Edema

Question 1

what are the causes of non-inflammatory edema?

Answer 1

• increased hydrostatic pressure
• decreased plasma colloid osmotic pressure
• impaired lymph flow
• renal retention of salt and water

Question 2

what causes local increases in hydrostatic pressure

Answer 2

impaired venous outflow (lower extremities) due to thrombosis/stasis

Question 3

what are examples in generalized increases in hydrostatic pressure?

Answer 3

heart failure
renal failure

Question 4

why does renal failure cause an increase in BP? how does this cause edema?

Answer 4

• can’t make urine to decrease the amount of fluid in arteries and veins
• ^BP pushes fluid into ECF

Question 5

decreased plasma colloid osmotic pressure is due to…

Answer 5

loss of serum (plasma) albumin

Question 6

name 3 conditions that could result in loss of serum albumin

Answer 6

• nephrotic syndrome
• cirrhosis
• malnutrition

Question 7

if you have less albumin in your blood what will happen to the water in the capillaries?

Answer 7

the water will rush out of the capillaries

Question 8

what specific type of edema occurs due to a loss of serum albumin?

Answer 8

ascites (peritoneal edema)

Question 9

what are causes of LYMPHATIC obstruction?

Answer 9

inflammation
neoplasia
parasitic infection

Question 10

how does inflammation cause lymphatic obstruction?

Answer 10

if a lymph node gets to large due to inflammation then it can block the lymph flow

Question 11

how can a neoplasia cause lymphatic obstruction?

Answer 11

tumor compresses lymphatics
eg. breast cancer related lymphedema (axillary nodes)

Question 12

what kind of edema will right sided heart failure cause?

Answer 12

bilateral ankle edema

Question 13

what are some causes of salt and water retention?

Answer 13

• primary/ reduced renal function
• secondary/ heart disease

Question 14

how would left sided heart failure impact salt and water retention?

Answer 14

• decreased BP to kidney
• activates RAAS (^Na retention, H2O follows)
• ^BP -> ^P on heart
• worsens LSHF

Question 15

how does reduced renal function impact salt and water retention?

Answer 15

• if decreased BP to kidney -> RAAS system activated
• causes ^Na retention (H2O follows)
• ^blood volume = ^BP

Question 16

what are the 3 different clinical presentations of edema in subcutaneous tissues?

Answer 16

• dependent edema
• ascites
• generalized edema/anasarca

Question 17

dependent edema is most often due to ____

Answer 17

heart failure (R sided)

Question 18

where does dependent edema occur and what is it influenced by?

Answer 18

• lower extremities
• gravity

Question 19

what is ascites?

Answer 19

peritoneal edema (abdomen)

Question 20

what kind of pathologies most commonly have ascites?

Answer 20

• MC: liver pathologies (cirrhosis)
• also seen in caput medusae

Question 21

what is generalized edema/anasarca?

Answer 21

severe edema, seen everywhere in the body, including periorbital and pitting edema

Question 22

generalized edema/Anasarca is most often due to ____

Answer 22

renal failure

Question 23

what condition is associated with the most severe edema?

Answer 23

renal failure

Question 24

which is more severe:
dependent edema or generalized edema/anasarca?

Answer 24

generalized edema

Question 25

what are some spots where generalized edema will go

Answer 25

periorbital edema and pitting edema
but will have edema everywhere

Question 26

what severity of pitting edema will have a 4mm pit?

Answer 26

2+

Question 27

how deep will the pit be in 4+ pitting edema?

Answer 27

8mm pit (just multiply it by 2)

Question 28

what causes pulmonary edema?

Answer 28

due to heart failure or microvascular (microbial) damage (eg. pneumonia)

Question 29

in a patient with left sided heart failure, what type of fluid is found within the alveoli?

Answer 29

edematous (pulmonary edema), proteinaceous (frothy, white) fluid

Question 30

what are common symptoms of pulmonary edema?

Answer 30

dyspnea and chest pain

Question 31

what are the 2 ways that brain edema can present?

Answer 31

localized or diffuse

Question 32

brain edema causes an increase in ____

Answer 32

ICP (intracranial pressure)

Question 33

what is hyperemia?

Answer 33

(active) increased blood flow to a tissue

Question 34

what are the 2 different ways that hyperemia can be mediated?

Answer 34

chemically or sympathetic mediated

Question 35

what is congestion?

Answer 35

(passive) decreased blood flow away from a tissue

Question 36

T/F: congestion is only localized

Answer 36

F: it is localized or diffuse

Question 37

congestion results in ____/____ of the affected tissue

Answer 37

hypoxia/ischemia
(cyanosis)

Question 38

congestion usually results in ____

Answer 38

edema
(hyperemia will not cause edema)

Question 39

name 2 examples of chronic passive congestion

Answer 39

• lungs: LSHF
• liver: RSHF

Question 40

left sided heart failure causes what in the lungs?

Answer 40

heart failure cells (macrophages in the lungs clean up ^RBC)

Question 41

what is another name for macrophages in the lungs?

Answer 41

hemosiderin-laden macrophages

Question 42

what does right sided heart failure cause?

Answer 42

nutmeg liver (liver engorged with blood)

Question 43

what symptom in the lower extremity will you see in a patient with right sided heart failure?

Answer 43

(nutmeg liver)
bilateral ankle edema (usually pitting)