34. generalised Edema

Question 1

causes of bilateral edema- systemic ones

Answer 1

Systemic:
PREGNANCY
Congestive cardiac failure.
Hypoproteinaemia, eg liver failure, nephrotic syndrome, malnutrition, protein-losing enteropathy.
Renal failure.
Fluid overload.
Anaemia.
Drugs, eg calcium antagonists, non-steroidal anti-inflammatory drugs.
Hypothyroidism.
Hereditary angioneurotic oedema.

Question 2

causes of acute local unilateral edema?

Answer 2

Local:
Acute:
Trauma
Deep vein thrombosis
Cellulitis
Allergic reaction
Rheumatoid arthritis

Question 3

causes of chronic local unilateral edema?

Answer 3

Chronic:
Venous: varicose veins, obstruction of venous return, eg pregnancy, pelvic tumours, inferior vena cava obstruction, post-phlebitis.
Lymphoedema: lymphatic obstruction due to malignancy, post-irradiation, surgery, recurrent infection, lymphatic hypoplasia, filariasis.
Congenital malformations, eg arteriovenous fistula.
Stasis: paralysis, poor mobility and dependency, obesity.

Question 4

name some investigations to be carried out in (bilateral leg) edema?

Answer 4

Urinalysis: proteinuria suggests renal cause.

FBC: high white cell count in infection; anaemia.

Biochemistry: renal function and electrolytes (raised creatinine in renal failure); LFTs (impaired liver function and associated low albumin); glucose (infection associated with diabetes); TFTs (hypothyroidism).
CRP
Clotting screen: abnormal clotting associated with spontaneous haematoma.
CXR: pulmonary oedema.
D-dimer blood test: D-dimers are products of fibrin degradation and are raised in patients with venous thromboembolism. Sensitivity of the test is high but specificity is poor.
ECG: heart failure.
Ultrasound, CT scan: haematoma, tumour, abdominal or pelvic mass.
Duplex Doppler, venography: deep vein thrombosis, arteriovenous fistula.
Lymphangiography: demonstrates cause of lymphoedema and whether due to hypoplasia or obstruction.
Lymph node biopsy: infection, tumour.
Other investigations may include renal biopsy, echocardiogram.

Question 5

name an infection causing nephrotic syndrome?

Answer 5

Glomerulonephritis can present with different clinical syndromes. These include nephrotic and nephritic syndrome (post streptococcal infections)

Question 6

what are the 4 main clinical features of nephrotic syndrome?

Answer 6

• –Proteinuria (formerly defined as >3.5 g/day but there appears to be individual variation around this cut-off figure).
• –Hypoalbuminaemia as a result of urinary protein loss (albumin levels usually in range

Question 7

Primary renal causes of nephrotic syndrome?

Answer 7

• —–Minimal-change glomerular disease (15%) - the most common cause in children.
• –Focal segmental glomerulosclerosis (35% of nephrotic syndrome) - the most common cause of idiopathic nephrotic syndrome in adults.
• —-Membranous glomerular disease (33%).
• ——Membranoproliferative glomerulonephritis (14%).

Question 8

name secondary renal disease causing nephrotic syndrome?

infections?drugs?metabolic?inherited?malignant? pregnancy?

Answer 8

—-Post-infectious causes - eg, Group A beta-haemolytic streptococci, tuberculosis, malaria, syphilis, viruses (such as varicella-zoster, hepatitis B, human immunodeficiency), infectious mononucleosis.

Metabolic diseases - eg, diabetes mellitus, amyloidosis.

Inherited disease - eg, Alport’s syndrome, hereditary nephritis, sickle cell disease.

Malignant disease - eg, multiple myeloma, leukaemia, lymphoma, carcinoma of breast/lung/colon/stomach.

Medications - eg, non-steroidal anti-inflammatory drugs (NSAIDs), captopril, lithium, gold, diamorphine, interferon-alpha, penicillamine, probenecid and many others.

Toxins - eg, bee sting, snake bites, phytotoxins.

Pregnancy - eg, pre-eclampsia.
Transplant rejection.