DSA Edema

Question 1

MCC of hydronephrosis

Answer 1

UPJ Obstruction

Question 2

Abnormally large amounts of fluid in intercellular spaces

Answer 2

Edema

Question 3

How does general/localized edema occur?

Answer 3

• 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

Question 4

massive generalized edema

Answer 4

Anasarca

Question 5

What is swelling?

Answer 5

Increased blood flow in dilated vessels => increased engorgement of tissues=> abnormal enlargement or increased volume of a body part

Question 6

Transient eminence/ elevation

Answer 6

local inflammatory reaction to insect bites or immunization injections

Question 7

Non-pitting vs pitting edema

Answer 7

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.

Question 8

impaired fluid return in the lymphatic system due to hereditary or secondary causes including crush injuries and tropical infections

Answer 8

Lymphedema

Question 9

how can we control lymphedema

Answer 9

compression sleeve

Question 10

________ is the #1 cause world wide of lymphedema

Answer 10

Filarial infection

Question 11

What is lipedema and is it local or generalized?

Answer 11

• Lipidema: fat cells grow and proliferate => fluid retention around the cells, often seen with morbid obesity
• Local or generalized

Question 12

Can be difficult to distinguish ___________ vs lymphedema or both

Answer 12

morbid obesity

Question 13

When do morbid obesity and lymphedema occur together

Answer 13

ORGAN DYSFX

CHF,

nephritic syndrome

liver disease

Question 14

edema is most commonly first noticed in

Answer 14

• LE
• Periphery (hands and feet) d/t decreased venous return

Question 15

What if helpful to know when examining a pt with edema

Answer 15

BASELINE WEIGHT

Question 16

Signs of CHF (Congestive Heart Failure)

Answer 16

1. Exertional dyspnea
2. Orthopnea
3. Paroxysmal dyspnea
4. S3 on cardiac exam
5. Bilateral crackles on lung exam

Question 17

Generate a differential diagnosis for edema focusing on the potentially life-threatening and the most common

Answer 17

• 1. CHF
• 2. Pulmonary edema (advanded form of CHF)
• 3. Nephrotic sundrome
• 4. Venous stasis, dependent edema d/t gravity or sedentary activity

Question 18

Edema + SOB (dyspnea), what should our differentials be?

Answer 18

• 1. PE
• 2. Pneumonia

Question 19

What symptoms suggest nephrotic syndrome?

Answer 19

1. Puffy eyes, ankles, skin
2. Abdominal distention/fluid
3. Weakness
4. Anorexia
5. Sense of feeling sick
6. High cholesterol

Question 20

Bilateral leg edema – systemic causes

• CV
• Renal
• Hepatic
• Hematologic

Answer 20

Cardiovascular

1. Systolic or diastolic heart failure
2. Constrictive Pericarditis
3. Pulmonary hypertension

Renal

1. Advanced kidney disease – any cause
2. Nephrotic syndrome

Hepatic – cirrhosis

Hematologic – anemia

Question 21

Bilateral leg edema – systemic causes

• GI
• Meds
• Endocrine

Answer 21

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

Question 22

is DVT unilateral or bilateral

Answer 22

either

Question 23

what venous or lymphatic causes can cause bilateral leg edema

Answer 23

1. venous obstruction

2. pelvic or retroperitoneal lymphandenopathy

3. venous insufficiency

4. lymphadema

Question 24

What can cause unilateral limb edema?

Answer 24

1. venous obstruction
2. pelvic or retroperitoneal lymphandenopathy
3. venous insufficiency
4. lymphadema
   * d.t neoplasm, surgery, radiation, TB and filarisis
5. Baker Cyst

Question 25

what are extrinsic factors that contribute to edema?

Answer 25

• 1. Na intake
• 2. Sedentary lifestyle
• 3. Increased calorie intake
• 4. NSAIDs can cause AIS or nephrotic syndrome
• 5. Excess alcohol intake

Question 26

what blood panels do you get for a pt with edema?

Answer 26

• 1. CMP
• 2. TSH: to determine is hypothyroidism or myxedema
• 3. CBC: to determine if anemia can cause SOB and high WBC count means infections

Question 27

scans for pt edema

Answer 27

• 1. CXR-PA and lateral view: to determine if fluid in lungs and or cardiac enlarge
• 2. EKG
• 3. Echo

Question 28

If we suspect edema as the cause of CHF, what should we order?

Answer 28

• 1. BNP: protein made by ventricles d/t increase pressure in the <3****
     * preferred bc wider concentrations
• 2. ANP: made in atria d/t increase pressure in the <3

Question 29

_____ correlates with LV dysfunction

Answer 29

ANP and BNP

Question 30

tumors that hemorrhage or necrosis, rule out _____

Answer 30

seminomas

Question 31

if diagnostics are not conclusive, what do we have to do??

Answer 31

1. Revisist H&P

2. antinuclear ab, hepB/C titers,
3. Renal ultrasound
4. renal biopsy

Question 32

______ do NOT help lymphedema or lipedema

Answer 32

DIURETICS

Question 33

How can we treat lymphedema?

Lipedema?

Answer 33

• Lymphedema: elevation and compression
• Lipedema: weight loss ***, compression, exercise and elevation