pathophysiology

1. Edema Yu-Hong Jia, Ph.D Pathophysiological department Dalian medical university

5. ( Ⅰ ). imbalance of fluid exchange between plasma and interstitial compartment

6. capillaries When blood flows through capillary, fluid exchange, including water and some small molecules that can pass through the capillary wall, will happen between plasma and interstitial compartment.

7. Total Pressure Differences Inside and Outside Capillary The force promoting fluid outshift from capillary to interstitial compartment includes blood pressure and negative interstitial pressure. The force attracting fluid from interstitial compartment to capillary is blood colloid osmotic pressue. At the arterial end, the sum of the forces causes fluid to move from the capillary into the tissue. At the venous end, the sum of the forces causes fluid to move into the capillary. About nine-tenths of the fluid that leaves the capillary at its arterial end reenters the capillary at its venous end. About one-tenth of fluid passes into the lymphatics. ↑ ↑ permeability ↓ obstruction

12. (Ⅱ). Imbalance of fluid exchange between extra- and intra-body ------ renal retention of sodium and water

19. the protein concentration in the plasma entering the peritubular capillaries increases The peritubular capillary oncotic pressure increases enhancing fluid reabsorption from the renal interstitial space to the capillary decreases renal interstitial pressure favoring reabsorption across the tubular epithelium and minimizing back flux from the renal interstitial space to the tubule lumen. ↑ Reabsorption in proximal tubule Increased FF Increased FF make elevated reabsorption of proximal tubule

20. Causes of FF increasing Congestive heart failure Nephrotic syndrome Decreased effective circulatory blood volume Sympathetic-adrenal medullary system exciting Efferent arteriole constricts stronger than afferent one ↑ Efferent arteriole resistance GFR is increased relative to renal plasma flow ↑ FF

21. -Increased reabsorption in distal tubule and collecting duct increased ADH and ADS secretion 3. Congestive heart failure Nephrotic syndrome ↓ Effective circulatory blood volume ↑ ADH secretion ↓ Renal blood flow ↓ Renal perfusion pressure ↓ GFR->sodium at macula densa ↑ Secretion of renin by Juxtaglomerular cell Sympathetic nerve excitation Renin-angiotensin-aldosterone systm activation Retention of sodium and water ↓ Stimulation of volume-receptor in left atrim and thoracic vessel

22. ADH feedback regulation mechanism

23. The renin-angiotensin-aldosterone system Renin Ang Ⅰ Ang Ⅱ Adrenal gland

25. Ⅳ . Alterations of metabolism and function