水肿ppt课件

EDEMA 1 Thedistributionofwaterbetweenbloodandinterstitialtissuesismaintainedbyanetequilibriumbetweenhydrostaticandoncoticpressures Pathophysiology BloodInterstitialtissuesHydrostaticpressureHydrostaticpressure 流体静水压 tissuetension ColloidoncoticpressureColloidoncoticpressure 胶体渗透压 2 interstitialtissues Inter Latinprefix amongorbetween在 之中Interstitialtissue 组织间隙 meanstissuebetweenthecellsofastructure 3 Hydrostaticpressure静水压 Hydro staticHydro waterStatic notactiveormoving静止的 4 oncoticpressure oncoticpressure胶体渗透压 5 Normally fluidflowsintotheextravascularinterstitialspaceinresponsetohydrostaticpressureintheprecapillaryarteriolesandcapillaries intravascular interstitial whichisonlypartiallyoffsetbytheopposingoncoticpressure intravascular interstitial physiology BloodInterstitialtissuesHydrostaticpressureHydrostaticpressure 流体静水压 tissuetension ColloidoncoticpressureColloidoncoticpressure 胶体渗透压 6 Precapillary 前毛细管的 Pre Latinprefix beforeprediabetes 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 7 Intravascular 血管内的 intra aprefixmeaning within usedintheformationofcompoundwords intracellular 细胞内的intravenous 静脉内Vascular 血管的vasculitis 血管炎extravascular 血管外的 8 9 physiology Inthepostcapillaryvenules theloweredintravascularhydrostaticpressureismorethancompensatedbytheintravascularoncoticpressure resultinginreturnofinterstitialwatertotheintravascularspace 10 11 Interstitialfluid proteins andcellsarealsoremovedfromtheinterstitialspaceand ultimately returnedtothebloodthroughthelymphatics 淋巴系统 Alterationofanyoftheseforcesupsetstheequilibrium physiology 12 Lymphatics lymph 淋巴lymphatics 淋巴系统lymphedema 淋巴水肿 13 14 Anincreaseinthesystemicvenouspressureincongestiveheartfailureproducesgeneralizededema 全身性水肿 Occlusionofaveinmayresultinlocalizededema 局部性水肿 Obstructionoflymphaticchannelsproduceslymphedema pathophysiology 15 16 etiology Reductionintheplasmaalbuminresultsinloweringtheoncoticpressureoftheplasma permittingedematoform albumin theplasmaproteinwiththehighestcontributiontooncoticpressureThistypeofedemamayfirstappearinareasofdecreasedtissuepressuresuchastheperiorbital 眶周的 tissues 17 18 etiology Tissueinflammationbybacterial chemical thermal ormechanicalmeansincreasescapillarypermeability 通透性 tomakelocalizededema 19 20 DEFINITION Excessiveaccumulationofinterstitialfluid eitherlocalized 局部性 orgeneralized 全身性 istermededema Whentheamountofgeneralizededemaisgreat theconditionistermedanasarca 全身性水肿 ordropsy 浮肿 21 Pittingandnon pittingedema Pittingedema 凹陷性水肿non pittingedema 非凹陷性水肿 22 Edema Pittingedema Non pittingedema 23 Pittingedema Intheadult about4 5kgoffluidaccumulatesbeforeitisdetectableaspittingedema 24 Pittingedema Todemonstratethepresenceofedema gentlypressyourthumbintotheskinagainstabonysurface suchastheanteriortibia 胫骨前 fibula 腓骨 dorsum 背部 ofthefoot orsacrum 骶骨 Whenthethumbiswithdrawn anindentationpersistsforashorttime 25 Edema Pittingedema Non pittingedema 26 dependentedema Becausedependentedema 坠积性水肿 respondstogravity itfirstappearsinthefeetandanklesofwalkingpatient orovertheposteriorcalvesorsacrumofthesupine 仰卧的 patient Seldomdoesdependentedemarisehigherthantheheart 27 Anterior Ant erior 前面的Posterior Post erior 后面的Superior sup erior 上面的Inferior inf erior 下面的anteriortibiaposteriorcalvessuperiorvenacavaInferiorvenacava AnteriorPosteriorSuperiorInferior 28 Brawnyedema Chronicedemaofthelegsleadstofibrosisofthesubcutaneoustissuesandskin sotheynolongerpitonpressure thisissometimescalledbrawnyedema 29 Brawnyedema 30 etiology Symmetricaffectingbothlegssuggeststhattheproblemisinthepelvis 骨盆 ormoreproximally 31 etiology Edemalimitedtothearmsandheadsuggestssuperiorvenacavaobstruction 上腔静脉阻塞 32 33 etiology Edemalimitedtooneextremitysuggestsalocalproblemwithvascularchannelsorlocalinflammation 34 Thedistributionofedema Symmetricaffectingbothlegssuggeststhattheproblemisinthepelvisormoreproximally Edemalimitedtothearmsandheadsuggestssuperiorvenacavaobstruction Edemalimitedtooneextremitysuggestsalocalproblemwithvascularchannelsorlocalinflammation 35 Localedema Toevaluatelocaledema theexaminermustconsiderthelocalanatomyofthearteries veins lymphaticsandsofttissues thepresenceofanylocalinflammatoryorstructuraldiseaseandthenformhypothesesastothelikelymechanismandanatomicsiteofthelocalproblem 36 etiology Becauseexclusivedependenceuponclinicalinformationmaymisscardiovascularcausesofbilaterallegedema considermeasurementofB typenatrureticpeptide B型利钠肽 and orechocardiographic 超声心动图 evaluation 37 ClinicalCausesofEdema Generalizededema Localizededema 38 Localizededema InflammationinfectionAngioedemaVenousthrombosisVenousorlymphaticcompressionmalignanciesChemicalorphysicalinjuries 39 Bilateraledemaabovethediaphragm Superiorvenacavaobstruction 40 Bilateraledemabelowthediaphragm CongestivecardiacfailurePortalveinhypertensionorobstructionInferiorvenacavaobstructionDrugs calciumchannelblockersangiotensin convertingenzymeinhibitors 41 Portalveinhypertensionorobstruction Cirrhosis肝硬化Portalveinthrombosis门静脉血栓形成Schistosomiasis血吸虫病 42 Inferiorvenacavaobstruction ThrombosisExtrinsiccompressionPregnancy 43 Inferiorvenacavaobstruction 44 Bilateraledemabelowthediaphragm CongestivecardiacfailurePortalveinhypertensionorobstructionInferiorvenacavaobstructionDrugs calciumchannelblockersangiotensin convertingenzymeinhibitors 45 Generalizededema HypoalbuminemiaRenalretentionofsaltandwaterIncreasedcapillarypermeability 46 hypoalbuminemia hypoLatinprefix beloworunderforexample hypoglycemiameans低血糖症emiaLatinsuffix aconditionofthebloodForexample anemiameans贫血 47 Hypoalbuminemia NephroticsyndromeCirrhos