SWELLING ON THE BODY

 THE SWELLING ON THE BODY

The technical term for the swelling on the body – IS – EDEMA – SOMETIMES CALLED OEDEMA….

Generally it means – TOO MUCH FLUID IN THE CELLS OR OUTSIDE THE CELLS.

TWO TYPES – PITTING – accumulation of fluid in the extracellular space means outside the cells

-          NON PITTING – accumulation of fluid in the intracellular fluids mean in the cells

There are four types of mechanisms working in the body which may cause edema in the body.-.-. ---

1.       Increased hydrostatic pressure—anything which increases the pressure of water in the blood vessels, the arterioles or the venules

a.       Kidney failure– failure of the kidney function == increased retention of the water in the vascular system i.e. blood vessels == causing increased pressure in arteries

b.      Hypoaldostronism–any condition that alter the function of the adrenal cortex part of the adrenal medulla gland which secretes Aldosterone ( a mineralocorticoid whose function is the resorption of sodium and water and excretion of potassium ions in the distal tubules of the kidneys ) --- aldosterone decreases === there is loss of more water and sodium through kidneys ==== in turn sodium becomes less in extracellular tissue == edema

c.       Increase of pressure in venules and veins ---

A.      Heart failure – causes back pressure in the veins – causes backflow of fluid to the periphery – increases pressure in capillaries === edema

B.      Failure of valves in the veins – causes backflow and stagnation of fluid in the veins – increases pressure in capillaries == edema

C.      Failure of venous pump – for the effective upward and forward flow of blood in the veins needs effective movements of skeletal muscles – impart pressure on veins for movements – failure of venous pump due to paralysis or long standing disorder – fails this pump --- pressure in capillaries increase == edema

D.      Venous obstruction – any reason like deep vein thrombosis – increased pressure in capillaries == edema

d.      Decreased arteriolar resistance – antihypertensive drugs like calcium channel blockers == dilatation of the arteries prior to capillaries ---- blood moves from the larger diameter artery to very small capillary === pressure increases manifold ==edema

2.       Decreased proteins in the blood –proteins are negative charged particle in the blood ---- 80% of the proteins in the blood is ALBUMIN – albumin has many functions, the important is maintaining osmotic pressure in the capillaries …… this pressure stops the water to go out from the capillaries --- any cause which decreases the albumin in the blood --- results in edema.  The causes may be –

a.       Loss of albumin in urine – due to any kidney disease or idiopathic

b.      Loss of proteins from blood – due to wound, bleedings, abscessesetc.

c.       Failure to manufacture proteins –

A.      Liver failure – (liver is making albumin) – decrease in albumin – decreased osmotic pressure in capillaries – water leaks out == edema

B.      Severe protein malnutrition – decreased albumin and other proteins – edema

3.       Increased capillary permeability –causes water to flow out == edema ----- reasons are ===

a.       Any immune reaction – cause release of histamine – permeability increased –edema

b.      Any inflammation or infection – disrupts the membranes or alters its functions – increased permeability == edema

c.       Toxins in the blood – attack the membrane and disrupt them --- edema

d.      Burns – causing disruption – edema

e.      Vitamin deficiency – especially vitamin C, which is necessary for the formation of the collagen which is the integral part of the capillary membrane

f.        Prolonged ischemia – when there is no blood supply to a part for a long periods – capillaries are destroyed there

4.       Obstruction in the lymphatic drainage – lymphatics have two main functions – one – immunity, second – drainage of excess body fluids in the extracellular fluids

When there is obstruction in lymph drainage – accumulation of excess water in extracellular fluids. Causes are ====

a.       Cancer – Hodgkin’s disease or non-Hodgkin’s disease

b.      Infection – causes accumulation of inflammatory and immune cells in the lyphatics resulting in obstruction

c.       Surgical removal

d.      Congenital absence or malformation