Edema

Question 1

Edema defined as; types? Give some examples

Answer 1

palpable swelling made by expansion of the interstitial fluid volume;
diffuse vs. localized;
pitting edema of the legs, DVT in one leg, anasarca (ascites in abdomen), angioedema; also brawny stasis edema seen in maybe varicose veins

Question 2

Edema formation sees capillary hemodynamics favoring

Answer 2

movement of fluid from vascular space into interstitium; you see retention of dietary or IV administered Na and water by kidneys

Question 3

Does hemoconcentration and shock occur with fluid entering interstitium?

Answer 3

No: kidney responds by retaining Na and water, and some fluid stays in the vascular space; most fluid enters interstitium but enough stays in plasma

Question 4

5 examples of edema pathophys:

Answer 4

1. Increased cap hydraulic pressure (increased venous pressure by blood volume EXPANSION with heart failure, renal disease, cirrhosis, pregnancy, or VENOUS OBSTRUCTION like cirrhosis and DVT)
2. Decreased plasma oncotic pressure (hypoalbuminemia, nephrotic sndrome, decreased albumin synthesis in liver failure)
3. Increased capillary perm: burns, ARDS, angioedema
4. Lymphatic obstruction (lymphedema)
5. Hypothyroidism leads to accumulation of interstitial albumin and low lymphatic flow

Question 5

Compensatory factors to help prevent edema?

Answer 5

1. lymphatic flow and contractility increase with tissue edema and remove some excess filtrate
2. interstitial hydraulic pressure raised, reducing pressure gradient favoring filtration
3. fluid entry into interstitium lowers interstitial oncotic pressure, by dilution and lymphatic mediated removal of interstitial proteins

Question 6

Big time causes of generalized edema?

Answer 6

Focus on heart failure, cirrhosis, nephrotic syndrome and other renals diseases; minor preg and anemia

Question 7

If edema is intermittent, think; what can be seen in liver disease? What meds could lead to edema?

Answer 7

premenstrual;
papal sign and spider telangiectasia (from micronodular cirrhosis);
Ca channel blockers

Question 8

Things to look for on PE:

Answer 8

General appearance: anasarca, visible edema, evidence of malnutrition;
HEENT: orbital edema, thyroid disease like goiter?
Cardiovascular exam: HR, diaphoretic, S3 gallop, heart murmurs, JVD
Pulmonary: crackles, wheezing
Abdo exam: Ascites, asterixis, cirrhosis, portal HTN, HSM
Extremities: look for unilateral vs. bilateral edema, peripheral pulses, pitting pedeal edema vs. nonpitting (pretibial myxedema or thyroid edema), venous insufficiency or stasis dermatitis

Question 9

For unilateral/localized edema, look at

Answer 9

angioedema, urticaria, cellulitis (blistering, erythema, warmth);
entire limb: acute unilateral limb edema look for DVT

Question 10

For bilateral/generalized,

Answer 10

1. Look at above
2. Review meds (Ca channel blocker?)
3. Order CBC, CMP, UA, oximetry
4. CXR, EKG, echo;
   if none of the usual culprits, do leg elevation and compression stockings for venous insufficiency, but if the usual (cardiac, hepatic, renal disease), give diuretics but not too much

Question 11

When must edema be treated? How should edema fluid be removed?

Answer 11

Do this for L-sided heart failure, especially if S3 gallop is heard;
remove fluid at pace that won’t cause other med problems in patient

Question 12

Only form of generalized edema that is life-threatening? What diuretic is used first?

Answer 12

Pulmonary edema!!!

Loop diuretic like furosemide!!!