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DEFINITION
Edema= increase in interstitial
volume, localised or generalised, due
to sodium and water accumulation in
the subcutaneous tissue. The normal
anatomic profile disappears and pits
appear under pressure.
TYPES OF EDEMA
Anasarca
Clinical syndrome characterised by
MECHANISMS OF EDEMA
Local factors: the fluid volume which
Hidrostatic pressure
Tissue osmotic
pressure
Capillary
permeability
Lymphatic drainage
CARDIAC EDEMA
Gravitation dependent.
In bedridden patients lombosacral
edema is dominant.
Untreated edema develops in a cranial
direction, until anasarca appears.
Edema is cyanotic and cold ( stasis
cyanosis ) due to low cardiac output.
Pits are persistent.
CARDIAC EDEMA
The presence of dyspnoea is mandatory.
Increased levels of BNP are mandatory.
Edema is much more frequent in right heart
failure.
It is produced by an increase in central
venous pressure.
There is marked sodium and water retention
due to reduced glomerular filtration rate.
RENAL EDEMA.
Nephrotic edema due to protein loss
after basal membrane
damage(albuminuria>4g/24hr.).
Nephritic edema- protein loss not so
important to justify edema, sodium
retention is much more important.
Edema is white and soft, normal
temperature, easy pits.
Face, eyelids, dorsal aspect of feet,
external genitalia.
Starvation edema
Generalised, soft, pits appear easy.
Localised at the legs and face.
General aspect similar to renal edema.
Main mechanism is hipoalbuminemia,
due to malabsorbtion, hepatocelular
failure, serumalbumin synthesis
failure.
HEPATIC EDEMA
White, soft, inferior limbs.
Appears in decomensated liver chirosis.
Ascites is not proportional with edema.
Jaundice and spider naevi are present.
Mechanisms: hipoalbuminemia,
hyperaldosteronism.
Reduced liver aldosterone turnover.
PREGNANCY EDEMA
Moderate, white, soft, localised at the
inferior limbs, determined by
multiple factors:umoral, inferior vena
cava compression.
Generalised edema after the 20th
pregnancy
week+hypertension+proteinuria=pre
eclampsia, which can lead to
eclampsia=seizures, coma, death.
MIXEDEMA
Appears in severe hypethiroidism.
It is determined by infiltration of the
subcutatenous tissue with
mucopolyzaccharides.
The skin is thickened.
IATROGENIC EDEMA
EXCESSIVE WATER AND SODIUM
ADMINISTRATION.
CORTICOIDS.
ESTROGENS
Other drugs.
INFLAMMATORY EDEMA
Infection
Trauma
Burns.
Red,hot, painful, pit does not appear.
Quincke edema
VENOUS EDEMA
Superficial thrombophlebitis edema
Limphedema
Also called in severe cases
elphantiasis.
Cause: lymphatic obstruction.