DSA Edema - Dr. Kirila Flashcards
What are common complaints of pts presenting with edema?
- leg swelling
- dyspnea
- PND
- orthopnea
- chest pain, indigestion
- weigh changes
- skin/hair/nail changes
- frothy urine
- GI changes
Pt. presents with “frothy urine”. What are you concerned for?
proteinuria
What can cause localized edema? generalized?
a. obstruction (ex. DVT)
b. HF, renal disease
*anasarca - massive generalized edema
Pt. presents with new onset of HF. What physical finding should you check for?
edema of LE (pools there first due to gravity)
What is the definition of edema?
abnormally large amounts of fluid in intercellular spaces
What is the definition of swelling?
transient abnormal enlargement or increased volume of a body part/area
- due to increased BV in dilated vessels
- transient, so seen with bug bites or local inflammatory rxns
Pt. presents to your Florida clinic with Myxedema. She also is known to have a lymphatic disease. What type of edema do you expect?
non- pitting
*risk factors: warm weather, thyroid dx, lymph dx
What causes pitting edema?
organ dysfunction - heart, kidney, liver
When is a compression sleeve helpful?
lymphedema - impaired fluid return to lymph system (hereditary or secondary to injury/infection)
*often seen post mastectomy
Filarial infection is the number one cause world wide of…
lymphedema
What is a finding of morbidly obese pts?
lipedema
fat cells grow/proliferate –> fluid retention around cells
It is helpful to know what before edema onset?
pts weight
DDX for edema
- CHF
- PE
- PE/Pneumonia (if dyspnea is primary sx)
- Nephrotic syndrome
- Venous stasis
Pt. presents with puffy eyes and ankles, generalized weakness, anorexia, and high cholesterol. What is causing their edema?
nephrotic syndrome
What medications can cause b/l LE edema?
- Antidepressants
- Antihypertensives
- Hormones
- NSAIDs
- Thiazolidinediones
Lymphedema secondary to a neoplasm is likely to cause?
unilateral edema
*also from surgery, radiation, TB, filariasis
What modifiable factors can you advise your pt to do to reduce their edema?
- decrease alcohol intake
- decrease Na intake
- exercise
- decrease weight
What bloodwork help with dx of edema cause?
- CMP
- TSH
- CBC
- other tests: CXR-PA and lat, ECG, Echocardiogram
- BNP if you suspect CHF
What factors can affect BNP levels?
- Inflammation
- CAD
- RV or LV dysfunction
- Decreased clearance
ANP/BNP is correlated with what?
LV dysfunction
What diuretics should you give to a pt with lymphedema? lipedema?
none for either - diuretics are not helpful
What is the best treatment for lymphedema? lipedema?
a. elevation, compression, gentle exercise
b. weight loss, elevation, compression, gentle exercise
