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DDx > Edema > Flashcards

Edema Flashcards

1
Q

This is the term for a clinically apparent increase in interstitial fluid that can expand by several liters before the abnormality is evident.

A

Edema

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2
Q

This is the term for edema resulting from hypothyroidism.

A

Myxedema

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3
Q

This is the term for extreme generalized edema.

A

Anasarca

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4
Q

This is the term for abnormal accumulation of fluid in the peritoneal cavity.

A

Ascites

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5
Q

This is the term for the accumulation of serous fluid in one or both pleural cavities or pericardial space.

A

Hydrothorax/Hydropericardium

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6
Q

____ of water in the body is intracellular, and _____ of all the water in the body is extracellular.

A

2/3; 1/3

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7
Q

75% of the Extracellular Space is composed of ___________. The remaining 25% of the Extracellular Space is composed of _________.

A

Interstitial Fluid; Plasma

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8
Q

Define Starling’s Law

A

The exchange of fluid between the plasma and the interstitium is determined by the hydrostatic and colloid oncotic pressures in each compartment.

Net Filtration = Capillary Wall Porosity x (Hydrostatic Pressure - Oncotic Pressure)

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9
Q

Hydrostatic Pressure is a function of:

A
  1. Blood Pressure
  2. Intravascular Volume
  3. Venous Outflow
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10
Q

This is the term for the ability of albumin to form covalent bonds with water and retain fluid in a particular compartment.

A

Oncotic Pressure

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11
Q

Extracellular fluid normally moves from the _________ across ________ into the __________ and is then returned to the circulation via the lymphatic’s

A

Vascular Space; Capillary Walls; Interstitium

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12
Q

Production of Edema (could be a combination):

A
  1. Increased plasma volume
  2. Elevation in capillary hydrostatic pressure
  3. Increased Capillary Permeability
  4. Reduction in the Plasma Oncotic Pressure
  5. Lymphatic Obstruction
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13
Q

The increase in capillary pressure is generally due to _________. Why?

A

Increased Venous Pressure; Because the pre-capillary arteriole autoregulates capillary pressure.

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14
Q

What could cause increased capillary pressure?

A
  • Venous Obstruction (Venous Thrombosis)

- Expanded Venous Blood Volume (Heart Failure or Kidney Failure)

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15
Q

Cause of Decreased Plasma Oncotic Pressure

A
  • Hypoalbuminemia (< 2 g/dL)
  • Nephrotic Syndrome
  • Liver Failure
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16
Q

What causes Increased Capillary Permeability?

A

Augments transit of proteins into interstitium, therefor decreases oncotic pressure gradients.

Ex:

  • Burns
  • Angioedema
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17
Q

What can cause lymphatic obstruction?

A

Secondary to Tumor

*Rare

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18
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Pressure via:

Increased plasma volume due to renal Na+ Retention

A
  1. Heart Failure, including Cor Pulmonale
  2. . Primary renal sodium retention:
    a. Renal disease, including nephrotic syndrome
    b. Drugs: minoxidil, NSAIDS, estrogens
    c. Early hepatic cirrhosis
  3. Pregnancy and premenstrual edema
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19
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Pressure via:

Venous Obstruction

A
  1. Cirrhosis or Hepatic Venous Obstruction

2. Local Venous Obstruction

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20
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Pressure via:

Decreased Arteriolar Resistance

A
  1. Calcium Channel Blockers

2. Idiopathic Resistance

21
Q

Clinical conditions Assc with Edema Development Caused by:

Hypoalbuminemia via:

Protein Loss

A
  1. Nephrotic Syndrome

2. Protein-Losing Enteropathy

22
Q

Clinical conditions Assc with Edema Development Caused by:

Hypoalbuminemia via:

Reduced Albumin Synthesis

A
  1. Liver Dz

2. Malnutrition

23
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Permeability

A
  1. Idiopathic Edema
  2. Burns
  3. Trauma
  4. Inflammation or Sepsis
  5. Allergic Reactions
  6. DM
  7. IL2 Therapy
  8. Malignant Ascites
24
Q

Clinical conditions Assc with Edema Development Caused by:

Lymphatic Obstruction or Inc. Interstitial Oncotic Pressure

A
  1. Post-mastectomy
  2. Nodal Enlargement Due to Malignancy
  3. Hypothyroidism
  4. Malignant Ascites
25
Q

Classifying Edema

A
  1. Unilateral –> Localized vs. Limb

2. Bilateral –> Generalized

26
Q

This type of edema is generally due to a systemic cause and is manifested by bilateral leg edema or ascites.

A

Bilateral/Generalized Edema

27
Q

Cardiovascular Causes of Bilateral/Generalized Edema

A
  • Systolic and/or Diastolic Failure
  • Constrictive Pericarditis
  • Pulmonary HTN
28
Q

Hepatic Causes of Bilateral/Generalized Edema

A

Hepatocellular Injury

  • Cirrhosis
  • Hepatitis
29
Q

Renal Causes of Bilateral/Generalized Edema

A
  • Renal Failure

- Nephrotic Syndrome

30
Q

This type of edema is due to venous or lymphatic cause and manifested by unilateral (possibly bilateral) limb edema.

A

Unilateral/Limb Edema

31
Q

Venous Disease Causing Unilateral/Limb Edema

A

Obstruction

  1. DVT
  2. Lymphadenopathy
  3. Pelvic Mass
  4. Venous Insufficiency
32
Q

Lympathic Obstruction Causing Unilateral/Limb Edema

AKA Lymphedema

A
  1. Congenital
  2. Neoplasm
  3. Surgery
  4. Radiation
  5. Parasite
33
Q

Other Causes of Unilateral/Limb Edema

A
  • Burns
  • Angioedema/Hives
  • Infection/Trauma
34
Q

Questions to ask when taking a history about Edema

A
  1. When did swelling begin?
  2. How has it gotten worse?
  3. Weight gain?
  4. How do clothes fit?
  5. What is your medical history? (Heart/Liver/Thyroid/Kidney)
35
Q

Rule of Thumb with Edema Presentation?

A

Think about Serious Diagnoses First!!!

36
Q

Serious Dx causing Edema to consider

A
  • CHF
  • Anaphylaxis
  • Liver Failure
  • DVT leading to PE
37
Q

If a patient says they:

recently started a new medication before edema occurred,

what should you think?

A

Anaphylaxis

38
Q

If a patient says they:

were recently exposed to latex or chemicals before edema occurred,

what should you think?

A

Anaphylaxis

39
Q

If a patient says they:

had associated symptoms of chest discomfort, SOB, Orthopnea, or Paroxysmal Nocturnal Dyspnea with edema,

what should you think?

A
  • Valve Stenosis
  • Valve Insufficiency
  • Cardiac Ischemia
40
Q

If a patient says they:

had assc symptoms of loss of consciousness (syncope), or feeling like they were going to pass out esp. when walking (presyncope) with new onset edema,

what should you think?

A
  1. Outflow tract obstruction
    - – Aortic stenosis
    - – Hypertrophic CM
    - – Primary Pulm HTN
    - – Atrial Myxoma
  2. Pulmonary embolus
41
Q

If a patient says they:

had hx of alcohol abuse, unprotected sex, use of injective drugs, use of illicit drugs, or abdominal swelling with new onset edema,

what should you think?

A
  1. Liver Failure
  2. Outflow tract obstruction
    - – Aortic stenosis
    - – Hypertrophic CM
    - – Primary Pulm HTN
    - – Atrial Myxoma
  3. Pulmonary embolus
  4. Constrictive Pericarditis
42
Q

If a patient says they:

had assc symptoms with sedentary position for prolonged time, smoking, hx of blood clots, or use of oral contraceptives with new onset edema,

what should you think?

A

Pulmonary Embolism

43
Q

What does 1+ Pitting Edema mean?

A
  • Pitting Lasts 0 to 15 sec

OR

  • Mild Pitting, Slight Indentation, No perceptible swelling of the leg
44
Q

What does 2+ Pitting Edema mean?

A
  • Pitting lasts 16 to 30 sec

OR

  • Moderate Pitting, Indentation Subsides Rapidly
45
Q

What does 3+ Pitting Edema mean?

A
  • Pitting lasts 31 to 60 seconds

OR

  • Deep Pitting, Indentation remains for a short time, legs look swollen
46
Q

What does 4+ Pitting Edema mean?

A
  • Pitting Lasts 60+ seconds

OR

  • Very deep pitting, indentation lasts a long time, leg is very swollen
47
Q

What causes the pitting in pitting edema?

A

Reflects Movement of Excess Fluid Into Interstitial Space

48
Q

Physiology of Systolic Dysfunction in Left Sided Heart Failure

A
  • Commonly due to CAD or HTN
  • Weakened Myocardium
  • Unable to Contract Forcefully enough to meet Systemic Demands
  • Large dilated heart
49
Q

Physiology of Diastolic Dysfunction in Left Sided Heart Failure

A
  • Impaired ability or mycardium filling due to hypertrophic changes
  • Smal LV cavity
  • Concentric LB Hypertrophy

DDx (9 decks)

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