Download to read offline
Uploaded byGazi Rashid
Edema Pathophysiology
This document presents a 5-part approach to evaluating and building a differential diagnosis for lower extremity edema: 1) Localize whether the edema is unilateral or bilateral, 2) Determine the onset as acute or chronic, 3) Note any treatments, 4) Assess for dependency on elevation, and 5) Evaluate physical exam findings. Key factors that can cause edema are discussed relating to lymphatic drainage, venous drainage, protein gradient, hydrostatic pressure, and permeability. Two case examples are presented to demonstrate applying the approach.
Edema Pathophysiology
- 1. Intro • LE Edema •Life threatening • Take-away 2 things • 5 part approach to LEedema • Ins-Outs Approach to building a DDx • 6 cards for etio • Use 2 cases to put it together • Won’t Talk about Dx or MGMT, as it varies
- 2. •Localize •Onset •Rx •Dependent •Evaluate Ely, etal. Approach to leg edema of unclear etiology. J Am Board Fam Med 2006
- 3. Lymphatic Drainage Venous Drainage Protein Gradient Hydrostatic Pressure •CHF • Pulm. HTN (OSA) • Rx: Diuretics, CCB Permeability • Cellulitis • Allergic Reaction • Elephantiasis • Pelvic/Abdominal Obstruction • Chronic Venous Insufficiency • DVT • Compartment Synd. ↑ Loss • Nephrotic Synd. • Protein-Loss Enteropathy ↓ Gain • Malnutrition • Liver Disease
- 4. LORDE 68 yoobese “royal” who sits on the throne all day comes in annual appt 24 yo smoker flying to one of those “perfect places” comes in for leg pain 46 yo w/ fatigued obese comes in bc he recently fell asleep at a “Green Light” Lateralize BiL Uni Bilat Onset Chronic Acute Chronic Rx None None Diuretics Dependent Improves with leg elevation Elevating can relieve pain No change with elevation Evaluate Pitting Mild aching Brown discoloration over ankles and lower legs Pitting PainFUL Warm Erythematous Mild pitting Painless CVI affects 30% pop PHTN (OSA) – often
- 5.
Editor's Notes
- #3 Get a good H&P 5 Musts Localize – UL, BL Onset – days, months, years Rx – several Rx cause edema Dep – does it improve with elevation Eval – pitting? Nonpitt? Temperature? Skin findings?