SEMIOLOGY LECTURE 2

Question 1

EDEMA

Answer 1

• excessive accumulation of interstitial fluids, either
  localized or generalized.
• when the amount of generalized edema is great,
  the condition is termed anasarca or dropsy.
• in the adult fluid accumulates to the amount of
  about 4.5 kg before it is detectable by the
  examiner as pitting edema

Question 2

1. Cardiac edema

Answer 2

in: right cardiac failure, global cardiac failure,
constrictive pericarditis;
- principal mechanism: increase hydrostatic
pressure;
- secondary mechanism: hyperaldosteronism,
increase capilar permeability, hypoalbuminemia,
hypersecretion of antidiuretic hormon.
- location: it first appears in the lower parts of the
body: feet, calfs, thighs, sacrat region till it
becomes generalized edema - anasarca

Question 3

CARDIAC EDEMA CHARACTERISTICS

Answer 3

initially – white, soft,
- “classic cardiac edema”: bluish, cyanotic edema,
tough, little painful;
- associated with cyanosis, dyspnoea, painful
hepatomegaliy, dilated jugular veins with
hepatojugular reflux, increased venous pressure,
oliguria.

Question 4

TIME OF OCCURRANCE

Answer 4

: initially in the evening, after
prolonged orthostatism or physical effort and it is
relieving affer rest; it is absent in the morning;
after a period of evolution it becomes permanent

Question 5

Renal edema

Answer 5

in acute and chronic glomerulonephrities
- complex mechanism: disorders of capilar
permeability; decreased oncotic pressure; increased
reabsorbtion of water and sodium;

Question 6

RENAL EDEMA LOCATION

Answer 6

initially appears on the face, eyelids, hands,
but it is rapidly extended to lower
limbs, anterior wall of the abdomen and frequently it is
associated with anasarca

Question 7

RENAL EDEMA CHARACTERISTICS

Answer 7

soft, puffy, with significant pitch sign.
- white edema
- not painful;
- more evident in the morning and diminishes during the
day

Question 8

Hepatic edema

Answer 8

• in hepatic cirrhosis, in chronic hepatitis;
• mechanisms:
  🡪 principal: hyperaldosteronism;
  🡪 secondary: hypoalbuminemia, hyperestrogenemia,
  hypersecretion of antidiuretic hormone.

Question 9

HEPATIC EDEMA CHARACTERISTICS

Answer 9

white yellowish colour;
- small initially
- can become generalized anasarca;
- associated with jaundice, spider nevi, hepatomegaly;
- appears after ascities

Question 10

Carential edema

Answer 10

in neoplasms, tuberculosis, deficient intake of proteins
- mechanism: low oncotic pressure;
- soft, white, diffuse edema;
- localised in the lower half of body

Question 11

Hypothyroidism - mixedema

Answer 11

accumulation of mucopolizaharides in lax connective
tissue, producing increased colloid-osmotic pressure.
- generalized, white edema with reduced elasticity,
without pitch sign.
- skin is pale, dry, cold and scuamose

Question 12

LOCALIZED EDEMA TYPES

Answer 12

ALLERGIC EDEMA, LYMPHATIC EDEMA, VENOUS EDEMA

Question 13

ALLERGIC EDEMA

Answer 13

Angioneurotic edema (Quincke’s edema):
- sudden and temporary edema in a localized area of
skin or mucosa, from allergy
- signs: single or multiple pruritic nonpitting
swellings appear on the face, tongue, larynx,
hands, feet, genitalia, and subside with or without
treatment.

Question 14

Lymphatic edema

Answer 14

Types:
a. inflammatory edema: primary limphangitis;
b. non-inflammatory edema: neoplasms,
adenopathies
c. parasitosis: filaria.

Question 15

Lymphatic edema CHARACTERISTICS

Answer 15

Colour:
= white: edema by compression;
= red: in lymphangitis;
= purple: associated with teleangiectasis.
- Tough, nonpainful

Question 16

Venous edema cause

Answer 16

Causes: thrombophlebities (AKA blood clot forms in a vein)

Question 17

Venous Edema characteristics

Answer 17

Colour:
=white (when the skin capilar vessels are compressed): is
called “phlegmatia alba dolens“);
=bluish (when there is an important venous stasis), is
called “phlegmatia coerulea dolens”.

Question 18

Venous Edema forms

Answer 18

Forms of venous edema:
- acute form in thrombophlebitis: when it initially is
white, after which it becomes reddish and it is associated
with visible venous traject, fever, local pain, local warmth
- chronic form: associated with varices: purple colour,
more intense in orthostatism and associated with trophic
lesions of the skin.