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Hydrostatic Pressure
Which statement best describes hydrostatic pressure?
Pressure against the wall of a vessel is caused by the force of fluid traveling through a vessel.
Pressure is caused by the differences in the concentrations of two solutions.
A passive movement of fluid occurs through a membrane from a higher concentration to a lower concentration.
A change in the consistency of a wall or membrane allows more fluid to pass through.
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Hydrostatic pressure is caused by an increase in force exerting pressure on the wall of the vessel. This can occur with increases in blood pressure or blockages.
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Increased Permeability
Which statement best describes increased permeability?
A passive movement of fluid occurs through a membrane from a higher concentration to a lower concentration.
A change in the consistency of a wall or membrane allows more fluid to pass through.
Pressure is caused by the differences in the concentrations of two solutions.
Pressure against the wall of a vessel is caused by the force of fluid traveling through a vessel.
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An increase in permeability is described as a change in the wall of a membrane to allow more material to pass through it.
Decreased permeability occurs when less is let through the membrane.
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Osmotic Pressure
Which statement best describes osmotic pressure?
Pressure against the wall of a vessel caused by the force of fluid traveling through a vessel.
A passive movement of fluid through a membrane from a higher concentration to a lower concentration.
A change in the consistency of a wall or membrane to allow more to pass through.
Pressure is caused by the differences in the concentrations of two solutions.
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Osmotic pressure is caused when there is a change in concentration between one fluid and another, causing diffusion (the movement of fluid from a high concentration to a lower one).
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Cause of Edema
A lack of which of the following can cause an increase in edema?
Water
Histamines
Cortisol
Protein or albumin
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Edema related to the loss of plasma proteins, particularly albumin, results in a decrease in plasma osmotic pressure. Plasma proteins remain inside the capillary and seldom move through the semipermeable capillary membrane. The presence of fewer plasma proteins in the capillary allows more fluid to leave the capillary and less fluid to return to the venous end of the capillary.
Water increases edema, and cortisol causes edema and fluid retention. Histamines increase edema through inflammatory response.
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Cause of Edema
Due to low blood albumin, fluid moves out of the vascular space and enters into the interstitial space causing edema.
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Edema in Disease and Injury
The table below lists locations where edema can occur. Match the cause and pathology of the disease or injury to the correct location of edema.
| Cause | Pathology behind the change | |
| Lower extremities | ||
| Abdomen | The decreased circulatory pressure caused by a failing heart or vascular blockage leads to increased pressure in the venous system. This intravascular pressure pushes fluid into the interstitial spaces and gravity causes that fluid to settle in the feet and legs. | |
| Surrounding a wound | ||
| Upper or lower extremities | ||
| Generalized |
Failure of the kidneys can cause increased generalized edema as the kidneys are not able to eliminate any excess fluid that has already been metabolized.
The immune system draws fluid in and around an injury to send white blood cells and other immune mediators to fight any type of infection.
Inflammatory response
Renal disease
Liver disease
As the liver fails, elevated pressure in the portal vein of the liver circulation combined with reductions in protein cause movement of fluid into the abdomen causing ascites (edema).
Heart failure, blood clot
Removal or non-functioning lymph nodes
The lymph removes fluid and cells that have reached the end of their usefulness. When these lymph nodes which are located all over our bodies stop functioning or are removed, lymphedema occurs.
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| Location of Edema | Cause | Pathophysiologic Condition |
| Lower extremities | Heart failure, blood clot | The decreased circulatory pressure caused by a failing heart or vascular blockage leads to increased pressure in the venous system. This intravascular pressure pushes fluid into the interstitial spaces and gravity causes that fluid to settle in the feet and legs. |
| Abdomen | Liver disease | As the liver fails, elevated pressure in the portal vein of the liver circulation combined with reductions in protein cause movement of fluid into the abdomen causing ascites (edema). |
| Surrounding a wound | Inflammatory response | The immune system draws fluid in and around an injury to send white blood cells and other immune mediators to fight any type of infection. |
| Upper or lower extremities | Removal or non- functioning lymph nodes | The lymph removes fluid and cells that have reached the end of their usefulness. When these lymph nodes which are located all over our bodies stop functioning or are removed, lymphedema occurs. |
| Generalized | Renal disease | Failure of the kidneys can cause increased generalized edema as the kidneys are not able to eliminate any excess fluid that has already been metabolized. |
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Cause of Edema
A lack of which of the following can cause an increase in edema?
Water
Histamines
Protein or albumin
Cortisol
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Edema related to the loss of plasma proteins, particularly albumin, results in a decrease in plasma osmotic pressure. Plasma proteins remain inside the capillary and seldom move through the semipermeable capillary membrane. The presence of fewer plasma proteins in the capillary allows more fluid to leave the capillary and less fluid to return to the venous end of the capillary.
Water increases edema, and cortisol causes edema and fluid retention. Histamines increase edema through inflammatory response.
✖
Cause of Edema
Due to low blood albumin, fluid moves out of the vascular space and enters into the interstitial space causing edema.
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Signs and Symptoms of Edema
Which are possible signs or symptoms of edema? Select all that apply.
Swelling of lower extremities
Weight gain
Increased serum sodium
Increase in hematocrit (increase in the percentage of RBC in the blood)
Thirst
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Weight gain: An increase in fluid will cause an increase in weight.
Swelling of lower extremities (pitting edema +3): Increased fluid in the intestinal compartment.
Thirst: It is not usually associated with edema.
Increase in hematocrit (increase in the percentage of RBC in the blood): There is usually a decrease in hematocrit. This decrease is related to increased fluid diluting the blood.
Increased serum sodium: There is usually a decrease in serum sodium.
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Tissue Edema
Which condition may result in tissue edema?
Decreased level of proteins in the plasma
Reduced temperature at the skin surface
The ingestion of a large amount of carbohydrates
The ingestion of a large amount of salt
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The ingestion of salt leads to an increase in osmotic pressure as it causes an increase in concentration, thereby attracting less concentrated fluid.
Decreased blood pressure is more of a sign of hypovolemia and reduced edema. Reduced skin temperature or ingestion of a large amount of carbohydrates does not affect edema.
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Case Study: Edema
What Matters Most?
Select the signs or symptoms that are consistent with edema.
Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack’s ankles are swollen and he says he gained 5pounds in the past 2 days.
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Weight gain, swollen ankles, and shortness of breath are all signs or symptoms consistent with edema.
The difficulty breathing could be caused by pulmonary edema. History of heart failure and ingestion of a high-sodium meal do not necessarily mean that edema is present.
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Case Study: Edema
What Could It Mean?
Select the signs or symptoms that could be a cause of increased edema.
Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack’s ankles are swollen and he says he gained 5pounds in the past 2 days.
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Older adults, a history of heart failure, and high-sodium meals can all cause an increase in edema.
Difficulty breathing, swollen ankles, and weight gain are all signs or symptoms of edema.
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Case Study: Edema
Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack’s ankles are swollen and he says he gained 5 pounds in the past 2 days.
Question 1 / 2
What Is Happening?
Excessive magnesium potassium sodium levels in the extracellular fluid promote the accumulation of fluid in the interstitial intracellular vascular compartment. This happens because of increasing hydrostatic osmotic permeability pressure. Blood pressure is usually decreased elevated , too.
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Excessive sodium levels in the extracellular fluid promote accumulation of fluid in the interstitial compartment. This happens because of increasing osmotic pressure. Blood pressure is usually elevated, too.
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Case Study: Edema
Jack (preferred pronouns: he, him), a 70-year-old adult male, is in the clinic with difficulty breathing. His triage history states that he has heart failure and had several high-sodium meals over the holidays. Jack’s ankles are swollen and he says he gained 5 pounds in the past 2 days.
Question 2 / 2
How Can This Be Prevented?
Which strategies can reduce or prevent edema? Select all that apply.
Drinking an electrolyte replacement fluid
Sitting in a sauna
Reducing sodium intake
Taking diuretic medication as ordered
Propping up the legs above the level of the heart
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Strategies that can reduce swelling include propping your legs up so the blood can travel back to the heart, taking a diuretic, and reducing sodium intake.
Strategies that will not improve or prevent swelling include sitting in a sauna and drinking an electrolyte replacement drink.
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Risk of Edema
Which underlying conditions increase the risk of edema? Select all that apply.
Dyslipidemia
Epilepsy
Liver failure
Vascular disease
Chronic kidney disease
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Conditions that increase the risk of edema include vascular disease, chronic kidney disease, and liver failure.
Dyslipidemia and epilepsy do not increase the risk of edema.
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Causes of Edema
Match each cause of edema to its description.
| Increased hydrostatic pressure | If one or more of the lymph nodes are not able to collect these materials, they get caught in the interstitial areas, causing a type of edema called lymphedema. |
| Change in osmotic pressure | This can occur when the concentration of the blood or interstitial fluid changes. The difference in the concentration, or the osmolarity, affects osmotic fluid shifts between compartments, including the cell. |
| Lymphatic node dysfunction | This occurs when chemicals and proteins change the size of the vessel walls to allow fluid to travel into or out of the vascular system. |
| Increased vascular permeability | This occurs when there is a blockage or backup in the vascular system causing increased pressure against the vessel walls and the movement of fluid into interstitial spaces. |
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Increased vascular permeability: This occurs when chemicals and proteins change the size of the vessel walls to allow fluid to travel into or out of the vascular system.
Increased hydrostatic pressure: This occurs when there is a blockage or backup in the vascular system causing increased pressure against the vessel walls and the movement of fluid into interstitial spaces.
Change in osmotic pressure: This can occur when the concentration of the blood or interstitial fluid changes. The difference in the concentration, or the osmolarity, affects osmotic fluid shifts between compartments, including the cell .
Lymphatic node dysfunction: If one or more of the lymph nodes are not able to collect these materials, they get caught in the interstitial areas causing a type of edema called lymphedema.
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Edema Location
Drag and drop the location of the edema to match the most likely pathophysiologic condition.
| Pathophysiologic Condition | Location of Edema |
| Heart failure, blood clot | Lower extremities |
| Removal of non- functioning lymph nodes | Generalized |
| Inflammatory response | Surrounding a wound |
| Renal disease | Abdomen |
| Liver disease | Upper or lower extremities |
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| Location of Edema | Pathophysiologic Condition | Cause | |
| Lower extremities | Heart failure, blood clot | The decreased circulatory pressure caused by a failing heart or vascular blockage leads to increased pressure in the venous system. This intravascular pressure pushes fluid into the interstitial spaces and gravity causes that fluid to settle in the feet and legs. | |
| Abdomen | Liver disease | As the liver fails, elevated pressure in the portal vein of the liver circulation combined with reductions in protein cause movement of fluid into the abdomen causing ascites (edema). | |
| Surrounding a wound | Inflammatory response | The immune system draws fluid in and around an injury to send white blood cells and other immune mediators to fight any type of infection. | |
| Upper or lower extremities | Removal or non- functioning lymph nodes | The lymph removes fluid and cells that have reached the end of their usefulness. When these lymph nodes which are located all over our bodies stop functioning or are removed, lymphedema occurs. | |
| Generalized | Renal disease | Failure of the kidneys can cause increased generalized edema as the kidneys are not able to eliminate any excess fluid that has already been metabolized. | |
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Facts About Edema
Which statements best describe edema? Select all that apply.
Edema is an accumulation of excess fluid in the interstitial spaces.
Edema may be classified by the cause.
Edema can be classified as generalized or localized.
Persistent edema can eventually lead to skin breakdown and delayed wound healing.
Not all edema is visible in the body.
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Edema is an accumulation of excess fluid in the interstitial spaces. It can be classified as generalized or localized and may be classified by the cause. Not all edema is visible in the body. Persistent edema can eventually lead to skin breakdown and delayed wound healing.
