Oedema

Question 1

Define edema

Answer 1

• Commonly know as swelling
• Accumulation of fluid: interstitial spaces/cells
• Fluid is released from the capillaries into the interstitial spaces or cells

Question 2

Classify edema

Answer 2

Oedema can be classified according to following:

1. Pathophysiology
2. Location
   - Generalized (cardiac/ hepatic/ renal/ endocrine)
   - Localized (venous, lymphatic, angioedema, allergy, inflammation)
3. Clinical finding
   - Pitting (liver/kidney/heart)
   - Non-pitting (lymphatic/ thyroid)
4. Organ specific (brain, lung, peritoneum etc)

Question 3

Explain types of edema

Answer 3

1. Peripheral - Edema of peripheral vascular system parts like lower limbs (legs, feet and ankles)
2. Pedal - edema of foot is known as pedal oedema. common in the elderly and during pregnancy
3. Pulmonary - accumulation of fluids in air spaces and parenchyma lungs. It may lead to respiratory failure
4. Cerebral - Accumulation of fluid in the brain is known as cerebral oedema. It may be caused due to ischemic stroke, cancer, or brain inflammation due to meningitis or encephalitis
5. Angioedema/allergic reaction - It is different from hives where swelling is caused within the deeper layers of the skin, rather than the surface of the skin. It occurs on the face
6. Hereditary angioedema - Rare genetic condition that affects immune system. Swelling affects face, genitals and abdomen
7. Papilledema - Swelling of the optic nerve of the eye which is a result of increased intracranial pressure inside the skull and around the brain.
8. Macular edema - build-up of fluid in the macula, an area in the centre of the retina. The retina is the light-sensitive tissue at the back of the eye and the macula is the part of the retina responsible for sharp, straight-ahead vision. Fluid build-up causes the macula to swell and thicken, which distorts vision
9. Dependant edema - swelling that occur in the legs and lower body which is affected by gravity and which is position dependent
10. Scrotal edema – enlargement of the scrotal sac due fluid accumulation as a result of injury or underlying medical condition
11. Lipedema - a disorder characterized enlargement of the legs due to deposits of fat beneath the skin – blocks the lymphatic system – causing lymph edema
12. Idiopathic edema – accumulation of fluid in tissue – cause unknown
13. Myxedema – edema associated with hypothyroidism
14. Pitting - when pressure is applied on the skin and removed, a depression is seen (chronic edema)
15. Non-pitting – no presence of depression when pressure is applied

Question 4

Explain the causes of edema

Answer 4

1. Medication – e.g. vasodilators; NSAIDs
2. Diet: excessive salt intake – Na causes fluid retention
3. Menopause and pregnancy – hormonal changes cause fluid retention
4. Malnutrition – lack of vitamins B1, B6 and B5 may cause fluid retention
5. Burns/Injury – tissue damage cause local swelling
6. Heat - high temperatures body doesn’t work efficiently in removing the fluid from the tissues
7. Diabetes – due to circulatory problems
8. Allergies - some foods and insect bites causes swelling
9. Obstructive sleep apnea - cessation of breathing, especially during sleep due to increased hydrostatic pressure
   Diseases:
10. Kidney – renal failure affecting fluid filtration - failure in eliminating fluid and sodium from blood. Nephrotic syndrome – results in increased loss of protein ( oncotic pressure)
11. Heart – congestive heart failure (CHF) - Inability to pump blood effectively leads to the accumulation of the blood in limbs (venous pooling)
12. Lung – pulmonary edema associated with CHF or due to pneumonia/medication/high altitude
13. Liver – cirrhosis – damage of liver resulting in inflammation + reduced protein synthesis (albumin) results decreased plasma oncotic pressure
14. Brain – fluid accumulation due to a stroke or tumour

Question 5

Outline the signs and symptoms of oedema

Answer 5

1. Swollen, stretched, and shiny skin
2. Skin that retains a dimple after being pressed for a few seconds (pitting)
3. Puffiness of the affected area (e.g. ankles/face) / Ascites (accumulation of fluid in the peritoneal cavity)/abdominal swelling
4. Aching body parts and stiff joints
5. Weight gain or loss
6. Higher pulse rate and blood pressure
7. Headache
8. Chest pain
9. Difficulty in breathing/shortness of breath or cough

Question 6

Explain the pathophysiology

Answer 6

1. Increased capillary hydrostatic pressure
2. Decreased capillary oncotic pressure
3. Increase in capillary permeability (damage bld vessel wall – injury/inflammation)
4. Inadequate lymph drainage (obstructed lymph drainage)
5. Water retention in tissue (sodium and water retention – kidney)

Question 7

Outline diagnostic tests available

Answer 7

1. Blood tests
2. Liver function tests
3. Heart function tests (ECG/echocardiogram or TEE/MRI/CT scan)
4. Venous ultrasonography
5. Lymphoscintigraphy
6. Urine tests
7. Chest X-rays

Question 8

Outline the treatment options

Answer 8

1. Medication: diuretics/ Anticoagulant therapy
2. Diet - decrease salt intake (sodium)
3. Oxygen
4. Compression stockings
5. Body positioning - elevation
6. Exercise – circulatory/foot-pumping
7. Massage
8. Electrotherapy
9. K-tape