DSA Edema Flashcards
MCC of hydronephrosis
UPJ Obstruction
Abnormally large amounts of fluid in intercellular spaces
Edema
How does general/localized edema occur?
- Localized such as due to venous obstruction or lymphatic obstruction
- Generalized as seen with systemic causes such as HF and renal disease – however may be first apparent in LE due to gravity
massive generalized edema
Anasarca
What is swelling?
Increased blood flow in dilated vessels => increased engorgement of tissues=> abnormal enlargement or increased volume of a body part
Transient eminence/ elevation
local inflammatory reaction to insect bites or immunization injections
Non-pitting vs pitting edema
Non-pitting edema is due to a metabolic disease, such as thyroid or lymphatic disease
Pitting edema is d/t underlying organ dysfynction: <3, kidney or liver.
impaired fluid return in the lymphatic system due to hereditary or secondary causes including crush injuries and tropical infections
Lymphedema
how can we control lymphedema
compression sleeve
________ is the #1 cause world wide of lymphedema
Filarial infection
What is lipedema and is it local or generalized?
- Lipidema: fat cells grow and proliferate => fluid retention around the cells, often seen with morbid obesity
- Local or generalized
Can be difficult to distinguish ___________ vs lymphedema or both
morbid obesity
When do morbid obesity and lymphedema occur together
ORGAN DYSFX
CHF,
nephritic syndrome
liver disease
edema is most commonly first noticed in
- LE
- Periphery (hands and feet) d/t decreased venous return
What if helpful to know when examining a pt with edema
BASELINE WEIGHT
Signs of CHF (Congestive Heart Failure)
- Exertional dyspnea
- Orthopnea
- Paroxysmal dyspnea
- S3 on cardiac exam
- Bilateral crackles on lung exam
Generate a differential diagnosis for edema focusing on the potentially life-threatening and the most common
- CHF
- 2. Pulmonary edema (advanded form of CHF)
- 3. Nephrotic sundrome
- Venous stasis, dependent edema d/t gravity or sedentary activity
Edema + SOB (dyspnea), what should our differentials be?
- 1. PE
- 2. Pneumonia
What symptoms suggest nephrotic syndrome?
- Puffy eyes, ankles, skin
- Abdominal distention/fluid
- Weakness
- Anorexia
- Sense of feeling sick
- High cholesterol
Bilateral leg edema – systemic causes
- CV
- Renal
- Hepatic
- Hematologic
Cardiovascular
- Systolic or diastolic heart failure
- Constrictive Pericarditis
- Pulmonary hypertension
Renal
- Advanced kidney disease – any cause
- Nephrotic syndrome
Hepatic – cirrhosis
Hematologic – anemia
Bilateral leg edema – systemic causes
- GI
- Meds
- Endocrine
GI
- Nutritional deficiency or malabsorption leading to hypoalbuminemia
- Refeeding edema
Medications
- Antidepressants – MAO inhibitors
- Antihypertensives
- Calcium channel blockers – esp dihydropyridines
- Direct vasodilators (hydralazine, minoxidil)
- Beta-blockers
- Hormones
- NSAIDs
- Thiazolidinediones
Endocrine - myxedema
is DVT unilateral or bilateral
either
what venous or lymphatic causes can cause bilateral leg edema
1. venous obstruction
2. pelvic or retroperitoneal lymphandenopathy
3. venous insufficiency
4. lymphadema
What can cause unilateral limb edema?
- venous obstruction
- pelvic or retroperitoneal lymphandenopathy
- venous insufficiency
- lymphadema
* d.t neoplasm, surgery, radiation, TB and filarisis - Baker Cyst
what are extrinsic factors that contribute to edema?
- Na intake
- Sedentary lifestyle
- Increased calorie intake
- NSAIDs can cause AIS or nephrotic syndrome
- Excess alcohol intake
what blood panels do you get for a pt with edema?
- CMP
- TSH: to determine is hypothyroidism or myxedema
- CBC: to determine if anemia can cause SOB and high WBC count means infections
scans for pt edema
- 1. CXR-PA and lateral view: to determine if fluid in lungs and or cardiac enlarge
- 2. EKG
- 3. Echo
If we suspect edema as the cause of CHF, what should we order?
-
BNP: protein made by ventricles d/t increase pressure in the <3****
* preferred bc wider concentrations
-
BNP: protein made by ventricles d/t increase pressure in the <3****
- ANP: made in atria d/t increase pressure in the <3
_____ correlates with LV dysfunction
ANP and BNP
tumors that hemorrhage or necrosis, rule out _____
seminomas
if diagnostics are not conclusive, what do we have to do??
1. Revisist H&P
- antinuclear ab, hepB/C titers,
- Renal ultrasound
- renal biopsy
______ do NOT help lymphedema or lipedema
DIURETICS
How can we treat lymphedema?
Lipedema?
- Lymphedema: elevation and compression
- Lipedema: weight loss ***, compression, exercise and elevation
