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Edema Diagnosis and Management AAFP,July 15, 2013 ,volume 88, number 2 presented by Dr. Anne Zbaracki

Edema

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Edema Diagnosis and Management AAFP, July 15, 2013 ,volume 88, number 2 presented by Dr. Anne Zbaracki. Edema. Accumulation of fluid in interstitial space due to capillary filtration exceeding lymph drainage. Edema. - PowerPoint PPT Presentation

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Page 1: Edema

EdemaDiagnosis and Management

AAFP,July 15, 2013 ,volume 88, number 2presented by Dr. Anne Zbaracki

Page 2: Edema

Edema• Accumulation of fluid in interstitial space due

to capillary filtration exceeding lymph drainage

Page 3: Edema

Edema• Capillary hydrostatic pressure and oncotic

pressure is regulated by fluid between interstitial and intravascular spaces

• Disruption in local or systemic conditions

Page 4: Edema

Assessment

• History– Timing- acute, chronic– Position– Unilateral, bilateral– Medications– Systemic diseases

Page 5: Edema

Assessment

• PE • Focus on medial malleoulus, bony tibia, dorsum

– Pitting– Tenderness– Skin changes-temperature, color, texture

Page 6: Edema

Assessment

Kaposi-Stemmer sign, in lymphedema

Page 7: Edema

Assessment

• PE– Systemic causes• Heart failure-jvd, crackles• Renal-proteinuria, oligouria• Hepatic-jaundice, ascities, asterixis• Thyroid- exopthalmus, tremor, wt loss

Page 8: Edema

Local

• Cellulitis• Chronic venous insufficiency• Compartment syndrome• Complex regional pain syndrome type I• DVT• Iliac vein obstruction• Lipedema• Lymphedema primary or secondary• May-Thurner syndrome

Page 9: Edema

Systemic

• Allergic reaction, urticaria, angioedema• Cardiac disease• Hepatic disease• Renal disease• Malnutrition/malabsorption• Obstructive sleep apnea• Pregnancy, premenstrual

Page 10: Edema

Cellulitis

• Increased capillary permeability

Page 11: Edema

Chronic Venous insufficiency

• Increased capillary permeability from local venous hypertension

• treatment- compression, horse chest nut seed extract, skin care

Page 12: Edema

Compartment Syndrome

• Increased capillary permeability from local venous hypertension

Page 13: Edema

Complex regional pain syndrome type I

• Neurogenically mediated increased capillary permeability

Treatment- systemic steriods, topical dimethyl sulfoxide, PT, tricyclic, ca++ blockers

Page 14: Edema

Deep venous thrombosis

• Increased capillary permeability

Page 15: Edema

Lipedema

• Accumulation of fluid in adipose tissue

• Treatment- none

Page 16: Edema

Lymphedema

• Lymphatic obstruction

Page 17: Edema

May-Thurner syndromecompression of left iliac vein by right iliac artery

• Increased capillary permeability from local venous hypertension from compression

Page 18: Edema

Allergic reaction• Increased capillary permeability• Medications

– Antidepressants- monoamine oxidase inhibitors, trazodone– Antihypertensives- b-blockers, calcium channel blockers, clonidine,

hydralazine, methyldopa, minoxidil– Antivirals-acyclovir– Chemo- cyclophosphamide, cyclosporine, cytosine arabinoside,

mithramycin– Hormones- androgen, corticosteriods, estrogen, progesterone,

testoterone– Nsaids- celecoxib,ibuprofen– Diuretic- volume depletion and reflex renin angiotensin stimulation

Page 19: Edema

Cardiac disease

• Increased capillary permeability from systemic venous hypertension, increased plasma volume

Page 20: Edema

Hepatic disease

• Increased capillary permeability from systemic venous hypertension, decreased plasma oncotic pressure from reduced protein synthesis

Page 21: Edema

Renal disease

• Increased plasma volume, decreased plasma oncotic pressure from protein loss

Page 22: Edema

Malnutriton/ Malabsorption

• Decreased plasma oncotic pressure from reduced protein synthesis

Page 23: Edema

Obstructive sleep apnea

• Increased capillary hydrostatic pressure from Pulmonary hypertension

Page 24: Edema

Pregnancy

• Increased plasma volume

Page 25: Edema

Diagnostic studies

• Labs-bnp, creatinine, urinalysis, lft’s, albumin, d-dimer

• Ankle-brachial index• Ultrasonography- venous, compression w or

w/o dopplar, duplex• Lymphoscintigraphy- radionuclide• MRI- w venography• Echo-pulmonary arterial pressures