Edema

Question 1

Anasarca

Answer 1

Edema involving all aspects of the body: upper and lower extremities
and the face.

Question 2

Lipedema

Answer 2

Edema caused by fluid retained in the interstitial space by lipids in
the dermis

Question 3

Myxedema

Answer 3

Edema resulting from hypothyroidism.

Question 4

Pretibial myxedema

Answer 4

Not technically edema, the swelling on the anterior shins
is due to coalescing of subcutaneous plaques due to Graves disease antibodies
infiltrating dermal tissue.

Question 5

Unilateral extremity edema

Answer 5

is usually due to venous or lymphatic obstruction ,
deep venous thrombosis,
tumor obstruction,
primary lymphedema

Question 6

Stasis edema

Answer 6

of a paralyzed lower extremity also may occur.

Question 7

localized facial edema

Answer 7

Allergic reactions (“angioedema”) and superior vena caval obstruction

Question 8

Bilateral lower-extremity edema

Answer 8

inferior vena caval obstruction,
compression due to ascites,
and abdominal mass

Question 9

Periorbital edema

Answer 9

noted on awakening often results from renal disease and impaired Na
excretion

Question 10

Edema typically results:

Answer 10

❑ when the pressure in the vessels (Pin) overrides the
semipermeable capillary membrane, pushing more volume into
the extravascular space.
❑ When the lymphatic drainage of the tissues is obstructed,
❑ When the capillary membrane permeability is increased (K).
❑ When the blood protein concentration is decreased (Oncin).
❑ Excess fat in the interstitium may draw and hold water into the
interstitial space causing edema (lipedema).

Question 11

Pathogenesis In CHF

Answer 11

diminished cardiac output and arterial underfilling
result in both decreased renal perfusion and increased venous pressure
with resultant renal Na retention due to
renal vasoconstriction, intrarenal blood flow redistribution, direct Na-retentive effects
of norepinephrine and angiotensin II, and secondary hyperaldosteronism
leading to
distal tubular Na retention.

Question 12

Pathogenesis In cirrhosis

Answer 12

arteriovenous shunts and peripheral vasodilation are the proximate causes
of Na retention.
Ascites accumulates when increased intrahepatic vascular resistance
produces portal hypertension.
As in heart failure, the effects of excess intrarenal and
circulating norepinephrine, angiotensin II, and aldosterone lead to renal Na retention
and worsening edema.
Reduced serum albumin and increased abdominal pressure also
promote lower-extremity edema.

Question 13

Pathogenesis In acute or chronic renal failure

Answer 13

edema occurs if Na intake exceeds kidneys’
ability to excrete Na secondary to marked reductions in glomerular filtration.

Question 14

Pathogensis In nephrotic syndrome

Answer 14

loss of protein into the urine also leads to primary Na
retention, through effects on tubular Na transport

Question 15

idiopathic edema

Answer 15

a syndrome of
recurrent rapid weight gain

Question 16

Clinical Approach

Answer 16

• Onset: gradual or sudden
• Site of the edema
• History of recurrence or chronicity
• Color, warmth, induration, sensitivity, and/or pain
• Associated dyspnea or orthopnea
• Associated fever or chills
• Medications such as nonsteroidal anti-inflammatory, calcium
channel blockers, corticosteroids
• Endocrine diseases: hypothyroidism, Cushing’s disease
• Prolonged dependent position
• Pregnancy
• Increased sodium chloride intake
• Trauma: ecchymosis, abrasions.

Question 17

Physical examination

Answer 17

• Vital signs should be noted with special attention to an elevated temperature,
decreased oxygen saturation, tachypnea, and/or tachycardia.

• Mental status changes reported by the patient or the patient’s family should be
noted.

• Neck vein distension should be evaluated. It is necessary to listen carefully for a
gallop in the heart rhythm.

• Crackles in the lungs should also be noted.

• Ascites and hepatosplenomegaly should be evaluated.

• It should be noted whether the edema is generalized or localized, whether
it is pitting or nonpitting, and whether there is coloration if a painful
sensation is present

• A depression that does not rapidly refill and resume its original contour
indicates orthostatic (pitting) edema.

Question 18

Treatment of Oedema

Answer 18

1. Primary management is to identify and treat the underlying cause of
   edema.
2. Dietary Na restriction (<500 mg/d) may prevent further edema formation.
3. Bed rest enhances response to salt restriction in CHF and cirrhosis.
4. Supportive stockings and elevation of edematous lower extremities help to
   mobilize interstitial fluid.
5. If severe hyponatremia (<132 mmol/L) is present, water intake also should
   be reduced (<1500 mL/d).
6. Diuretics are indicated for marked peripheral edema, pulmonary edema,
   CHF, and inadequate dietary salt restriction.

Question 19

Overdiuresis

Answer 19

may result in hyponatremia, hypokalemia, and alkalosis, which
may worsen hepatic encephalopathy