Oedema Flashcards
What braod categories can cause Oedema?
Cardiac
Hepatic Disease
Renal
Malnutrition
On examination, how do you assess the extent of oedema?
Leg swelling
Sacral pad
Ascotes
Pleural Effusion
Pulmonary Oedema
On examination how do you assess the causes of oedema?
JVP
Signs of Cardiac, Liver, Renal Disease
Rectal, Vaginal Examination (looking for masses)
Lymphadenopathy
Oedema can be a presenting feature of which serious medical conditions?
Congestive heart failure
Liver Failure
Malnutrition
Nephoritic Syndrome (proteinuria, hypoalbuminemia and oedema)
Localised peripheral oedema can be as a result of?
Venous or Lymphatic Obstruction
What drugs can cause peripheral oedema?
NSAIDs and Calcium Channel Blockers
What two questions hold the key to an oedema diagnosis?
- Is the oedema unilateral or bilateral
- Is the venous pressure raised or not?
Oedema diffusely affecting the whole body suggests?
A low serum albumin or leaky capillaries, rather than heart failure
In bilateral leg oedema, what determines the diagnosis?
Determining if the JVP is raised or not.
Also, if there are any signs of liver diseae, severe immobility or malnourishment.
What would be expected in a patient with bilateral leg oedema with heart failure as the cause?
Leg oedema occurs as a result of right-sided heart failure and is always associated with a raised JVP.
Hepatomegaly is often seen
If oedema is mild in the legs but severe in the abdomen, pericardial constriction should be considered.
A patient presents with oedema caused by heart failure but has mild oedema in the legs but severe oedema in the abdomen, what should be considered?
If oedema is mild in the legs but severe in the abdomen, pericardial constriction should be considered.
How can liver disease cause bilateral leg oedema?
Oedema can be caused by low serum albumin.
There maybe signs of chronic liver disease, such as sider naevi, leuconychia, gynaecomastia, dilated abdominal veins indicating portal hypertension.
Does not cause a raised JVP
How can Renal Failure cause bilateral leg oedema?
Caused by either a low serum albumin - Nephrotic Syndrome, urine is frothy with protein
Or an inability to excrete fluid - nephritic syndrome, associated with hypertension and low urine output
What’re some of the causes of unilateral leg oedema?
DVT
Ruptured Baker’s Cyst - a knee joint bursa that juts into the popliteal fossa and usually occurs in rheumatoid arthritis, it can rupture causing sudden onset leg pain and calf swelling
Cellulitis - often painful and assocaited with a temperature and a raised ESR, CRP and WCC. Usually Staphylococci or Streptococci
Lymphatic Obstruction - woody form of unilateral oedema. Rare, when found is due to carcinomatous invasion and obliteration of the draining lymph nodes e.g metastatic melanoma
Pelvic Tumours - can unilaterally compress veins
Localised immobility
What’re the main investigations for Oedema?
Serum Albumin
Urinary protein loss
Liver function tests
Creatinine
ECG
Chest X-ray
