Approach to edema & clubbing

1. APPROACH TO CLUBBING &
EDEMA
DR.Bilal Natiq Nuaman,MD
C.A.B.M. , F.I.B.M.S. , D.I.M. , M.B.Ch.B.
Lecturer in Al-Iraqia Medical College
2018-2019

2. CLUBBING

11. • Edema involving the legs but sparing the feet
is lipedema, Because there is no fat on the top
of the feet, they are spared.
• Decreasing intravascular volume with diuretics
will not mobilize the fluid of lipedema.

14. Classifications of edema

21. • Peripheral edema is graded on a 1 to 4 scale
based on the pit recovery time (PRT). To assess
• the PRT, apply pressure with one finger over the
area of edema for 5 seconds.
• Release the pressure and assess the time
required for the pit to return to normal.
• Each 1 point on the scale corresponds to 30
seconds of PRT (1+ edema = < 30 seconds PRT; 2+
edema = 30–60
• seconds PRT, etc.). The higher the PRT, the
greater the likelihood that the edema is due to
increased hydrostatic pressure (ie, congestive
heart failure).

22. <30 seconds
30-60 seconds
60-90 seconds
>90 seconds

26. • Mild to moderate heart failure results in
edema involving the legs, feet, and toes.
Severe heart failure leads to edema involving
the legs and feet but sparing the toes.
• The inadequate cardiac output causes
peripheral vascular constriction to maintain
core mean arterial pressure, which decreases
blood flow to the toes, thus diminishing
edema in the toes.

29. Angioedema
Angioedema is an episodic, localized, non-pitting
swelling of submucous or subcutaneous tissues.

30. • characterized by soft-tissue swelling that most
frequently affects the face.
• Involvement of the larynx or tongue may
cause life-threatening respiratory tract
obstruction, and edema of the intestinal
mucosa may cause abdominal pain and
distension.