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  • 1. LOCALIZED GENERALIZED EDEMA  Cardiac  Hepatic  Renal  Nephrotic syndrome  Acute glomerulonephritis  Chronic renal insufficiency  Idiopathic edema  Other forms  Inflammation  Lymphatic obstruction  Venous obstruction  thrombophlebitis
  • 2. Table 01. diagnosis of hepatic edema evidence of chronic liver disease Spider angiomata Palmar erythema jaundice Presence of portal hypertension and ascites Prominent venous pattern on abdominal wall Esophageal varies Peripheral edema (usually, but not always, present)
  • 3. Table 02. major findings in three forms of edema CARDIAC HEPATIC RENAL Dependent edema ++++ +++ ++ Facial edema - - Present Ascites + ++++ + Hypoalbuminemia - ++ ++++ proteinuria 0- trace 0- trace ++++
  • 4. Table 03. other forms of generalized edema Type Comments Cyclic edema Can develop in women of childbearing age just before the monthly menstrual period; is self-limited and does not require treatment other than counseling; can be confused with idiopathic edema myxedema Is the characteristic brawny edema that resists pitting; develops in patients with hypothyroidism Edema due to the use of vasodilators Resullts from sodium retention (with agents such as minoxidil and hydralazine) and may also result from altered capillary permeability (with nifedipine and possibly other calcium channel blockers of the dihydropyyridine class); usually requires the addition of a diuretic to the therapeutic regimen Edema of pregnancy Is rarely a problem for the general internist, but its treatment often benefits from a nephrology consultation Capillary leak syndrome Develops in critically ill patients who are usually septic Inferior vena cava obstruction Rarely causes generalized edema Protein – losing enteropathy Rarely causes generalized edema
  • 5. Table 04. complications of edema and ascites Peripheral edema Cellulitis Venous thrombosis Impaired vision from periorbital edema Pain Unacceptable cosmetic impact Scrotal and penile edema Limitation of physical activity Pleural effusions
  • 6. ascites Impaired intestinal absorption Esophageal reflux Dyspnea from impaired diaphragmatic excursion Umbilical or inguinal hernias Spontaneous bacterial peritonitis From genes et al. [1*]; with permission
  • 7. Table 06. treatment of edema General measures Treatment of the primary disease Bed rest Sodium restriction Diuretic administration
  • 8. specific measures Fluid removal Pleurocentesis (heart failure, cirrhosis, nephrosis) Paracentesis (heart failure, cirrhosis, nephrosis) Plasma volume expansion Infusion of plasma or hyperoncotic albumin solutions (cirrhosis, nephrosis) Ascitic fluid reinfusion (cirrhosis) Insertion of a peritoneovenous shunt (cirrhosis) Head – out water immersion (cirrhosis, nephrosis) Pharmacologic therapy Vasodilators (heart failure) Angiotensin – converting enzyme inhibitors (heart failure, nephrosis) Vasoconstrictors (cirrhosis) Continuous arteriovenous hemofiltration (heart failure, nephrosis) Adapted from Gines et al. [1*]; with permission.