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Edema is a clinical condition characterized
by an increase in interstitial fluid volume and
tissue swelling that can be either localized or
generalized. Severe generalized edema is
known as anasarca. More localized interstitial
fluid collections include ascites and pleural
effusions.
Generalized edema is typically chronic and
progressive It may result from
cardiac, renal, endocrine, or hepatic disorders
as well as from severe burns, malnutrition, or
the effects of certain drugs and treatments
Common factors responsible for edema are
hypoalbuminemia and excess sodium
ingestion or retention, both of which
influence plasma osmotic pressure
1.
1.Skin disorders
2.Allergic reaction
3.Vasculitis
4.Septicemia
5.Vitamin E deficiency
6.Hereditary angioedema
1.Increased blood volume
1.Fluid overload
2.Cardiac failure
3.Renal disease
2. Increased venous pressure
2. Constructive pericarditis
3. Portal hypertension
4. Venous thrombosis
5. Tumor
3. Increased lymph pressure
1. Lymphedema
2.
1. Renal disease
1. Glomerulonephritis
2. Nephrotic syndrome
3. Renal failure
1.Acute and chronic liver disease
1.Hepatitis
2.Cirrhosis
3.Portal hypertension
2.Gastrointestinal disease
1.Protein-losing enteropathy
1.Cow milk protein sensitivity
2.Cystic fibrosis
3.Celiac disease
4.Inflammatory bowel disease
5.Intestinal lymphangiectasia
3.Protein-calorie malnutrition
4.Congenital albumin deficiency
3.
 Medical history questions documenting swelling
in detail may include the following
Time pattern
o When did you first notice this?
o Is it present all the time?
o Does it come and go?
Quality
o How much swelling is there?
o When you poke the area with a finger, does the
dent remain?
Location
o Is it overall or in a specific area (localized ?
o If swelling is in a specific area, what is that
area?
Others
o What seems to make the swelling better?
o What seems to make the swelling worse?
o Is the edema worse in the morning or at the
end of the day?
o Is it affected by position changes?
o Is it accompanied by shortness of breath or
pain in the arms or legs?
o Find out how much weight the patient has
gained
o Has his urine output changed in quantity or
quality?
o What other symptoms are also present?
 Next, ask about previous burns or
cardiac, renal, hepatic, endocrine, or GI
disorders. Ask the patient to describe his
diet so you can determine whether he
suffers from protein malnutrition. Explore
his drug history, and note recent I.V.
therapy.
Begin the physical examination by
comparing the patient’s arms and legs for
symmetrical edema. Also, note
ecchymosis, rash and cyanosis. Assess the
back, sacrum, and hips of the bedridden
patient for dependent edema. Assess the
abdomen for ascites and scrotum. Palpate
peripheral pulses, noting whether hands and
feet feel cold, and measure the blood
pressure. Finally, perform a complete
cardiac, respiratory and abdominal
 Skin Disorders
• Cellulitis, exfoliative dermatitis, and
burns can cause increase in capillary
permeability and edema.
• History and physical exam are
diagnostic.
 Allergic Reaction
• Release of histamine and other vasoactive
mediators can produce localized or generalized
edema.
• Drugs, chemical exposure by inhalation, foods)
especially milk, eggs, chocolate, nuts(, and bee
stings are common causes of allergic reactions.
• Lips, eyelids, and face are frequently
involved, and urticaria also may occur.
• Wheezing, laryngospasm, and hypotension
may be seen with anaphylactic reactions.
• History and physical exam are usually
diagnostic.
 Vasculitis
Common causes of vasculitis causing
edema include Kawasaki disease and
collagen vascular disease.
 Septicemia
Severe bacterial or rickettsial infections
can cause increase in capillary permeability
and edema.
 Vitamin E Deficiency
• Uncommon since addition of vitamin E
to infant formulas.
• Preterm infants 4–6 weeks of age
without normal intake of vitamin E may
develop generalized edema, hemolytic
anemia, and thrombocytosis.
• Serum concentration of vitamin E is low.
 Angioedema
Recurrent attacks of
acute, painless, nonpitting edema involving
the skin and mucous membranes — especially
those of the respiratory
tract, face, neck, lips, larynx, hands, feet, geni
talia, or viscera — may be the result of a food
or drug allergy or emotional stress; they may
also be hereditary. Abdominal
pain, nausea, vomiting, and diarrhea
accompany visceral edema; dyspnea and
stridor accompany life-threatening laryngeal
edema. .
• Diagnosis is confirmed by measurement of
Increased Hydrostatic Pressure
 Increased BloodVolume
• Administration of excessive amounts of
sodium or fluid can produce volume
overload and edema.
• In cardiac failure, diminished renal blood
flow leads to decrease in glomerular
filtration rate (GFR) and edema.
• Renal disease e.g., (glomerulonephritis)
or any cause of renal failure also may lead
to decrease in GFR and edema.
Severe, generalized pitting edema — occasionally
anasarca — may follow leg edema late in a patient
with heart failure. The edema may improve with
exercise or elevation of the limbs and tends to be
worse at the end of the day. Other classic late
findings include hemoptysis, cyanosis, marked
hepatomegaly, clubbing, crackles, and a ventricular
gallop. Typically, the patient also experiences
tachypnea, palpitations, hypotension, weight gain
despite anorexia, nausea, slowed mental
response, diaphoresis, and pallor.
Dyspnea, orthopnea, tachycardia, and fatigue
signal left-sided heart failure; jugular vein
distention, enlarged liver, and peripheral edema
 IncreasedVenous Pressure
• Increased venous pressure from deep
venous thrombosis, constrictive
pericarditis, portal hypertension, or
impaired venous drainage from tumor may
produce edema.
• Deep venous thrombosis in thigh or calf
produces pain and swelling of leg distal to
thrombus. U/S is usually diagnostic.
, generalized
pitting edema may be most prominent in
the arms and legs. It may be accompanied
by chest
pain, dyspnea, orthopnea, nonproductive
cough, pericardial friction rub, jugular vein
distention, dysphagia, and fever
 Increased Lymph Pressure
• Lymphedema is excessive accumulation
of lymph in interstitial space and is
principal cause of increased lymph
pressure.
• Can be congenital or acquired, sporadic
or familial, and may appear at birth or in
childhood or adolescence.
• Abnormal development or dysfunction
of lymphatic vessels, lymph node
obstruction, and venous stasis are
common mechanisms producing
lymphedema.
• Common presentation is
unilateral, painless edema of leg;
however, pain may occur with massive
edema or cellulitis.
• U/S and MRI are useful in detection of
lymphatic malformations and obstructive
lesions.
 Disorders with Proteinuria
• Any renal disorder causing severe
proteinuria may produce edema.
Nephrotic syndrome and acute
glomerulonephritis are common examples.
is characterized by
generalized pitting edema, the edema is
initially localized around the eyes. With
severe cases, anasarca develops, increasing
body weight by up to 50%. Other common
signs and symptoms are
ascites, anorexia, fatigue, malaise, depression
, and pallor.
 UG confirms presence of proteinuria.
Generalized pitting edema occurs as a late
sign of acute renal failure. With chronic renal
failure, edema is less likely to become
generalized; its severity depends on the
degree of fluid overload. Both forms of renal
failure cause oliguria, anorexia, nausea and
vomiting, drowsiness, confusion, hypertensi
on, dyspnea, crackles, dizziness, and pallor.
 Disorders without Proteinuria
 Acute and Chronic Liver Disease
• Decrease in synthesis of albumin in liver
produces hypoalbuminemia.
• Serum albumin of <2.5 g/dL causes
decrease in plasma oncotic pressure and
edema.
edema is a late sign of
cirrhosis, a chronic disease. Accompanying
signs and symptoms include abdominal
pain, anorexia, nausea and
vomiting, hepatomegaly, ascites, jaundice, p
ruritus, bleeding tendencies, musty
breath, lethargy, mental changes, and
asterixis.
 Gastrointestinal Disease
• Loss of serum albumin in GI tract leads to
decreased plasma oncotic pressure and
edema.
• Screening test for protein loss in stool is
measurement of alpha1-antitrypsin in spot
stool sample.
 Protein-Calorie Malnutrition
• Severe protein-calorie malnutrition can
produce edema because of decrease in
serum albumin.
• Growth failure, decreased muscle
mass, diarrhea, hepatomegaly, anemia, pi
gment changes of hair and
skin, fatigue, and apathy are other
findings.
• Edema resolves with adequate calorie
and protein intake.
 Congenital Albumin Deficiency
• Severe edema occurs with congenital
albumin deficiency, which is rare.
• Very low or undetectable serum albumin
concentration in absence of other causes
of hypoalbuminemia confirms diagnosis.
 Hydrops Fetalis: Immune and Nonimmune
Hydrops fetalis is term used to describe
severe generalized edema in fetus or
newborn, Because of use of anti-D
immune globulin for Rh isoimmunization;
most cases of Hydrops are nonimmune
type
• UG screens for proteinuria and renal disease.
• In absence of significant proteinuria or
cardiac failure, serum albumin should be
measured. Fluid overload and allergic reactions
are common causes of edema with normal
serum albumin. Decreased serum albumin
without proteinuria suggests liver
disease, protein-losing enteropathy, or protein-
caloric malnutrition.
• Electrolytes, B.urea and S.creatinine
• CXR, ECG, ECHO and others
• Jaundice, hepatomegaly, and abnormal
liver function tests are manifestations of liver
disease.
• Elevated fecal alpha1-antitrypsin level
indicates increased protein loss in stool and
is seen with various causes of protein-losing
enteropathy.
• Protein-calorie malnutrition can be
assessed by plotting weight and height on
growth charts
 Treatments for edema are focused on
reversing the underlying cause, if there is one
present treat accordingly.
 Bed rest, dietary and lifestyle
modifications, such as limiting sodium
chloride (salt) intakes, are recommended.
 many physicians implement diuretic
therapies. Diuretics are used to decrease the
amount of water in the body by increasing
the flow of urine.
 Avoid I.V. saline solution infusions and enteral
feedings may cause sodium and fluid
overload, resulting in generalized
edema, especially in patients with cardiac or
renal disease
 Monitor intake and output and daily weight.
Also monitor serum electrolyte levels —
especially sodium and albumin.
 Renal failure in children commonly causes
generalized edema. Monitor fluid balance
closely. Remember that fever and diaphoresis
can lead to fluid loss, so promote fluid intake.
Approach to child with generalized body swelling

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Approach to child with generalized body swelling

  • 1.
  • 2. Edema is a clinical condition characterized by an increase in interstitial fluid volume and tissue swelling that can be either localized or generalized. Severe generalized edema is known as anasarca. More localized interstitial fluid collections include ascites and pleural effusions.
  • 3. Generalized edema is typically chronic and progressive It may result from cardiac, renal, endocrine, or hepatic disorders as well as from severe burns, malnutrition, or the effects of certain drugs and treatments Common factors responsible for edema are hypoalbuminemia and excess sodium ingestion or retention, both of which influence plasma osmotic pressure
  • 4. 1. 1.Skin disorders 2.Allergic reaction 3.Vasculitis 4.Septicemia 5.Vitamin E deficiency 6.Hereditary angioedema 1.Increased blood volume 1.Fluid overload 2.Cardiac failure 3.Renal disease
  • 5. 2. Increased venous pressure 2. Constructive pericarditis 3. Portal hypertension 4. Venous thrombosis 5. Tumor 3. Increased lymph pressure 1. Lymphedema 2. 1. Renal disease 1. Glomerulonephritis 2. Nephrotic syndrome 3. Renal failure
  • 6. 1.Acute and chronic liver disease 1.Hepatitis 2.Cirrhosis 3.Portal hypertension 2.Gastrointestinal disease 1.Protein-losing enteropathy 1.Cow milk protein sensitivity 2.Cystic fibrosis 3.Celiac disease 4.Inflammatory bowel disease 5.Intestinal lymphangiectasia 3.Protein-calorie malnutrition 4.Congenital albumin deficiency 3.
  • 7.  Medical history questions documenting swelling in detail may include the following Time pattern o When did you first notice this? o Is it present all the time? o Does it come and go? Quality o How much swelling is there? o When you poke the area with a finger, does the dent remain? Location o Is it overall or in a specific area (localized ? o If swelling is in a specific area, what is that area?
  • 8. Others o What seems to make the swelling better? o What seems to make the swelling worse? o Is the edema worse in the morning or at the end of the day? o Is it affected by position changes? o Is it accompanied by shortness of breath or pain in the arms or legs? o Find out how much weight the patient has gained o Has his urine output changed in quantity or quality? o What other symptoms are also present?
  • 9.  Next, ask about previous burns or cardiac, renal, hepatic, endocrine, or GI disorders. Ask the patient to describe his diet so you can determine whether he suffers from protein malnutrition. Explore his drug history, and note recent I.V. therapy.
  • 10. Begin the physical examination by comparing the patient’s arms and legs for symmetrical edema. Also, note ecchymosis, rash and cyanosis. Assess the back, sacrum, and hips of the bedridden patient for dependent edema. Assess the abdomen for ascites and scrotum. Palpate peripheral pulses, noting whether hands and feet feel cold, and measure the blood pressure. Finally, perform a complete cardiac, respiratory and abdominal
  • 11.  Skin Disorders • Cellulitis, exfoliative dermatitis, and burns can cause increase in capillary permeability and edema. • History and physical exam are diagnostic.
  • 12.  Allergic Reaction • Release of histamine and other vasoactive mediators can produce localized or generalized edema. • Drugs, chemical exposure by inhalation, foods) especially milk, eggs, chocolate, nuts(, and bee stings are common causes of allergic reactions. • Lips, eyelids, and face are frequently involved, and urticaria also may occur. • Wheezing, laryngospasm, and hypotension may be seen with anaphylactic reactions. • History and physical exam are usually diagnostic.
  • 13.  Vasculitis Common causes of vasculitis causing edema include Kawasaki disease and collagen vascular disease.  Septicemia Severe bacterial or rickettsial infections can cause increase in capillary permeability and edema.
  • 14.  Vitamin E Deficiency • Uncommon since addition of vitamin E to infant formulas. • Preterm infants 4–6 weeks of age without normal intake of vitamin E may develop generalized edema, hemolytic anemia, and thrombocytosis. • Serum concentration of vitamin E is low.
  • 15.  Angioedema Recurrent attacks of acute, painless, nonpitting edema involving the skin and mucous membranes — especially those of the respiratory tract, face, neck, lips, larynx, hands, feet, geni talia, or viscera — may be the result of a food or drug allergy or emotional stress; they may also be hereditary. Abdominal pain, nausea, vomiting, and diarrhea accompany visceral edema; dyspnea and stridor accompany life-threatening laryngeal edema. . • Diagnosis is confirmed by measurement of
  • 16. Increased Hydrostatic Pressure  Increased BloodVolume • Administration of excessive amounts of sodium or fluid can produce volume overload and edema. • In cardiac failure, diminished renal blood flow leads to decrease in glomerular filtration rate (GFR) and edema. • Renal disease e.g., (glomerulonephritis) or any cause of renal failure also may lead to decrease in GFR and edema.
  • 17. Severe, generalized pitting edema — occasionally anasarca — may follow leg edema late in a patient with heart failure. The edema may improve with exercise or elevation of the limbs and tends to be worse at the end of the day. Other classic late findings include hemoptysis, cyanosis, marked hepatomegaly, clubbing, crackles, and a ventricular gallop. Typically, the patient also experiences tachypnea, palpitations, hypotension, weight gain despite anorexia, nausea, slowed mental response, diaphoresis, and pallor. Dyspnea, orthopnea, tachycardia, and fatigue signal left-sided heart failure; jugular vein distention, enlarged liver, and peripheral edema
  • 18.  IncreasedVenous Pressure • Increased venous pressure from deep venous thrombosis, constrictive pericarditis, portal hypertension, or impaired venous drainage from tumor may produce edema. • Deep venous thrombosis in thigh or calf produces pain and swelling of leg distal to thrombus. U/S is usually diagnostic.
  • 19. , generalized pitting edema may be most prominent in the arms and legs. It may be accompanied by chest pain, dyspnea, orthopnea, nonproductive cough, pericardial friction rub, jugular vein distention, dysphagia, and fever
  • 20.  Increased Lymph Pressure • Lymphedema is excessive accumulation of lymph in interstitial space and is principal cause of increased lymph pressure. • Can be congenital or acquired, sporadic or familial, and may appear at birth or in childhood or adolescence. • Abnormal development or dysfunction of lymphatic vessels, lymph node obstruction, and venous stasis are common mechanisms producing lymphedema.
  • 21. • Common presentation is unilateral, painless edema of leg; however, pain may occur with massive edema or cellulitis. • U/S and MRI are useful in detection of lymphatic malformations and obstructive lesions.  Disorders with Proteinuria • Any renal disorder causing severe proteinuria may produce edema. Nephrotic syndrome and acute glomerulonephritis are common examples.
  • 22. is characterized by generalized pitting edema, the edema is initially localized around the eyes. With severe cases, anasarca develops, increasing body weight by up to 50%. Other common signs and symptoms are ascites, anorexia, fatigue, malaise, depression , and pallor.  UG confirms presence of proteinuria.
  • 23. Generalized pitting edema occurs as a late sign of acute renal failure. With chronic renal failure, edema is less likely to become generalized; its severity depends on the degree of fluid overload. Both forms of renal failure cause oliguria, anorexia, nausea and vomiting, drowsiness, confusion, hypertensi on, dyspnea, crackles, dizziness, and pallor.
  • 24.  Disorders without Proteinuria  Acute and Chronic Liver Disease • Decrease in synthesis of albumin in liver produces hypoalbuminemia. • Serum albumin of <2.5 g/dL causes decrease in plasma oncotic pressure and edema. edema is a late sign of cirrhosis, a chronic disease. Accompanying signs and symptoms include abdominal pain, anorexia, nausea and vomiting, hepatomegaly, ascites, jaundice, p ruritus, bleeding tendencies, musty breath, lethargy, mental changes, and asterixis.
  • 25.  Gastrointestinal Disease • Loss of serum albumin in GI tract leads to decreased plasma oncotic pressure and edema. • Screening test for protein loss in stool is measurement of alpha1-antitrypsin in spot stool sample.
  • 26.  Protein-Calorie Malnutrition • Severe protein-calorie malnutrition can produce edema because of decrease in serum albumin. • Growth failure, decreased muscle mass, diarrhea, hepatomegaly, anemia, pi gment changes of hair and skin, fatigue, and apathy are other findings. • Edema resolves with adequate calorie and protein intake.
  • 27.  Congenital Albumin Deficiency • Severe edema occurs with congenital albumin deficiency, which is rare. • Very low or undetectable serum albumin concentration in absence of other causes of hypoalbuminemia confirms diagnosis.  Hydrops Fetalis: Immune and Nonimmune Hydrops fetalis is term used to describe severe generalized edema in fetus or newborn, Because of use of anti-D immune globulin for Rh isoimmunization; most cases of Hydrops are nonimmune type
  • 28. • UG screens for proteinuria and renal disease. • In absence of significant proteinuria or cardiac failure, serum albumin should be measured. Fluid overload and allergic reactions are common causes of edema with normal serum albumin. Decreased serum albumin without proteinuria suggests liver disease, protein-losing enteropathy, or protein- caloric malnutrition. • Electrolytes, B.urea and S.creatinine • CXR, ECG, ECHO and others
  • 29. • Jaundice, hepatomegaly, and abnormal liver function tests are manifestations of liver disease. • Elevated fecal alpha1-antitrypsin level indicates increased protein loss in stool and is seen with various causes of protein-losing enteropathy. • Protein-calorie malnutrition can be assessed by plotting weight and height on growth charts
  • 30.  Treatments for edema are focused on reversing the underlying cause, if there is one present treat accordingly.  Bed rest, dietary and lifestyle modifications, such as limiting sodium chloride (salt) intakes, are recommended.  many physicians implement diuretic therapies. Diuretics are used to decrease the amount of water in the body by increasing the flow of urine.
  • 31.  Avoid I.V. saline solution infusions and enteral feedings may cause sodium and fluid overload, resulting in generalized edema, especially in patients with cardiac or renal disease  Monitor intake and output and daily weight. Also monitor serum electrolyte levels — especially sodium and albumin.  Renal failure in children commonly causes generalized edema. Monitor fluid balance closely. Remember that fever and diaphoresis can lead to fluid loss, so promote fluid intake.