. […] Therefore, it is vital to assess the unique presentation and mechanism of edema to understand how it relates to disease pathophysiology, clinical presentation, and treatment. […] Several factors control the direction of flow of interstitial fluid including hydrostatic pressure, oncotic pressure, endothelial integrity, and lymphatic systems. […] The equation for Starlings law is as follows: Filtration= Kf x (Pc Pif Oc + Oif). […] Together, these factors contribute independently or cooperatively to form edema. […] Edema is believed to be the outward filtration predominating the arterial end of the capillary, and as hydrostatic pressures fall, fluid reverts to the capillary from the interstitium driven by the oncotic pressure gradient.

• #2 Physiology, Edema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537065/

  However, further investigation shows that in most capillary beds, there is a net filtration that continues throughout the capillary length, and many Starling relationships are invalid. […] The structure of the interstitial space leads to a hemodynamic difference compared to the Starling equation because these structures are far more complicated than previously believed. […] Despite current research developments on the cellular mechanisms of edema, edema development requires alteration in one or more Starling forces in the direction favoring increased net filtration and/or inadequate removal of filtered fluid by lymphatic drainage. […] Possible alterations include elevated capillary hydrostatic pressure, increased capillary permeability, higher interstitial oncotic pressure, lower plasma oncotic pressure, lymphatic obstruction, or a combination of these factors.

• #2 Physiology, Edema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537065/

  Edema formation occurs into two fundamental steps. Firstly, an alteration in capillary hemodynamics favoring the movement of fluids from the vascular space into the interstitium. […] Additionally, retention of dietary or intravenously administered sodium and water via the kidneys can cause edema. […] Edema can also form as a response to elevated capillary hydraulic pressures or increased capillary permeability, disruption of the endothelial glycocalyx, decreased interstitial compliance, lower plasma oncotic pressure, or a combination of these factors. […] Anything that raises capillary pressures, reduces oncotic pressure, increases endothelial permeability, or impairs lymphatic drainage will result in edema. […] Raised capillary pressure is a common cause of edema including cardiac failure such as right ventricular failure, left ventricular failure leading from pulmonary edema, or congestive cardiac failure.

• #2 Physiology, Edema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537065/

  Increased capillary permeability, typically due to vascular injury, results in edema for several reasons. […] The oncotic pressure gradient reduces and edema results. […] Additionally, lymphatic obstruction is a well-known cause of edema, and common causes include lymphedema, tumors, fibrosis, inflammation, infection such as Filariasis due to Wuchereria bancrofti, surgery, and congenital abnormalities.

• #3 Edema – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/edema

  Edema results from increased movement of fluid from the intravascular to the interstitial space or decreased movement of water from the interstitium into the capillaries or lymphatic vessels. The mechanism involves one or more of the following: […] Increased capillary hydrostatic pressure […] Decreased plasma oncotic pressure […] Increased capillary permeability […] Obstruction of the lymphatic system. As fluid shifts into the interstitial space, intravascular volume is depleted. Intravascular volume depletion activates the renin-angiotensin-aldosterone-vasopressin (ADH) system, resulting in renal sodium retention. By increasing osmolality, renal sodium retention triggers water retention by the kidneys and helps maintain plasma volume. Increased renal sodium retention also may be a primary cause of fluid overload and hence edema. Excessive exogenous sodium intake may also contribute.

• #3 Edema – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/edema

  Less often, edema results from decreased movement of fluid out of the interstitial space into the capillaries due to lack of adequate plasma oncotic pressure, as in nephrotic syndrome, protein-losing enteropathy, liver failure, or starvation. […] Increased capillary permeability occurs in infections or as the result of toxin or inflammatory damage to the capillary walls. In angioedema, mediators, including mast cell-derived mediators (eg, histamine, leukotrienes, prostaglandins) and bradykinin and complement-derived mediators, cause focal edema. […] The lymphatic system is responsible for removing protein and white blood cells (along with some water) from the interstitium. Lymphatic obstruction allows these substances to accumulate in the interstitium.

• #4 Pathophysiology of edema | PPT

  https://www.slideshare.net/slideshow/pathophysiology-of-edema/47958862

  Edema is swelling caused by excess fluid in the interstitial spaces between tissues. […] The key mechanisms that can cause edema are increased hydrostatic pressure, reduced plasma oncotic pressure, lymphatic obstruction, and sodium and water retention. […] The movement of fluid between blood vessels and tissues is normally regulated by the balance of hydrostatic and oncotic pressures according to Starling’s forces, but imbalances in these forces can result in excess fluid accumulation in the tissues and cause edema. […] Changes in the variables in Starling’s equation can contribute to the formation of edemas 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. […] Either increased capillary pressure, diminished colloid osmotic pressure or inadequate lymphatic drainage can result in an abnormally increased interstitial fluid i.e. edema.

• #5 EDEMA, oedema, mechanism of edema, types | PPT

  https://www.slideshare.net/slideshow/edema-oedema-mechanism-of-edema-types/270250436

  What is edema? Edema or oedema is a medical term from the Greek word oidema which means „swelling. Edema is the abnormal and excessive accumulation of free fluid in the interstitial space (locations beneath the skin) and serous cavities. It can also be a local or generalized condition in which the body tissues contain an excessive amount of tissue fluid. It was formerly known as dropsy or hydropsy. It is caused by injury, dislocation, fracture, disease states or microbial infection. Elephantiasis is a typical form of edema caused by parasitic infection. […] Pathogenesis of edema Oedema is caused by mechanisms that interfere with normal fluid balance of plasma, interstitial fluid and lymph flow. The following mechanisms may be operating singly or in combination to produce oedema: A. Decreased plasma oncotic pressure B. Increased capillary hydrostatic pressure C. Lymphatic obstruction D. Increased capillary permeability E. Sodium and water retention

• #5 EDEMA, oedema, mechanism of edema, types | PPT

  https://www.slideshare.net/slideshow/edema-oedema-mechanism-of-edema-types/270250436

  DECREASED PLASMA ONCOTIC PRESSURE The plasma oncotic pressure exerted by the total amount of plasma proteins tends to draw fluid into the vessels normally. A fall in the total plasma protein level (Hypoproteinaemia of less than 5 g/dl), results in lowering of plasma oncotic pressure in a way that it can no longer counteract the effect of hydrostatic pressure of blood. This results in increased outward movement of fluid from the capillary wall and decreased inward movement of fluid from the interstitial space causing oedema. […] INCREASED CAPILLARY HYDROSTATIC PRESSURE The hydrostatic pressure of the capillary is the force that normally tends to drive fluid through the capillary wall into the interstitial space by counteracting the force of plasma oncotic pressure. A rise in the hydrostatic pressure at the venular end of the capillary which is normally low (average 12 mmHg) to a level more than the plasma oncotic pressure results in minimal or no reabsorption of fluid at the venular end, consequently leading to oedema.

• #5 EDEMA, oedema, mechanism of edema, types | PPT

  https://www.slideshare.net/slideshow/edema-oedema-mechanism-of-edema-types/270250436

  LYMPHATIC OBSTRUCTION Normally, the interstitial fluid in the tissue spaces escapes by way of lymphatics. Obstruction to outflow of these channels causes localized oedema, known as lymphedema. Example-Inflammation of the lymphatics as seen in filariasis. […] INCREASED CAPILLARY PERMEABILITY An intact capillary endothelium is a semipermeable membrane which permits the free flow of water and crystalloids but allows minimal passage of plasma proteins normally. However, when the capillary endothelium is injured by various capillary poisons such as toxins and their products, histamine, anoxia, venoms, certain drugs and chemicals, the capillary permeability to plasma proteins is enhanced due to development of gaps between the endothelial cells, leading to leakage of plasma proteins into interstitial fluid. This, in turn, causes reduced plasma oncotic pressure and elevated oncotic pressure of interstitial fluid which consequently produces oedema.

• #5 EDEMA, oedema, mechanism of edema, types | PPT

  https://www.slideshare.net/slideshow/edema-oedema-mechanism-of-edema-types/270250436

  SODIUM AND WATER RETENTION The possible factors responsible for causation of oedema by excessive retention of sodium and water in the extravascular compartment are; a. Reduced glomerular filtration rate in response to hypervolemia. b. Enhanced tubular reabsorption of sodium and consequently its decreased renal excretion. c. Increased filtration factor i.e. increased filtration of plasma from the glomerulus. d. Decreased capillary hydrostatic pressure associated with increased renal vascular resistance. […] Types of Edema 1. Renal edema 2. Cardiac edema 3. Pulmonary edema 4. Cerebral edema 5. Hepatic edema 6. Nutritional edema 7. Myxoedema

• #6 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Edema-Mechanism.aspx

  Factors that contribute to the development of edema include: An increase in the hydrostatic pressure, A decrease in the blood vessel oncotic pressure, An increase in tissue oncotic pressure, An increase in vessel wall permeability, Obstructed lymphatic drainage, Water retention in tissues. For example, increased hydrostatic pressure often indicates sodium and water retention in the kidney.

• #6 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Edema-Mechanism.aspx

  The production of interstitial fluid is regulated by the Starling equation forces. Hydrostatic pressure building up within the blood vessels causes water to flow out of the blood vessels and into the surrounding tissue. This increases the concentration of protein in the plasma, which causes more fluid to be drawn back into the vessels from the tissue. […] The majority of leakage occurs in the capillaries or post capillary venules, which have membranes that are semipermeable and therefore allow water to pass more easily than protein. Gaps between the cells of the vessel wall open up and the permeability to water is increased. As the gaps increase in size, however, the membrane also becomes permeable to protein. If the forces in the Starling equation are altered, edema is more likely to occur.

• #7 The Diagnosis of Edema and Its Pathogenesis | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-52423-8_18

  Edema is the presence of an excess of interstitial fluid and is an important sign of ill health in clinical medicine. It is most common within the peripheral subcutaneous space. The differential diagnosis of edema comprises four broad categories: elevated hydrostatic pressure, pathological sodium retention, reduced plasma oncotic pressure, inflammation, and intrinsic malfunction of the lymphatic circulation. […] The presence of edema signals a failure of body fluid homeostasis. […] This homeostasis is governed by the Starling forces, namely, the hydrostatic and oncotic pressures that prevail in the plasma and in the interstitium, respectively. […] The modern view of the Starling forces suggests that there is a net, ever-diminishing filtration that occurs along the entire length of the capillary, with no venous reabsorption. […] Lymphatic homeostasis requires an equilibrium between the lymphatic load and the lymphatic transport capacity.

• #8 Cardiogenic Pulmonary Edema: Background, Etiology, Prognosis

  https://emedicine.medscape.com/article/157452-overview

  Cardiogenic pulmonary edema (CPE) is defined as pulmonary edema due to increased capillary hydrostatic pressure secondary to elevated pulmonary venous pressure. CPE reflects the accumulation of fluid with a low-protein content in the lung interstitium and alveoli as a result of cardiac dysfunction. […] Pulmonary edema can be caused by the following major pathophysiologic mechanisms: Imbalance of Starling forces – ie, increased pulmonary capillary pressure, decreased plasma oncotic pressure, increased negative interstitial pressure; Damage to the alveolar-capillary barrier; Lymphatic obstruction; Idiopathic (unknown) mechanism. […] Increased hydrostatic pressure leading to pulmonary edema may result from many causes, including excessive intravascular volume administration, pulmonary venous outflow obstruction (eg, mitral stenosis or left atrial [LA] myxoma), and LV failure secondary to systolic or diastolic dysfunction of the left ventricle. CPE leads to progressive deterioration of alveolar gas exchange and respiratory failure.

• #9 Generalized and Localized Edema: A Clinical Breakdown – Manual of Medicine

  https://manualofmedicine.com/topics/generalized-and-localized-edema-a-clinical-breakdown/

  Edema is a pathological accumulation of fluid in the interstitial space. […] The most significant pathophysiological mechanisms that lead to the formation of edema are: increased venous and capillary pressure, increased permeability of the capillary wall, diminished drainage efficiency of the lymphatic system. […] Therefore a precondition for the development of edema is renal sodium and water retention. […] Heart failure leads to an increase of the left ventricular end-diastolic pressure and ultimately to pulmonary edema. […] The increase in venous pressure may be transferred as far as the venular side of the capillary vessels, so that less interstitial fluid is reabsorbed. […] In addition, decreased cardiac output activates humoral and neurohumoral processes, which lead to increased water and salt retention by the kidneys and consequently to an increase in the amount of extracellular.

• #9 Generalized and Localized Edema: A Clinical Breakdown – Manual of Medicine

  https://manualofmedicine.com/topics/generalized-and-localized-edema-a-clinical-breakdown/

  Hypoproteinemic edema may be caused by a number of diseases: The main disease that causes hypoproteinemic edema is nephrotic syndrome. […] Apart from hypoproteinemia other factors, such as sodium retention and the disturbance of the capillary permeability, are also involved in the pathogenesis of edema. […] In glomerulonephritis, there is evidence of a general increase in capillary permeability. […] Myxedema is an important form of endocrine-related edema. […] Interstitial deposits of hydrophilic mucopolysaccharides and the resulting deterioration of lymphatic drainage are pathophysiologically significant. […] People with diabetes are prone to edema, particularly in the lower extremities, even in the absence of hypoproteinemia. […] The abuse of diuretics may also cause edema. […] Edema as a result of bacterial infection is characterized by the three classic symptoms: rubor, calor, and dolor. […] The causes of edema in angiodysplasia include atypical varicose veins or angiomas, arteriovenous fistulas, and aplasia or hypoplasia of the lymph vessels. […] Both of these forms of edema may be attributable to an ischemic damage of the capillary walls.

• #10 Edema: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0715/p102.html

  Edema is an accumulation of fluid in the interstitial space that occurs as the capillary filtration exceeds the limits of lymphatic drainage, producing noticeable clinical signs and symptoms. […] Edema is an accumulation of fluid in the intercellular tissue that results from an abnormal expansion in interstitial fluid volume. The accumulation of fluid occurs when local or systemic conditions disrupt this equilibrium, leading to increased capillary hydrostatic pressure, increased plasma volume, decreased plasma oncotic pressure (hypoalbuminemia), increased capillary permeability, or lymphatic obstruction. […] Edema associated with decreased plasma oncotic pressure (e.g., malabsorption, liver failure, nephrotic syndrome) does not change with dependency. […] The mechanism often includes the retention of salt and water with increased capillary hydrostatic pressure.

• #11 Inflammatory Mediators Leading to Edema Formation through Plasma Membrane Receptors | IntechOpen

  https://www.intechopen.com/chapters/78035

  Edema is a swelling from liquid accumulation in body tissues. Injuries in tissues or organs may cause this disorder leading to chemical mediators releasing and triggering the inflammatory process. Inflammatory mediators, when released in response to injuries, promote biological reactions at the affected site. Furthermore, plasma membrane receptors modulate the inflammatory chemical agent synthesis and release. […] The inflammatory agent overproduction mediates increase in vascular permeability and leukocyte recruitment, causing edema formation and hyperalgesia. […] Therefore, this chapter will address the plasma membrane receptors modulation on inflammatory agents and subsequent edema formation. […] The inflammation course and edema formation are linked because edema is one of inflammation cardinal signs.

• #11 Inflammatory Mediators Leading to Edema Formation through Plasma Membrane Receptors | IntechOpen

  https://www.intechopen.com/chapters/78035

  TLR activation may exhibit a crucial role in edema formation through inflammatory mediator production. […] The IL-1 inhibition in inflammation and pain has been addressed in several inflammation studies. […] The TRPV1 receptor (heat sensor) together with TRPA1 (cold sensor) can modulate the neuropeptide molecules release like substance P. This molecule encompasses many biochemical processes involved in inflammation, such as histamine and serotonin released by mast cells, which leads to increased vascular permeability and hyperalgesia. […] Bradykinin also promotes a role in vascular permeability. Bradykinin receptors divide into B1, and B2 (GPCRs) play a crucial role in edema pathogenesis.

• #12 Edema: Types, causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/159111

  Certain medications can also increase the risk of edema. […] During pregnancy, the body releases hormones that encourage fluid retention. […] A number of dietary factors can also affect the risk of edema, such as consuming too much salt. […] Some complications of diabetes include cardiovascular disease, acute renal failure, and protein-losing enteropathy, which can result in edema. […] Some causes of swelling in the brain include head injuries, stroke, and brain tumors. […] Edema can indicate one of many health conditions. […] Treatment will also depend on the cause of edema. […] Diuretics are a type of medication. They help eliminate excess fluid by increasing the rate of urine production by the kidneys. […] Untreated edema can lead to painful swelling, stiffness and difficulty walking, and poor blood circulation. […] Some self-care techniques can help reduce or prevent edema. […] Edema occurs when fluid builds up in the body. This causes swelling, which can sometimes be painful. […] There are several potential causes of edema, including pregnancy, heart failure, liver disease, and certain medications.

• #12 Edema: Types, causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/159111

  Edema refers to swelling due to fluid buildup in bodily tissues. […] Edema can result from circulatory problems, infection, tissue death, malnutrition, total body fluid overload, and electrolyte problems. […] If one or both of the lower chambers of the heart cannot pump blood properly, blood can accumulate in the limbs, causing edema. […] The body of a person with a kidney disorder may not be able to eliminate enough fluid and sodium from the blood. This puts pressure on the blood vessels, which causes some of the liquid to leak out. Swelling can occur around the legs and eyes. […] Cirrhosis affects liver function. It can lead to changes in the secretion of hormones and fluid-regulating chemicals and reduced protein production. This causes fluid to leak out of the blood vessels into surrounding tissue.

• #13 Edema: Types, Causes, Symptoms, and Treatment

  https://www.webmd.com/heart-disease/heart-failure/edema-overview

  When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. […] Severe liver disease, such as cirrhosis, causes you to retain fluid. […] A kidney condition called nephrotic syndrome can cause severe leg edema and sometimes whole-body edema. […] Mild leg edema is common during pregnancy. […] Head trauma, low blood sodium (called hyponatremia), high altitudes, brain tumors, and a block in fluid drainage in the brain (known as hydrocephalus) can cause cerebral edema. […] Many medicines can cause edema, including NSAIDs, calcium channel blockers, corticosteroids, and others.

• #13 Edema: Types, Causes, Symptoms, and Treatment

  https://www.webmd.com/heart-disease/heart-failure/edema-overview

  Edema happens when your small blood vessels leak fluid into nearby tissues. That extra fluid builds up, which makes the tissue swell. It can happen almost anywhere in the body. […] Edema can also come from other conditions or from when the balance of substances in your blood is off. […] Low albumin may contribute to edema, but its not usually the only cause. […] Edema is a part of most allergic reactions. In response to the allergen, nearby blood vessels leak fluid into the affected area. […] If drainage of fluid from a part of your body is blocked, fluid can back up. A blood clot in the deep veins of your leg can cause leg edema. A tumor blocking the flow of blood or another fluid called lymph can cause edema. […] Critical illness can cause a reaction that allows fluid to leak into tissues almost everywhere. This can cause edema all over your body.

• #14 Pulmonary edema – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-edema/symptoms-causes/syc-20377009

  Pulmonary edema is a condition caused by too much fluid in the lungs. This fluid collects in the many air sacs in the lungs, making it difficult to breathe. […] In most cases, heart problems cause pulmonary edema. But fluid can collect in the lungs for other reasons. These include pneumonia, contact with certain toxins, medications, trauma to the chest wall, and traveling to or exercising at high elevations. […] Cardiogenic pulmonary edema is caused by increased pressures in the heart. […] It’s usually a result of heart failure. When a diseased or overworked left lower heart chamber (left ventricle) can’t pump out enough of the blood it gets from the lungs, pressures in the heart go up. The increased pressure pushes fluid through the blood vessel walls into the air sacs. […] Pulmonary edema that is not caused by increased pressures in the heart is called noncardiogenic pulmonary edema. […] In high-altitude pulmonary edema (HAPE), it’s believed that blood vessels in the lungs squeeze together (constrict), increasing pressure. This causes fluid to leak from the blood vessels to the lung tissues and eventually into the air sacs.

• #15 Pulmonary edema – Wikipedia

  https://en.wikipedia.org/wiki/Pulmonary_edema

  Fluid accumulation in the tissue and air spaces of the lungs Not to be confused with Pneumonia. […] Pulmonary edema has multiple causes and is traditionally classified as cardiogenic (caused by the heart) or noncardiogenic (all other types not caused by the heart). […] The amount of fluid in the lungs is governed by multiple forces and is visualized using the Starling equation. There are two hydrostatic pressures and two oncotic (protein) pressures that determine the fluid movement within the lung air spaces (alveoli). […] Imbalance in any of these forces can cause fluid movement (or lack of movement) causing a buildup of fluid where it should not normally be. […] Cardiogenic pulmonary edema is caused by increased hydrostatic pressure causing increased fluid in the pulmonary interstitium and alveoli.

• #16 New insights into the pathophysiology of oedema in nephrotic syndrome | Nefrología

  https://revistanefrologia.com/en-new-insights-into-pathophysiology-oedema-articulo-X2013251411051700

  Oedema is a common clinical manifestation of nephrotic syndrome. However, the pathophysiological mechanism of sodium retention in nephrotic syndrome has been intensely debated for decades. Several clinical and experimental observations argue against the classic or „underfill” hypothesis of oedema formation in nephrotic syndrome. […] In nephrotic syndrome, a defective glomerular filtration barrier allows the passage of proteolytic enzymes or their precursors, which have the ability to activate the epithelial sodium channel, thereby causing the subsequent sodium retention and oedema. […] The cortical collecting duct is the nephron site of sodium retention in nephrotic syndrome. Activation of the epithelial sodium channel in the cortical collecting duct is responsible for sodium retention in nephrotic syndrome.

• #16 New insights into the pathophysiology of oedema in nephrotic syndrome | Nefrología

  https://revistanefrologia.com/en-new-insights-into-pathophysiology-oedema-articulo-X2013251411051700

  Contrary to the classic hypothesis, the alternative hypothesis (also called the overfill hypothesis) postulates that sodium retention in many NS patients is a primary renal phenomenon and may be caused by an intrinsic renal defect in sodium excretion, which in turn causes an expansion in plasma volume (hence the term overfill). […] The first observations supporting the overfill hypothesis were made by Chandra and Ichikawa. […] The cortical collecting tubule is the reabsorption point for sodium in nephrotic syndrome. […] The role of the Na+/K+-ATPase pump in sodium retention in nephrotic syndrome. […] Another sodium transporter that has been reported to be strongly involved in sodium retention in NS is the epithelial sodium channel or amiloride-sensitive sodium channel (ENaC). […] Plasmin would then activate ENaC, resulting in sodium retention with the subsequent appearance of oedema.

• #17 New insights into the pathophysiology of oedema in nephrotic syndrome | Nefrología

  https://www.revistanefrologia.com/en-new-insights-into-pathophysiology-oedema-articulo-X2013251411051700

  In nephrotic syndrome, a defective glomerular filtration barrier allows the passage of proteolytic enzymes or their precursors, which have the ability to activate the epithelial sodium channel, thereby causing the subsequent sodium retention and oedema. […] The classic hypothesis, also called the underfill hypothesis, postulates that sodium retention in NS is secondary to decreased effective arterial blood volume, hence the term underfill. […] Contrary to the classic hypothesis, the alternative hypothesis (also called the overfill hypothesis) postulates that sodium retention in many NS patients is a primary renal phenomenon and may be caused by an intrinsic renal defect in sodium excretion, which in turn causes an expansion in plasma volume (hence the term overfill). […] Most of our understanding of the molecular mechanisms of sodium retention in NS has come from the use of animal models that induced NS by puromycin aminonucleoside (PAN).

• #17 New insights into the pathophysiology of oedema in nephrotic syndrome | Nefrología

  https://www.revistanefrologia.com/en-new-insights-into-pathophysiology-oedema-articulo-X2013251411051700

  The cortical collecting tubule is the reabsorption point for sodium in nephrotic syndrome. […] The first observations on ENaC activation by serine proteases in proteinuric states were made by Kastner et al. […] Plasmin is known to come from the activation of plasminogen through the enzymatic action of urokinase, which is normally present in the collecting tubule. […] Plasmin would then activate ENaC, resulting in sodium retention with the subsequent appearance of oedema.

• #18 Neurogenic Pulmonary Edema – EMCrit Project

  https://emcrit.org/ibcc/npe/

  (1) The primary mechanism appears to be increased sympathetic outflow from the central nervous system. […] (2) Another potential mechanism may be increased pulmonary capillary permeability. This could be caused by various factors: […] The blast theory suggests that a transient increase in transcapillary pressure (due to factors described above) may cause pulmonary microvascular injury, leading to a prolonged increase in pulmonary capillary permeability. […] Elevated intracranial pressure (ICP) may be the most common physiological trigger of neurogenic pulmonary edema. […] The pathophysiology of neurogenic pulmonary edema involves predominantly fluid shifts into the lungs, rather than changes in total body volume. Therefore, aggressive diuresis is generally not indicated.

• #19 Neurogenic Pulmonary Edema: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/300813-overview

  Neurogenic pulmonary edema (NPE) is a relatively rare form of pulmonary edema caused by an increase in pulmonary interstitial and alveolar fluid. Any acute central nervous system (CNS) insult can result in pulmonary edema. The most common causes are subarachnoid hemorrhage, cerebral hemorrhage, traumatic brain injury (TBI), and seizures. […] The pathogenesis of neurogenic pulmonary edema (NPE) is not completely understood. Because the most common neurological events are associated with increased intracranial pressure, intracranial hypertension is considered a key etiologic factor. […] Within the central nervous system, the sites responsible for the development of neurogenic pulmonary edema are not fully elucidated. Animal studies suggest that hypothalamic lesions, stimulation of the vasomotor centers of the medulla, elevated intracranial pressure, and activation of the sympathetic system have potential roles.

• #20 Negative pressure pulmonary edema (Review)

  https://www.spandidos-publications.com/10.3892/etm.2023.12154

  Negative pressure pulmonary edema (NPPE) is a complication resulting from acute or chronic upper airway obstruction, often posing challenges in recognition and diagnosis for clinicians. […] The primary pathophysiological mechanism of NPPE involves the need for high inspiratory pressure to counteract upper airway obstruction, subsequently causing a progressive rise in negative pressure within the pleural cavity. Consequently, this results in increased pulmonary microvascular pressure, leading to the infiltration of pulmonary capillary fluid into the alveoli. […] The occurrence of NPPE is the result of a combination of factors. There are two main pathogenic mechanisms in NPPE: Hydrostatic and increased permeability pulmonary edema. The mechanism behind hydrostatic pulmonary edema suggests that NPPE is caused by marked fluid shifts triggered by changes in the intrathoracic pressure. The mechanism behind increased permeability pulmonary edema suggests that the destruction of alveolar epithelium and pulmonary microvascular membranes caused by severe mechanical stress results in increased pulmonary capillary permeability and protein-rich pulmonary edema.

• #21 Edema disease | Iowa State University

  https://vetmed.iastate.edu/vdpam/about/focus-areas/swine/swine-disease-manual/index-diseases/edema-disease

  Edema disease is caused by toxins produced in the small intestine by pathogenic serogroups of Escherichia coli (E. coli). […] Pathogenic E. coli colonize and proliferate in the small intestine by pilus-mediated attachment to the epithelial cells. Enterotoxins produced by pathogen strains induce the disease, with Stx2e causing damage to small arteries and arterioles. Degenerative angiopathy leads to increased vascular permeability and accumulation of edema at various sites, most notably colon, stomach, small intestine, eyelids, and brain. Damage to vessels in brain can cause malacia in the brain stem and basal ganglia, a feature in subacute stages of the disease having central nervous system (CNS) disturbance. High doses of Stx2e may cause acute hemorrhagic gastroenteritis or sudden death.

• #22 Edema Disease in Pigs – Generalized Conditions – Merck Veterinary Manual

  https://www.merckvetmanual.com/generalized-conditions/edema-disease/edema-disease-in-pigs

  Edema disease is a peracute toxemia caused by a specific pathotype of Escherichia coli that affects primarily healthy, rapidly growing nursery pigs. […] Edema disease is caused by hemolytic E coli that produce F18 fimbrial adhesins and Shiga toxin 2e (Stx2e, also known as verotoxin 2e or VT2e). […] Shiga toxin 2e produced in the intestine of colonized pigs is responsible for the major clinical signs and pathologic changes observed in edema disease. This cytotoxin inhibits protein synthesis, leading to cell death. […] Edema disease-causing strains of E coli may colonize the mesenteric lymph nodes and produce Stx2e there. […] Sites highly susceptible to the toxin include the submucosa of the stomach, the mesocolon, the subcutaneous tissues of the forehead and eyelids, the larynx, and the brain. Damage to vascular endothelium results in edema, hemorrhage, intravascular coagulation, and microthrombosis.

• #23 Managing peripheral oedema caused by calcium channel blockers – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice

  https://www.sps.nhs.uk/articles/managing-peripheral-oedema-caused-by-calcium-channel-blockers/

  All calcium channel blockers may cause peripheral oedema. There are different treatment options and the incidence can be affected by different factors. […] Peripheral oedema, including ankle oedema, is a recognised adverse effect of calcium channel blockers (CCBs). This may affect compliance but also limit their usefulness, particularly in an aging population who are more likely to have co-morbidities. […] The mechanisms by which CCBs give rise to ankle oedema are not currently understood. […] Proposed mechanisms include: an increase in capillary pressure, resulting in fluid loss from the capillaries and leakage into interstitial areas, or by interference with local vascular control, blocking reflex increases in precapillary resistance which occur on standing, compounding oedema formation.

• #23 Managing peripheral oedema caused by calcium channel blockers – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice

  https://www.sps.nhs.uk/articles/managing-peripheral-oedema-caused-by-calcium-channel-blockers/

  Unlike peripheral oedema caused by fluid retention, CCB-induced oedema appears to be due to redistribution of fluid from capillaries to interstitial spaces. […] It seems unaffected by administration of diuretics, supporting the idea that it may be due to fluid pooling rather than fluid retention. […] Oedema occurs despite CCBs possessing inherent diuretic effects. […] While ankle oedema associated with CCBs is rarely clinically serious, it may significantly reduce adherence to these potentially useful agents. […] The mechanism by which this occurs is not currently known. It may be due to the dilation of venous capacitance vessels, which may then lead to a reduction in capillary hypertension and therefore leakage of fluid into the surrounding tissues. […] The mechanisms by which ARBs reduce incidence of CCB-induced ankle oedema remains unknown, but are likely to be similar to that involved when an ACEi is added to CCB therapy.

• #24 Mechanisms of Myocardial Edema Development in CVD Pathophysiology

  https://www.mdpi.com/2227-9059/12/2/465

  Myocardial edema is the excess accumulation of fluid in the myocardial interstitium or cardiac cells that develops due to changes in capillary permeability, loss of glycocalyx charge, imbalance in lymphatic drainage, or a combination of these factors. […] This condition is called myocardial edema. Although it was previously believed that myocardial edema was a secondary phenomenon and a consequence of acute and chronic cardiovascular diseases (CVDs), it has recently been shown that edema itself causes aggravation of the disease, increasing the risks of adverse outcomes, and often leads to irreversible changes in the interstitium structure. […] Myocardial edema can be observed in coronary heart disease due to hypoxia, myocardial infarction, myocarditis, and various types of cardiomyopathies, which account for more than 70% of all deaths from cardiovascular diseases in the world.

• #24 Mechanisms of Myocardial Edema Development in CVD Pathophysiology

  https://www.mdpi.com/2227-9059/12/2/465

  Myocardial edema impairs the contractility of cardiomyocytes and is the cause of systolic and diastolic dysfunction. […] Thus, myocardial edema covers a colossal amalgam of cardiovascular diseases, not only being a consequence of various disorders, but also independently leading to complications and increasing the risk of complications. […] The accumulation of excess fluid inside the cell triggers depolymerization of actin filaments, mitochondrial damage, cytoskeletal abnormalities, and a significant increase in the length of sarcomeres, the radial distance between myofibrils and the distance between mitochondria and myofibrils, which directly affects the contractility of cells. […] Excessive mechanical stress, including interstitial and cellular edema, contributes to changes in mitochondrial homeostasis, leading to cardiac dysfunction.

• #24 Mechanisms of Myocardial Edema Development in CVD Pathophysiology

  https://www.mdpi.com/2227-9059/12/2/465

  The increase in force exerted by the extracellular matrix induces a wide range of intracellular signals, including signals from the Akt, c-Jun N-terminal kinase, and MAPK-ERK-p38 pathways. […] The molecular pathways that are activated during edema have not been studied, but, most certainly, severe mechanical stress will influence the restructuring of the cardiomyocyte microenvironment and impair cell contractility, which only emphasizes the importance of further research.

• #25 Orthostatic Edema: Definition and Pathogenesis | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4684-8962-0_2

  Orthostatic edema is defined as a disorder characterized by edema that becomes detectable after a period of time (no more than 12 hr) in the sitting or standing posture and that disappears spontaneously in recumbency. […] Its occurrence does not depend on intrinsic cardiac, renal, hepatic, or obstructive venous disorders, nor is it associated with an abnormal tendency to retain fluids in recumbency. […] A specific maximal duration of orthostasis required for the development of manifest edema has to be included in the definition, as ankle edema may develop in individuals in robust health after more prolonged periods of sitting or standing.

• #26 The Mechanism for Licorice (Glycyrrhiza glabra) Induced Swelling and Edema

  https://www.ebmconsult.com/articles/licorice-glycyrrhiza-glabra-edema-swelling-mechanism-side-effect

  Licorice ingestion can lead to excess mineralocorticoid activity that is manifested by suppressed renin levels, sodium retention, hypervolemia, hypokalemia, hypertension and edema. […] The increased cortisol is available to bind to the mineralocorticoid receptor in the kidney resulting in the reabsorption of sodium and water that leads to increases in intravascular volume and capillary hydrostatic pressures that contribute to edema formation. […] The change in intravascular volume appears to be the major contributor to the increased risk in patients developing swelling or edema when taking licorice supplements. […] Licorice is a known inhibitor of 11 beta-HSD2 and thus prevents the inactivation of cortisol, thereby causing a state of excess mineralocorticoid activity or pseudohyperaldosteronism.

• #26 The Mechanism for Licorice (Glycyrrhiza glabra) Induced Swelling and Edema

  https://www.ebmconsult.com/articles/licorice-glycyrrhiza-glabra-edema-swelling-mechanism-side-effect

  The increase in mineralocorticoid activity results in greater sodium and water reabsorption at the expense of potassium excretion. This will eventually manifest as an increase in hydrostatic and overall blood pressures thereby resulting in the development of edema. […] Excess mineralocorticoid activity and resulting increases in blood volume are clearly the main mechanisms by which licorice causes both edema and hypertension.

• #27

  https://www.healio.com/news/dermatology/20190605/researchers-propose-pathogenesis-of-acute-inflammatory-edema

  In a paper recently published in Journal of the American Academy of Dermatology, researchers proposed there is a three-part pathogenesis of acute inflammatory edema, a form of pseudocellulitis commonly seen in critically ill patients. […] Elizabeth M. Marchionne, MD, from the department of dermatology at the University of California, San Francisco, and colleagues described a three hit pathogenesis of acute inflammatory edema that includes acute onset volume overload … in patients with impaired lymphatic return … [that] leads to dermal edema, microtears in connective tissue, and an influx of inflammation. […] Recognizing and naming this entity allows for a bedside diagnosis and avoidance of a broad, costly workup and treatment, the researchers wrote.

• #28 The pathomechanism of bone marrow edema in the femoral head necrosis with pericollapse stage | Scientific Reports

  https://www.nature.com/articles/s41598-024-83376-6

  Bone marrow edema (BME), a notable manifestation during the progression of osteonecrosis of the femoral head (ONFH), exhibits significant associations with femoral head collapse, pain, and prognosis, however its pathogenesis remains underexplored. […] Immune responses, inflammatory reactions and oxidative stress were markedly altered in ONFH cases with BME. […] In conclusion, BME in ONFH at pericollapse stage is associated with inflammation, fibrosis, heightened oxidative stress and increased osteoclast activity. These factors collectively elevated the risk of collapse or re-collapse. […] Understanding the pathological mechanisms of ONFH with BME is particularly important for selecting hip preservation treatments during the peri-collapse stage. […] The results indicated that MDA levels were higher in the sclerotic regions of the BME group when compared to the control group. This observation implies that individuals with BME may undergo heightened oxidative stress, consistent with the functional enrichment analysis results of the aforementioned DEPs.

• #28 The pathomechanism of bone marrow edema in the femoral head necrosis with pericollapse stage | Scientific Reports

  https://www.nature.com/articles/s41598-024-83376-6

  Therefore, it speculated that when ONFH is accompanied by BME, the enhanced activity of osteoclasts leads to increased bone resorption, resulting in a decline in the biomechanical properties of the bone tissue, which may be a contributing factor to the occurrence of femoral head collapse or re-collapse. […] A porcine model demonstrated that necrotic bone byproducts can induce the upregulation of pro-inflammatory cytokines, a process dependent on macrophage activation of Toll-like Receptor 4. […] This study has certain limitations. […] BME in ONFH patients significantly impacts both the biological and morphological aspects of the surrounding environment. Biologically, the condition triggers inflammatory and oxidative stress responses, leading to tissue fibrosis and heightened osteoclast activity. This elevated osteoclast activity subsequently causes structural damage to the bone tissue. Morphologically, the primary change observed is an increase in the area of low bone mass. Such changes render the femoral head more prone to subchondral fractures under stress.

• #29 Brain edema in acute liver failure. A window to the pathogenesis of hepatic encephalopathy | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-brain-edema-in-acute-liver-S1665268119321532

  Brain edema in acute liver failure. A window to the pathogenesis of hepatic encephalopathy […] Hepatic encephalopathy and brain edema are important complications in the course of a patient with acute liver failure. […] In acute liver failure, an osmotic disturbance in the astrocyte, in combination with an alteration of cerebral blood flow results in overt brain edema and intracranial hypertension. […] For many years, several hypotheses have tried to independently explain the occurrence of brain swelling in ALF. […] A critical role for ammonia is now evident. […] An osmotic disturbance of the astrocyte as a result of ammonia is an observation that finds most support in clinical and experimental data. […] The presence of increased brain glutamine levels in animal models and patients with ALF or hyperammonemia has been confirmed in multiple studies.

• #29 Brain edema in acute liver failure. A window to the pathogenesis of hepatic encephalopathy | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-brain-edema-in-acute-liver-S1665268119321532

  An alteration of the blood-brain barrier could explain a vasogenic theory for brain edema in ALF. […] A potential role for oxidative and nitrosative stress in the pathogenesis of brain edema in ALF is being increasingly explored. […] In ALF, intracranial hypertension is usually the manifestation of an increase in water content of brain tissue. […] In patients with ALF, a wide spectrum of values of CBF has been reported, ranging from abnormally low to abnormally high levels. […] The loss of autoregulation can be explained by the presence of vasodilatation of cerebral arterioles. […] In patients with ALF, cerebral hyperemia has been associated with deeper coma, increased brain edema and higher mortality. […] The mechanism by which CBF can influence brain edema deserves further attention. […] Changes in CBF and cerebral autoregulation in ALF could favour water flux into the brain by affecting mainly several components of the Starling equation.

• #30 Diabetic Macular Edema – EyeWiki

  https://eyewiki.org/Diabetic_Macular_Edema

  Diabetic macular edema (DME) is the accumulation of excess fluid in the extracellular space within the retina in the macular area, typically in the inner nuclear layer, outer plexiform, Henles fiber layer, and subretinal space. […] Chronic hyperglycemia-related accumulation of advanced glycated end products disrupts the bloodretina barrier (BRB), leading to endothelial cell junction breakdown and pericyte loss. The inner BRB is composed of endothelial cells in the retinal capillaries, while the outer BRB is composed of retinal pigment epithelium cells. When the BRB is altered, interstitial fluid is accumulated within and underneath the retina through leakage of molecules dependent on intact cell-to-cell junctions. […] Evidence also shows that DME has an inflammatory component, with several chemokines and cytokines involved in its development. These include vascular endothelial growth factor (VEGF), interleukins (ILs), matrix metalloproteinases, and tumor necrosis factor (TNF). Upregulation of multiple pathways leads to increased inflammation, oxidative stress, and vascular dysfunction.

• #30 Diabetic Macular Edema – EyeWiki

  https://eyewiki.org/Diabetic_Macular_Edema

  Significant changes are seen in the neurovascular unit, altering the homeostasis between astrocytes, ganglion cells, Mller cells, retinal vascular endothelial cells, and amacrine cells. […] Retinal vascular permeability changes also involve the kallikrein-kinin system, which induces vasorelaxation via bradykinin and nitric oxide.

• #31 Edema – Signs and Symptoms – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.I.1.23.

  Edema (swelling) is the accumulation of fluid in the tissue interstitium. […] There are 4 major mechanisms that fundamentally lead to edema. Frequently 1 mechanism is present. […] Increased hydrostatic pressure at the venous end of the capillary bed (eg, in patients with congestive heart failure (HF) or venous valve incompetence). […] Decreased plasma oncotic pressure (due to hypoalbuminemia). […] Increased capillary wall permeability (most frequently due to inflammation). […] Impaired lymphatic drainage (eg, in patients with severe lymphadenopathy, with a recent history of lymphadenectomy or radiotherapy, or with filariasis).

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