Today we are going to talk about the core
concepts related with the "Edema".
Right?
Now!
Before I really give the lecture I would love
to ask you a few questions, how do you define?
What is Edema?
Yes please?
Right, She is saying that edema is an accumulation
of interstitial fluid.
Interstitial fluid is normally there.
Interstitial fluid is normally there, but
normally we are not edematous.
Someone can improve on this definition?
Yes?
Its really we can say, you are saying its
accumulation of abnormal fluid in Interstitium.
Still not good.
Yes Aizaz?
You can make it better?
Ok he is saying that Edema means the accumulation
of excessive of fluid in Interstitium.
Right!
This is the right definition but its not the
complete.
Because by this definition you miss a big
part of Edema.
Anyone can improve it further?
Definition of Edema?
Yes?
Abnormal accumulation of fluid in the Interstitium.
Yet not..... yes?
Ok anyone else?
EXCELLENT!
Very good!
He is saying excess fluid in the body there
is excessive fluid either inside the cell
which is "Intracellular Edema" or in the Interstitium
and body cavities which is called "Extra-cellular
Edema".
So my dear friends at least you should know
what is Edema.
Let me tell you, Edema is just...
Edema is excessive fluid....excess fluid in
body tissues.
That's it!
What is Edema?
Edema is excess fluid, yes?
In body tissues.
That's it!
It maybe intracellular or edema may be extra
cellular.
Right?
When you say edema means fluid in Interstitium,
That is wrong!
Because normally there is fluid in Interstitium
and if you say edema is excessive fluid in
Interstitium than you miss intracellular edema.
Right?
So.... what is edema?
Edema simply means an excessive amount of
fluid present in the body tissues, but lets
refine it further.
Why?
Because excessive fluid not in all body tissues!
for example, if there is excessive fluid in
the blood, if there is excessive fluid in
the blood, is it called edema?
No!
If there is excessive fluid in the blood that
is not called edema.
It means that whenever there is excessive
fluid in the vascular compartment that is
not considered "Edema".... so we can further
improve our definition, that edema is excessive
fluid in body tissues extravascularly.
"Extravascularly".
Right?
Now let me draw a diagram to make it more
clear.
Lets suppose from your body I remove a piece
of tissue.
Right?
This is a piece of tissue, a typical tissue
from your body and naturally, this tissue
is having arterial supply.
Right?
Lets suppose here is your left heart.. right?
Systemic circulation and this is hypothetically
we make that there is arterial supply coming
to this tissue.
Right?
Arterial input.
In the same way this tissue must have some
outflow mechanism that is venous and that
will be going to which side of the heart?
Yes please?
Right heart!
Very good!
That will be going to the right heart and
of course all of you know that blood from
the right heart.
Yes!
Blood from the right heart to the pulmonary...what...atteries
go to lungs and through the microvasculature
of the lungs, blood is eventually being drained
to the left side through pulmonary veins which
have oxygenated blood.
Right?
Now... what I have....What I am showing in
this diagram from the left heart blood is
going to the tissues.
Right? and we have taken a sample tissue here
and this is the arteriolar input and here
I have shown the venous output.
Is that right?
Now, lets see...in detail in this tissue.
Right?
Arterial system of course arteries come they
divide into arterioles and eventually they
divide into capillaries.
Right?
This I am going to draw the microcirculation....
this is your microcirculation. this one, right!
and there is arterial input here is venous
output... here are your cells... cells in
the tissue.. right?Parenchymal cells and lets
suppose.... this is representing body cavities.
Right?
Body cavities...these are parenchymal cells
in the body and this area....this area this
is Interstitial tissue.
What is this?
Interstitial tissue.... so we can say Interstitial
tissue is between the parenchymal cells and
the vasculature.
Is that right?
This is Interstitial tissue...
Now!
lets divide our body weight and see what are
the normal fluid compartment, because when
we define edema as excessive fluid..... we
define edema as excess amount of fluid...
in body tissues... but extravascularly.
Right?
When we define like this we must know... what
is the normal amount of fluid in different
body compartments....
Right?
Fluid is excess than it is edema but as a
good doctor, you must know what is the normal
amount of fluid in different body compartments.
Lets suppose here you are... your beautiful
picture.
Right?
Yes...lets suppose you are an adult and your
weight is 72 kg.... right?
If you are 72 kg how much water will be there
in your body?
5 Liter water.
I think I will die immediately...
5-liter water is too low water... you know
if you are 72 kg and if you have only 5 liters
of water in total body you must be dead already.
One person... yes?
42 liter...how did you calculate it?
EXCELLENT!
Very good.
Actually when we say total body weight....
total body weight... right?
72 kg is the total body weight of this person....total
body weight is divided into two..."Total body
water" and "Lean body mass".....Lean body
mass and total body water...
If we remove...for example....if this diagram
is representing all the body weight... right?
If it is representing all the body weight...
then in this person this whole should represent
42 kg out of that...total body weight divided
into Lean body mass which is about 40% and
total body water is about 60%...this is very
important to understand.
Whatever our weight...approximately 60% we
are just water.
When we say.....if I say I am falling in love
with a girl actually 60% water of Dr. Najeeb
is and plus 40% of lean body mass is falling
in love with the girl's 60% of the water and
40% of the lean body mass.
You need to remember this, that all of us
consist of about 60% of water.... about 60%
of water... is that right?
Children have a little more percentage.
Anyway so 60% of water it means if my weight
is 72 kg...then... ok this whole system has
72 kg weight.....how much water?
60%... about 42 liters so if my weight is
72 kg I will have how much water?
42 liters...don't tell 42 kg and if my weight
is 100 kg than how much water I have?
60 liters.
So is that clear?
Right?
Out of this 42 liter is divided into very
important fluid compartments in the body.
Right?
For example...Out of this 42....one third
is in the intracellular fluid....it means
one-third fluid is present inside the cells...these
are cells... so all your...so if my weight
is 42...yes?
72 kg...total water I have is 42...out of
that intracellular is two-third and extracellular
fluid is one-third.
Extracellular is one-third...intracellular
is two-third...and what is extracellular fluid?
Extracellular fluid means outside the cell...outside
the cell means...fluid in the Interstitium...including
body cavities....and fluid in the blood...you
are understanding?
So if I have 72 kg weight...there is 42 liters
water in my body...out of that 28 liters is
present inside the cells because...42...two-third
is 28 liters...and one-third is...14 liters.
So it means I will write it here how much
I have?
28...twenty eight liters here...and how much
is left then?
14...so fourteen liters is here outside the
cells....out of this fourteen, inside the
plasma is about 3.5 liters....and outside
is about 10.5 liters.
Approximately!
Of course, degree of hydration changes from
person to person and time to time but approximately
now we come back..so....what we have decided?
That extracellular fluid is divided into Interstitial
fluid..which is here and what is this?
Intravascular fluid.
Normally how much blood you have?
How much blood you have?
5 Liters!
You were answering this thing :)....you were
saying 5 liters...Five litres is the amount
of blood in a person but we have fluid outside
the blood...secondly in the blood even 5 liter
is not the whole fluid...there are cells too...we
are talking about....lets suppose...this is
vascular system..these are red blood cells...now
which is the fluid inside the red blood cells...
that is "Intravascular"...not only intravascular
that is intracellular too!
In the blood vessels you have 5 liters of
the blood but in the blood there are cells...
right? and there are red blood cells and white
blood cells and there are platelets...all
of them have fluid inside but that fluid is
considered part of the intracellular compartment.
That is considered part of the intracellular
compartment so plasma which is left that is
considered extracellular.
