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8/10/2019 10 Edema#80fb
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EDEMA
Dr. Alexandru Nechita
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DEFINITION
Edema= increase in interstitial volume,localised or generalised, due to sodium
and water accumulation in thesubcutaneous tissue. The normal anatomicprofile disappears and pits appear under
pressure.
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TYPES OF EDEMA
Local causes: inflammatory, allergic.
General causes: cardiac, renal mandatory generalised hidrosaline
retention.
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EDEMA- general features.
Initially the skin is under tension and shiny.
In the resolution phase: fine longitudinal foldsappear, together with thickening of theteguments.
Colour: renal edema is white, cardiac andvenous is cyanotic, inflammatory or alergic red.
Local temperature: increased in inflammatoryedema, normal in renal, decreased in cardiacedema.
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EDEMA- general features.
Consistency: renal or starvation edema issoft, easy pitting present, inflammatory
and venous edema pits appear very hard,or not at all.In chronic edema skinthickening is present.
Pain: inflammatory edema is painful, thegeneral cuase edema are generally notpainful.
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Anasarca
Clinical syndrome characterised bypronounced water and sodium retention.
Generalised edema fluid accumulation inthe serous spaces of the body:hidrothorax, ascites, hidropericardium.
The liquid is clear with a green-yellow tan.They have a small content of proteins.
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Where to look for edema ?
Retromaleolar region: by aplying digital pressure on thearea until a pit is formed.
Anterotibial.
Over the knee articulation. Anterior abdominal wall: when you fold the skin pits and
orange like surface appear.
Sacral region- bed imobilised patients.
Breast edema- inferoexternal aspect. Upper limbs: infero-internal and posterior aspect, over
the elbow.
Face edema: compare the aspect wuth a recent photo.
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MECHANISMS OF EDEMA
Local factors: the fluid volume whichleaves the capillary at the arterial end is
superior to the resorbed volume at thevenous extremity.
Water and sodium retention, when thelocal mechanism of water transudation
becomes secondary, this is associated witha decrease in sodium, and secondary,water excretion.
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Local factors that influence theonset of edema
Hidrostatic pressureColoid-osmotic pressure
Tissue mechanical pressure
Capillary permeability
Lymphatic drainage
Tissue osmotic pressure
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CARDIAC EDEMA
Gravitation dependent.
In bedridden patients lombosacral edema
is dominant. Untreated edema develops in a cranial
direction, until anasarca appears.
Edema is cyanotic and cold ( stasiscyanosis ) due to low cardiac output.
Pits are persistent.
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CARDIAC EDEMA
The presence of dyspnoea is mandatory.
Increased levels of BNP are mandatory.
Edema is much more frequent in right heartfailure.
It is produced by an increase in central venouspressure.
There is marked sodium and water retention dueto reduced glomerular filtration rate.
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RENAL EDEMA.
Nephrotic edema due to protein loss afterbasal membranedamage(albuminuria>4g/24hr.).
Nephritic edema- protein loss not so importantto justify edema, sodium retention is much moreimportant.
Edema is white and soft, normal temperature,easy pits.
Face, eyelids, dorsal aspect of feet, externalgenitalia.
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Starvation edema
Generalised, soft, pits appear easy.
Localised at the legs and face.
General aspect similar to renal edema.
Main mechanism is hipoalbuminemia, dueto malabsorbtion, hepatocelular failure,
serumalbumin synthesis failure.
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HEPATIC EDEMA
White, soft, inferior limbs.
Appears in decomensated liver chirosis.
Ascites is not proportional with edema.
Jaundice and spider naevi are present.
Mechanisms: hipoalbuminemia,hyperaldosteronism.
Reduced liver aldosterone turnover.
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PREGNANCY EDEMA
Moderate, white, soft, localised at theinferior limbs, determined by multiple
factors:umoral, inferior vena cavacompression.
Generalised edema after the 20thpregnancy
week+hypertension+proteinuria=preeclampsia, which can lead toeclampsia=seizures, coma, death.
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CATAMENIAL OR CYCLIC EDEMA
Discreet and moderate edema of the legs,which appears predominantly in thesecond half of the menstrual period.
They are dependent on secondaryhyperaldosteronism.
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MIXEDEMA
Appears in severe hypethiroidism.
It is determined by infiltration of the
subcutatenous tissue withmucopolyzaccharides.
The skin is thickened.
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IATROGENIC EDEMA
EXCESSIVE WATER AND SODIUMADMINISTRATION.
CORTICOIDS. ESTROGENS
Other drugs.
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INFLAMMATORY EDEMA
Infection
Trauma
Burns.
Red,hot, painful, pit does not appear.
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Quincke edema
Pruriginous, pink, easy painful.
Eyelid, superior lip.
Glotic edema can appear. bad prognosisbecause respiratory obstruction.
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VENOUS EDEMA
Superficial thrombophlebitis edema islimited beyond the thromosed vein.
Deep thrombophlebitis edema: inferior orsuperior limb.
Initially moderate, then it can be
important. Painful,white, pain in the legs.
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CHRONIC VENOUS FAILURE
Consecutive to recurrent deep venous
thrombosis-posthrombotic syndrome. Increased in orthostatic position.
Skin is often cyanotic, with brown
dermatitis, complicated with varicousulcer.
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Limphedema
Also called in severe cases elphantiasis.
Cause: lymphatic obstruction.