050415 edema Flashcards
differential for bilateral leg edema
heart failure
cirrhosis
renal
anemia
meds:
- dihydropyridine Ca ch blockers
- direct vasodilators
- corticosteroids
- estrogens, progesterones, testosterone
- NSAIDs
- others
GI (malabsorption, nutritional deficiency) venous obstruction (more likely unilat) venous insufficiency myxedema lymphedema (lymphatic obstruction)
causes of R sided heart failure
L sided heart failure
cor pulmonale (pulmonary causes-sleep apnea)
pulmonary HTN
constrictive pericarditis (TB)
differential for unilateral leg edema
venous obstruction:
- acute-DVT
- subacute-external compression as in proximal LAD
venous insufficiency
lymphedema/lymphatic obstruction
baker cyst
localized edema
causes of lymphedema/lymphatic obstruction
usually secondary: neoplasm, surgery, radiation, relatively uncommon infections (TB, cat scartch, filiarisis)
causes of localized unilateral edema
cellulitis/erysipelas
burns
angioedema/urticaria (hives)
trauma
what can fever point you towards in terms of edema
infection-cellulitis
DVT
PE
what can elevated BP point you towards
heart failure
renal failure
what can tachypnea and low pulse ox point you towards
PE, cor pulmonale, CHF
what can tachycardia point you towards
meds (vasodilators) CHF with or w/o shock PE cellulitis sepsis
what can tenderness, warmth, erythema point you towards
infection, DVT, etc
non pitting edema
lymphedema, cellulitis
risk factors for cellulitis
chronic edema
obesity
entry methods (tinea pedis, injection drug, IV site, scratch)
immunosuppression
bugs for cellulitis
most common:
- beta hemolytic strep (usually no exudate)
- staph aureus (sometimes has exudate, can be MRSA)
others:
- hot tub-Pseudomonas aerug
- salt water-vibrio vulnificus
- fresh water-aeomonas hydrophilia
- diabetic foot ulcer-polymicrobial
- perianal-group A strep, gran neg rods
are beta lactams reversible or irreversible at binding to PBPs?
irreversible
MOA of clindamycin
binds to 50S and blocks translocation along ribosomes
MOA of tetracyclines
transported into cells, prevent attachment of aminoacyl-tRNA to 30S ribosomal subunits
MOA of linezolid
binds to 50S ribosomal subunit, interfering w formation of 70S initiation complex
ex of anti-folates
sulfonamides (sulfamethoxazole, sulfadiazine)
trimethoprim
nephrotic syndrome-manifestations
hypoalbuminemia, proteinuria
hyperlipidemia
hypercoagulability
relative immune deficiency
tx of nephrotic syndrome
ACE inhibitors/ARBs
loop diuretics
consider heparins in high risk situations
consider HMG-CoA reductase inhibitor
for kidney diseases:
consider corticosteroids/immunosuppresants
list loop diuretics
furosemide
bumetanide
ethacrynic acid
in pt w liver failure, what can decreased breath sounds in lower third of right lung field indicate
ascites that comes up from diaphgram-pleural effusion
dupuytren’s contractures
fingers can’t straighten completely (palmar fibromatosis)
why can platelets RBCs and WBCs be low in cirrhosis
due to portal HTN and splenic sequestration
