edema

Question 1

edema

Answer 1

palpable swelling produced by expansion of the interstitial fluid volume. can be diffuse or localized.

Question 2

how much does the interstitial fluid have to be expanded before it is clinically relevant?

Answer 2

2.5-3 liters

Question 3

what are the two basic steps for the formation of edema?

Answer 3

1. ) alteration in the capillary hemodynamics that favors the movement of fluid into the interstitial space.
2. ) retention of dietary sodium and water by the kidneys.

Question 4

why is there no hemoconcentration or shock in edema/

Answer 4

because the vascular plasma volume is kept at close enough levels to restore tissue perfusion

Question 5

what is the normal situation for hemodynamics within the body, as far as hydrostatic pressure, etc?

Answer 5

there is normally a net pressure for the filtration of the plasma. this is taken care of by the lymphatics.

Question 6

what are the five basic causes of edema?

Answer 6

increased capillary hydraulic pressure, decreased plasma oncotic pressure, increased capillary permeability, lymphatic obstruction, myxedema

Question 7

increased capillary hydraulic pressure?

Answer 7

increased venous pressure by blood volume expansion or venous obstruction. HF, renal disease, cirrhosis, pregnancy. DVT or cirrhosis.

Question 8

decreased plasma oncotic pressure

Answer 8

hypoalbuminemia/malnutrition, nephrotic syndrome, decreased hepatic albumin synthesis in liver failure

Question 9

lymphatic obstruction

Answer 9

lymphedema

Question 10

myxedema

Answer 10

hypothyroidism leads to accumulation of interstitial albumin and low lymphatic flow

Question 11

how does lymphatic flow compensate for edematous scenarios

Answer 11

flow and contractility will increase with tissue edema and remove some excess filtrate

Question 12

how does fluid flow itself contribute to edema compensation

Answer 12

fluid entry into the interstitium raises the hydraulic pressure, reducing the pressure gradient favoring filtration. this also lowers the interstitial oncotic pressure.

Question 13

what are the most common causes of generalized edema

Answer 13

HF, cirrhosis, nephrotic syndrome and other renal diseases, premenstrual edema and pregnancy. anemia.

Question 14

what is peripheral edema only suggestive of?

Answer 14

right sided HF, pericardial disease, renal disease, local venous or lymphatic disease

Question 15

what does intermittent edema in a female patient indicate?

Answer 15

common premenstrual symptom.

Question 16

what is anasarca?

Answer 16

whole body edema

Question 17

what does periorbital or specific localized edema indicate?

Answer 17

hereditary angioedema

Question 18

what do we look for on abdominal exam?

Answer 18

ascites, hepatojugular reflux, cirrhosis, signs of portal HTN, splenomegaly.

Question 19

what does palmer flush indicate?

Answer 19

this is indicative of liver failure

Question 20

what does non-pitting edema indicate?

Answer 20

this is usually indicative of lymphatic obstruction or lymphedema.

Question 21

what is the differential for localized edema?

Answer 21

angioedema, urticaria, cellulitis, erysipelas

Question 22

if localized edema is the entire limb?

Answer 22

need to perform duplex ultrasound. if DVT then start anticoagulants.

Question 23

if localized edema is the entire limb and no DVT?

Answer 23

consider cellulitis, obstruction from neoplasm, radiation, lymphedema

Question 24

for bilateral/generalized edema with no cardiac, hepatic, renal or anemia is found then what?

Answer 24

look for venous insufficiency -if yes then start leg elevation and compression stockings. If no look for meds that would cause this.

Question 25

for bilateral/generalized edema with cardiac, hepatic, renal or anemia is found then what

Answer 25

establish cause, start diuretics

Question 26

treatment of edema?

Answer 26

reversal of underlying causes. sodium restriction, compression stockings, diuretic meds

Question 27

what is the only life threatening edema?

Answer 27

pulmonary edema.

Question 28

what is a common therapy for edema?

Answer 28

slowly reducing edema through use of diuretics such as furosemide.