Evaluation of Edema - PR

Question 1

What is anasarca?

Answer 1

Massive and generalized edema (expansion of the interstitial fluid volume)

Question 2

What are the four causes of Edema?

Answer 2

1) High Capillary Hydrostatic Pressure
2) Loss of Plasma Proteins/Low Capillary Osmotic Pressure
3) Lymphatic Obstruction
4) Increased Capillary Permeability

Question 3

What pressures cause distribution from capillaries to the tissues? From the tissues to the capillaries?

Answer 3

1) Capillaries to Tissues: Capillary Hydrostatic Pressure & Interstitial Osmotic Pressure
2) Tissues to Capillaries: Capillary Osmotic Pressure & Interstitial Fluid Hydrostatic Pressure

Question 4

How much of total body water is confined to the extracellular space? How many liters of excess fluid must be present before overt edema occurs?

Answer 4

1/3 of total body water is confined in extracellular space

2.5-3.0 Liters of excess fluid

Question 5

What are the principle causes of Generalized Edema, what are their signs, and what labs can you use to Dx? (Cardiac)

Answer 5

1) Cardiac: S/S → Dyspnea, PND, JVD, S3 gallop, displaced apical pulse, peripheral cyanosis, cool extremeties.
Labs → ↑ BUN/Cr, ↓ Na, ↑ Uric Acid, ↑ BNP

Question 6

What are the principle causes of Generalized Edema, what are their signs, and what labs can you use to Dx? (Hepatic)

Answer 6

2) Hepatic: S/S → Dyspnea, ETOH abuse, ↓ BP, jaundice, palmar erythema, asterixis.
Labs → ↓ albumin, cholesterol, ↑ liver enzymes

Question 7

What are the principle causes of Generalized Edema, what are their signs, and what labs can you use to Dx? (Renal)

Answer 7

3) Renal: S/S → Dyspnea in the presence of ascites, Hx of ETOH abuse, ↓ BP, jaundice, palmar erythema, asterixis, periorbital edema.
Labs → albuminuria, hypoalbuminemia, hyperkalemia, metabolic acidosis, normocytic anemia

Question 8

What are causes of Edema via Increased Hydrostatic Pressure?

Answer 8

1) Impaired venous return due to:
- CHF
- Constrictive pericarditis
- Ascites
- venous obstruction
2) Arteriolar Dilation due to:
- Heat
- Neurohumoral

Question 9

What are causes of Edema via Reduced Plasma Osmotic Pressure?

Answer 9

1) Hypoproteinemia
- Nephrotic Syndrome
- Cirrhosis
- Malnutrition

Question 10

What are causes of Edema via Lymphatic Obstruction?

Answer 10

-Inflammatory
-Neoplastic
-Post-surgical
-Post-irriadiation
(usually unilateral)

Question 11

What are causes of Edema via Increased Capillary Permeability/Sodium Retention?

Answer 11

• Excessive salt intake
• Increased tubular reabsorption (renal hypoperfusion)
• Inflammatory/Immune reaction

Question 12

What would be the treatment/management of Dependent Edema?

Answer 12

• Restrict Na intake
• Compression Stockings
• Avoid Diuretics (work initially but often fail)
• Weight loss
• Sclerosis or removal of damaged veins

Question 13

What are the characteristics of “Brawny” Edema?

Answer 13

• Chronic venous insufficiency
• Thickened, dark colored skin (hemosiderin deposits from lysed RBCs)
• Non-pitting edema
• Ulcerations

Question 14

What drugs can cause generalized edema?

Answer 14

-calcium channel blockers

Question 15

What are the characteristics of Idiopathic Cyclic Edema?

Answer 15

• Occurs on relatively predictable cycle
• Related to hormonal cycles
• Normally female (menstrual cycle)
• Significant weight change during the day
• Increased capillary permeability
• Tx: Na restriction

Question 16

If the edema is worse in the AM, what is the most likely etiology?

Answer 16

-Renal → hypoalbumin states

Question 17

What would facial involvement of generalized edema mean?

Answer 17

• renal/myxedema/allergic

Question 18

What would increased edema at the end of the day improving at night suggest?

Answer 18

-Cardiac/ dependent/ cyclic