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Edema
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- 2. DEFINITION ▸ Greek word“oideima” – swelling ▸ Abnormal and excessive accumulation of free fluid in the interstitial tissue spaces and serous cavities.
- 3. PHYSIOLOGY: DIVISION OFBODY FLUIDS _
- 4. PATHOPHYSIOLOGY OF EDEMA ▸ Fluidmovement across capillaries 1. Hydrostatic pressure 2. Oncotic pressure 3. Capillary permeability ‣ Lymphatic flow A perturbation of these factors singly or in combination results in Edema
- 5. CAUSES A. INCREASE INhydrostatic pressure Normal serum proteins ‣ Congestive heart failure ‣ Renal failure ‣ Pericarditis ‣ Cirrhosis of liver ‣ Pregnancy B. DECREASED ONCOTIC PRESSURE Low serum protein ▸ Increased protein loss Burns Nephrotic syndrome Bowel disease ▸ Decreased intake / synthesis Kwashiorkor Malabsorption Liver disease
- 6. C. LYMPHATIC OBSTRUCTION LYMPHOEDEMA Malignancy Radiation induced Filariasis Myxoedema-hypothyroidism Pretibial myxedema- Graves’ disease
- 7. UNILATERAL EDEMA Cellulitis Thrombophlebitis DVT Acute trauma FACIALEDEMA ▸ Hypothyroidism ▸Allergies ▸Nephrotic syndrome ▸Angio-oedema ▸Trichinosis
- 8. CONGENITAL EDEMA ▸ Milroy’sdisease ▸ Meigs disease ▸ Lymphoedema Praecox ▸ Lymphoedema Tarda DRUG INDUCED EDEMA ▸ Nifedipine ▸Corticosteroids ▸Oestrogen ▸NSAIDs ▸Insulin
- 9. TECHNIQUE Inspect the legsfor any swelling. Look at the skin between the medial malleolus and Achilles tendon for the presence or absence of convexity - flat or convex means edema Apply pressure 1 inch above the medial malleolus using the pulp of the thumb for a minimum of 30seconds on both lower limbs simultaneously. Inspect and palpate the area for any dimple or pitting. When there is edema repeat the test in the rest of the limb from below up to note the extent of edema Check for oedema in thighs, genitalia & rest of the body . Bed ridden patients- Turn the patient to a side and uncover the sacral area. Apply pressure over the sacrum with right thumb for 30seconds and palpate and look and for dimple.
- 10. SITES OF EXAMINATIONOF EDEMA In mobile patient Leg 2-3 cm above the medial malleolus In bedridden supine patient Sacrum Back over the scapula Abdominal wall edema Pinch the skin over the abdomen
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- 12. CLASSIFICATION TYPES OF EDEMA ▸Accordingto pathophysiological mechanism: a) Transudate (low protein) b) Exudate ( high protein )
- 13. ACCORDING TO LOCATION ▸Localised: Venous edema, lymphatic Edema, allergy/angio- oedema/inflammation ▸Generalised- cardiac Edema, hepatic Edema, renal Edema
- 14. ACCORDING TO CLINICALFINDINGS ▸ Pitting: due to cardiac and renal causes, liver disease, calcium channel blockers ▸Non-pitting: myxoedema, elephantiasis, Angioneurotic
- 15. ORGAN SPECIFIC EDEMA ▸Brain – cerebral Edema ▸Lung -(intra alveolar) pulmonary Edema ▸(Intra pleural) pleural effusion ▸Peritoneum-ascites
- 19. GENERAL INVESTIGATIONS ▸ Urinedipstick and microscopy Proteinuria Hematuria Casts ▸Renal function test Serum urea Serum creatinine ▸Thyroid function tests. ▸Serum electrolytes ▸CBC and PBF ▸Liver function test Transaminases eg ALT,AST Serum albumin Serum bilirubin ▸Chest x-ray Cardiomegaly Left ventricular hypertrophy Perihilar vascular margins ▸ECG ST elevation with T wave inversion (pericarditis)
- 20. TREATMENT OF EDEMA ▸Supportive & treatment of underlying cause. ▸Bed rest ✓ Decreased peripheral pooling ✓ Increase cardiac output ✓ Increase renal and hepatic perfusion ✓ Increased sodium diuresis ▸Sodium restriction ✓ 1 - 1.5 mEq/kg/day ✓ Avoid extra salt
- 21. FOLLOW-UP OF PATIENT WITHEDEMA ▸ Weight ▸ Abdominal girth ▸ Input/output chart ▸ Edema status
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