Edema Lecture Powerpoint Flashcards
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Edema definition
Palpable swelling produced by expansion of insterstitial fluid volume in the tissue itself
Pitting vs nonpitting edema
Pitting edema leaves an indentation when pressed with a finger and indicates less severe fluid buildup, nonpitting edema bounces back from indentation when pressed with a finger and indicates severe fluid buildup
Anasarca definition
Massive and generalized fluid build up, extreme edema
Capillary hydrostatic pressure definition
Pressure pushed on the capillary walls due to blood pressure to release fluid into the tissue bed, increased in cases of inflammation and venous congestion
Capillary osmotic pressure definition
The pressure pulling water back into the capillary vessel due to plasma proteins within the vessel
Lymphatic obstruction and it generally manifests ___laterally
Tumors, parasites, fibrosis, or removal of lymph nodes that cause obstruction of the flow and edema, generally manifests unilaterally
Interstitial osmotic pressure definition
The pressure Inward pulling force of fluid from the capillary into the interstitial space where proteins drive the fluid
Interstitial hydrostatic pressure
The pressure pushing fluid out of the interstitial space and back into the capillaries
___ of total body water is confined to extracellular space, generalized edema requires ___ of excess fluid before even being noticable
1/3, 2.5 to 3 L
Cardiac signs of generalized edema (5)
- dyspnea upon exertion
- paroxysmal nocturnal dyspnea
- JVD
- displaced apical pulse
- cool extremities
Cardiac labs of generalized edema, how is BUN/Cr ratio? How is sodium level? How is BNP level?
Elevated BUN/Cr ratio
- Decreased Na+
- Elevated BNP
Brain natriuretic peptide (BNP) definition
A protein released in the body when the heart is working very hard and failing
Often a patient with paroxysmal nocturnal dispnea will have to do this to sleep
Prop pillows underneath them
Hepatic signs of generalized edema (4)
- history of alcohol abuse
- ascites
- jaundice
- asterixis
Ascites definition
Excessive fluid retention in peritoneal space, often resulting from portal hypertension, has large tortuous veins called caput medusa
Asterixis definition
Flapping fingers when holding hand outright due to nervous system effect
Hepatic Labs of generalized edema, how are liver enzymes?
Elevated
Renal signs of generalized edema (4)
- Uremia
- metalic or fishy taste
- uremic frost
- elevated BP
- periorbital edema
Uremic frost definition
Uremic crystal formation on skin due to renal failure, smells foul
Renal labs of generalized edema, how is albuminuria? RBC count? K+ levels?
- Positive for albuminuria
- Normocytic anemiaRBC count
- Hyperkalemic
Edema can be caused by increased hydrostatic pressure caused by these 2 mechanisms
1) impaired venous return
2) arteriolar dilation
Edema can be caused by reduced plasma osmotic pressure caused by these 3 mechanisms
1) protein losing gastroenteropathy or glomerulopathy
2) liver cirrhosis
3) Malnutrition
Edema can be caused by lymphatic obstruction caused by these 3 mechanims
1) inflammation
2) post surgical
3) post irradiation
Edema can be caused by increased capillary permeability or sodium retention caused by these 2 mechanisms
1) exccess salt intake or reabsorption
2) inflammation/immune rxn
Hydrothorax definition
A type of edema with accumulation of excess fluid in chest cavity
Hydropericardium definition
A type of edema with fluid in the pericardial sac that can lead to compression of heart
Exudate definition
A type of edema with inflammatory fluid spilling out of skin
Some common causes of anasarca (4)
- nephrotic syndrome
- cirrhosis
- myxedema (hypothyroidism)
- anaphylaxis
Nephrotic syndrome can cause edema because of the…
….massive proteinuria diminishing the colloid oncotic pressure
An early and a late finding in cirrhosis
Early - telangiectasias, broken sensitive vessels seen on face
Late - jaundice
A left sided congestive heart failure sees back up in the ___ while a right sided sees backup in the _____
lungs, extremities
Dependent edema definition
Edema that works with gravity via venous insufficiency and failure of valves causing blood to pool in veins increasing venous pressure and leading to edema that usually resovles when legs are elevated
Dependent edema treatment (3)
- restricted sodium intake
- stockings
- weight loss
Brawny edema definition
Edema caused by chronic venous insufficiency causing thickened, dark colored skin with pectachiae and ulcerations
Idiopathic cyclic edema definition and treatment
Edema that occurs on a predictable cycle possibly related to hormones, normally seen in female menstrual cycle with weight change during day around period
Treated with sodium restriction or diuretics with caution
Drug class known to be a source of edema
Calcium channel blockers
If edema is worse in the morning, think of ___ edema origin
Renal
Facial involvement of edema, think of one of these 3 types involvement
- renal
- myxedema
- allergic
Increased edema at end of day improving at night think of ___ edema origin
Cardiac
What type of edema is often treated with stockings?
Dependent edema
How does cirrhosis of liver progress regarding edema?
To ascites then to generalized edema
