Normally, the high hydrostatic pressure of arterial blood antering tissue capillary beds causes some fluid to filter

through the capillary bed hydrostatic pressure falls and the loss of fluid resuld in a rise in the plasma osolality as a result in a rise in the plasma osmolality as a result of plasma proteins, these changes in capillary hydrostatic or osmotic pressure can cause edema, the accumulation of excess fluid in the interstitium. Venous obstruction or hypervolemia raises hydrostatic pressure at the venous end of the capillary bed, which reduce interstitial fluid reabsorption. A low plasma protein concentration lowers the capillary osmotic pressure and reduce interstitial fluid reabsortion Generalized edema occurs only when the body volume is too high. This can happened in adveance renal failure because the kidneys cannot excrete enough sodium or water. Howover the major causes are congestive heart failure, , in these conditions, renal sodium-handling mechanisms are intact, but the kidney receives neuroendocrine signel tha promoted sodium or water retention. This occurs because the volume sensors perceive that the circulation is underfilled and drive a volume-conserving respons similar to that during hemorrhage. This response includes enhanced sympathetic and chetocolamine activity, enhced renin-angiotensin II aldosterone activity and excess anti diuretic hormone (ADH) secretion. Perceived hypovolemia Arterial baroreceptors are the dominant volume sensors, and monitor the stretching of artherial walss. In congestive heart filure, reduce cardiac output lowes the blood pressure wich stimulates arterial baroreceptors. Low vascular resistance is caused by splanchnic vasodilation and the development of multiple arterivenous shunts. The vasodilation may be caused by either raised nitric oxide levels of failure of the deiseased liver to degrade other vasoactive substances. The volume conserving response in nephrotic syndrome is less clearly understood. One possibility is that heavy proteinuria lowers plasma protein levels, allowing fluid to leak into the the interstitium. The reduce circulating volume would then trigger a volume-conserving response. Location of edema Edem fluid collects in slack tissues are low in the body. Here, gravity causes a high hydostatic venous pressure, opposing interstitial fluid reabsorption. Clinically, edema may be detectable in the lungs as pulmonary edema or as peripheral edema around the ankles, scrum, and scrotum excess fluid can also accumulate as effusion, such as pleural effusion or ascites Clinical aspects High body volume usually raises the venous pressure, causing a high jugular venous pulse pressure. Outside the circulation, there is subcutaneous pitting edema fluid moves away from a point where pressure is applied. Pulmonary edema can be