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Clinical features of edema
Cardiac, renal, liver disease and hypoproteinemia can cause generalized edema. Cardiac edema presents as pitting edema in the legs, ankles and feet that worsens at the end of the day. Renal edema in nephrotic syndrome causes severe generalized edema involving the face, legs and ascites with massive proteinuria and hypoalbuminemia. Liver cirrhosis causes edema in the legs and face due to decreased protein synthesis. Localized edemas include cellulitis, DVT, lymphedema and angioneurotic edema. Certain endocrine conditions like hypothyroidism and Cushing's disease can also cause edema.
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Clinical features of edema
- 1. CLINICAL FEATURES OFEDEMA
- 2. GENERALISED EDEMA-ANASARCA Fluid accumulation in tissues and body • Pericardial effusion fluids • Constrictive pericarditis • Cardiac failure • Myxedema • Renal disease • Idiopathic • Liver disease • Epidemic dropsy • Hypoproteinemia • Drugs
- 4. CARDIAC EDEMA • Rightsided heart failure-systemic congestion and generalised edema • Left sided heart failure-initially pulmonary congestion and edema later generalised edema • Pitting • Dependent Ambulant-maximal over ankles & feet(pedal) -worse towards end of day -clears up with recumbence Bedridden-maximal over sacrum
- 5. • Legs face ascites • Early-nocturnal polyuria (clears up at night) • Later-established at all times • Clears with Diuretic therapy • Other signs of cardiac failure -exertional dysnea -engorged jugulars -tender hepatomegaly
- 6. RENAL EDEMA • Nephrotic,Nephritic, Renal failure • Nephrotic -severe, generalised,dependent -loose connective tissue, subcutaneous tissue, visceral organs -face(periorbital) legs ascites (with scrotal swelling) Other features -massive proteinuria -hypoalbuminemia -hypercholesterolemia
- 7. • Acute nephritic -mild -loose connective tissue-eyelids and face ,ankles,genitalia -moderate proteinuria • Both -more on waking up after sleep -generalised,pitting
- 8. LIVER DISEASE • LiverCirrhosis • Chronic liver disease -decreased protein synthesis -Ascites legs face
- 9. NUTRITIONAL EDEMA • Proteinlosing enteropathy • Starvation • Dependent • Hypoproteinemia Albumin<2.5g/dL
- 10. DRUG INDUCED EDEMA • Nifedipine-ankle edema • Corticosteroids • Estrogen • NSAIDs
- 11. ENDOCRINE • Myxodema- hypothyroidism, infiltrative edema due to deposition of mucinous material, nonpitting • Pretibial myxodema- Grave’s disease, swelling over shins, nonpitting • Cushing’s disease- hyperaldosteronism
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- 13. EPIDEMIC DROPSY • Ingestionof edible oil contaminated with oil from seeds of argemone mexicana • Bilateral pitting edema of lower limbs generalised edema • Pigmentation of skin over edema • Fever,diarrhoea,abdominal pain,malaise
- 14. IDIOPATHIC EDEMA • Youngmenstruating women, not cyclical • Periodic episodes of edema with pain and discomfort • Sitting and standing-abdomen and legs • On lying down-face and eyelids • Diurnal weight changes • Has to be differentiated from cyclical edema
- 15. LOCALISED EDEMA Redistribution ofedema fluid, no accumulation • Cellulitis • DVT • Lymphedema • Angioneurotic • Trauma • Milroy’s edema • Nifedipine
- 16. CELLULITIS,TRAUMA,COMPARTMENT SYNDROME,DVT •Localised • Sudden onset • Painful edema
- 17. ANGIONEUROTIC EDEMA • Hypersensitivity • Solid edema-involves deeper layers of skin • Localised-Tongue,lips,face,eyelids • Develops rapidly,pale or faint pink, itching • Threatens life by suffocation • ACE inhibitor induced • Congenital-C1 esterase inhibitor deficiency
- 18. LYMPHADEMA • Surgery, radiation, chemotherapy • Filariasis • Nonpitting edema • localised
- 19. MILROY’S EDEMA • Lymphedemaat birth due to congenital absence of lymphatic tissue • Autosomal dominant inheritance • Unilateral limb edema progressive both legs
- 21. REFEEDING EDEMA • Edemaoccurring following feeding after prolonged starvation • Increased salt intake • Insulin release sodium reabsorption
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