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UF COM ClinDx Unit 4 > L7 - Edema > Flashcards

L7 - Edema Flashcards

1
Q

What law dictates fluid movement at the capillaries?

A

Starling’s Law

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2
Q

By what 3 forces/mechanisms can edema be caused?

A

Increases hydrostatic pressure –> more force pushes fluid out of the

Decrease protein in blood –> less oncotic/osmotic force for fluid to return to circulation

Increased capillary permeability

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3
Q

Increased hydrostatic pressure where is most closely correlated with edema?

A

Venous side of capillary

If have isolated high pressure in arterial side, it tends to just increase flow not cause edema

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4
Q

Generally speaking what are the main causes of decreased oncotic pressure?

A

Kidney, GI or liver diseases (only if excreting protein)

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5
Q

How does heart failure cause edema?

A

Failure to pump enough –> fluid backs up into venous system –> increases venous hydrostatic pressure –> edema

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6
Q

What are the heart failure classifications?

A

L vs. R

Ischemic vs. non-ischemic

Systolic vs. diastolic

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7
Q

Where does fluid back up during L sided heart failure?

A

Lungs –> pulmonary edema –> crackles

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8
Q

Where does fluid back up during R sided heart failure?

A

Periphery

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9
Q

If see peripheral edema, what assumptions can be made about the classification of the underlying heart failure with regards to being L or R sided?

A

R sided is the cause of the peripheral edema, but the most common cause of R sided heart failure is L sided heart failure so it isn’t ruled out either

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10
Q

What are the causes of isolated R sided heart failure?

A

Usually pulmonary HTN due to COPD, Pulmonary embolism, pulmonary fibrosis, familial respiratory disease or obstructive sleep apnea

Can also have isolated R sided MI or R sided valvular problem but this is rare

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11
Q

What is the main ischemic cause of heart failure?

A

MI

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12
Q

What are the non-ischemic causes of heart failure?

A

Valvular problem

Pericardial effusion (fluid in pericardial sack)

Constrictive Pericarditis (thick fibrosed inflamed pericardium doesn’t allow heart to expand)

Cardiomyopathy (tachycardia induced, restrictive, dilated or hypertrophic)

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13
Q

What is systolic heart failure? How does it correlate to the other classifications of heart failure?

A

Can’t pump enough

Can be R or L sided (or both), ischemic or non-ischemic

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14
Q

How is systolic heart failure mainly diagnosed?

A

Low EF on echo

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15
Q

What type of heart failure is very sensitive to increases in HR or BP?

A

Diastolic

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16
Q

What is diastolic heart failure? How does it correlate to the other classifications of heart failure?

A

Can’t fill –> cant relax or is too rigid/thick

L or R sided. Generally, non-ischemic

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17
Q

Causes of diastolic heart failure?

A

Long standing HTN –> thicker ventricle

Aortic stenosis

Constrictive pericarditis

Restrictive cardiomyopathy

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18
Q

What is Anasarca? What is suggested by it?

A

Full body edema

Liver, GI or kidney origin (decreased oncotic)

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19
Q

What is suggested by full body edema?

A

= Anasarca

Liver, GI or kidney origin (decreased oncotic)

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20
Q

What GI disorders can cause edema? How do they cause edema?

A

Not enough protein eaten/absorbed or too much excreted due to diarrhea –> low oncotic pressure

IBD/Chrons/UC or infection –> diarrhea

Malnutrition (low protein intake)

Celiac disease –> malabsorption

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21
Q

How do liver diseases cause edema?

A

Not making enough proteins (including albumin) –> low oncotic

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22
Q

What renal disorders cause edema?

A

Chronic renal failure

Nephrotic syndrome

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23
Q

How do pulmonary problems cause edema? What pulmonary problems cause edema?

A

Somehow inhibit flow to lungs –> blood backs up –> R sided heart failure –> blood backs up into periphery

Pulmonary HTN due to COPD, Pulmonary embolism, pulmonary fibrosis, familial respiratory disease and obstructive sleep apnea

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24
Q

What pulmonary cause of edema is most common?

A

obstructive sleep apnea

25
Q

What vascular problems can cause edema?

A

DVT

Intrinsic/extrinsic obstruction (compress vessels)

Venous Insufficiency (valvular problem)

26
Q

What is suspected with non-pitting edema?

A

Lymphadema

Hypothyroid

27
Q

What is angioedema? What causes it?

A

Swelling of the face

allergic or autoimmune reaction to ACEI or NSAID –> increases capillary permeability

28
Q

What is suggested by swelling of the face?

A

= Angioedema

Most likely ACEI, but could also be NSAID

Acute symptoms can come on even in somebody who has been on the medication for years

29
Q

What causes of edema work by all 3 mechanisms?

A

Pregnancy

Hypothyroid

30
Q

Mechanism of pregnancy induced edema?

A

all 3

31
Q

Mechanism of hypothyroid induced edema?

A

all 3

32
Q

What causes edema by increasing fluid pressure?

A

Heart failure

Pulmonary HTN

Vessel/Lymphatic obstruction/compression

Renal failure –> not excreting Na –> water follows –> increased in blood volume –> increase in venous pressure

33
Q

What causes edema by lowering oncotic pressure?

A

Liver & GI problems

Not listed but if kidney disease involves nephrotic syndrome will lose protein and cause low oncotic pressure

34
Q

What causes edema by increasing capillary permeability?

A

ACEI

CCB

Idiopathic cyclic edema

35
Q

What is idiopathic cyclic edema? Mechanism?

A

Normal bloating associated with menstrual cycle

Capillary permeability

36
Q

What is suspected for edema and dyspnea? Tests?

A

L sided heart failure (dyspnea) causing R sided heart failure (peripheral edema)

Echo & CXR

37
Q

What is suspected for edema and orthopnea? Tests?

A

L sided heart failure (dyspnea) causing R sided heart failure (peripheral edema)

Echo & CXR

38
Q

What is suspected with edema and crackles on auscultation of lungs?

A

Pulmonary edema = L sided heart failure

39
Q

What blood test is used to test for suspected heart failure?

A

NT-proBNP

high during heart failure

40
Q

What must be done for a patient with new onset edema and LV dysfunction?

A

MI workup

41
Q

What 2 things can combine to predispose somebody to liver cirrhosis?

A

Alcoholism and hepatitis C

42
Q

What is suspected for lower limb edema & abdominal distention? Tests?

A

Liver problem –> ascites

CMP, PT/INR, RUQ ultrasound

43
Q

What is suspected for edema and fluid wave, shifting dullness, caput medusa, gynecomastia or spider angioma?

A

Liver problem and ascites

44
Q

What is suspected for normal AST/ALT?

A

Could be healthy or the liver could be so bad it isn’t even making the proteins anymore in high enough levels to give a high reading. Look at rest of Liver function test

45
Q

What is suspected for edema & small nodular liver on ultrasound?

A

Liver cirrhosis

46
Q

What is suspected for edema and splenomegaly?

A

Liver problem –> portal hypertension –> backs up into spleen

47
Q

What type of liver disease causes edema?

A

Usually chronic

Only very severe forms of acute liver disease like fulminant Hep B, toxins or drug overdose can cause edema

48
Q

Ascites can be difficult to determine in what type of patients?

A

Obese

49
Q

What is suspected for edema with mild hepatosplenomegaly & fatty liver change?

A

Probably not cirrhosis, keep looking for cause

50
Q

What is the gold standard for definitive diagnosis of R sided heart failure?

A

Right heart catheterization to measure pulmonary artery pressure

51
Q

How do you test for obstructive sleep apnea?

A

Sleep study

52
Q

Does DVT usually present bilat or unilat?

A

Usually unilat

But can have separate DVTs in both legs or a blockage of IVC –> bilat

53
Q

What is the mechanism of edema in Obstructive Sleep Apnea?

A

During the night become hypoxic –> low levels of O2 cause vasoconstriction of the alveolar vessels –> increase pulmonary arterial pressure –> pulmonary hypertension –> blood backs up into R heart & then periphery

54
Q

Kidney diseases can cause edema by what mechanism(s)?

A

Nephrotic –> protein loss –> decreased oncotic

Kidney Disease –> lower excretion on Na –> increased blood volume –> increased venous hydrostatic pressrue

55
Q

What is orthopnea? Its presence in somebody with edema suggests what etiology?

A

SOB when lay down cuz increase venous return. Less effect of gravity on blood flow means less in legs and more blood to congested lungs

Often need to sleep on more than 2 pillows

Probably related to L sided heart failure –> pulmonary edema

56
Q

How does the echo present in diastolic heart failure?

A

Normal

57
Q

How does heart failure present on CXR?

A

Cardiomegaly
Pul edema
Cephalization

May have effusion

58
Q

How does liver function panel present during cirrhosis?

A

Low proteins

High Alk phos

High Bilirubin

ALT/AST can be normal

UF COM ClinDx Unit 4 (10 decks)

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