Oedema

Question 1

What are some important cardinal features to ask about regarding oedema?

Answer 1

• Site
• Quality
• Onset/Time
• Severity
• Context
• R/A Factors
• Associated features

Question 2

What are some considerations when looking at oedema for Site?

Answer 2

• where?
• One limb/two?
• moving?
• Changing?
• use a pen to demarkate borders?

Question 3

What are some considerations when looking at oedema for Quality?

Answer 3

• pitting?

Question 4

What are some considerations when looking at oedema for Onset?

Answer 4

Fast/slow?

Question 5

What are some considerations when looking at oedema for Time Course?

Answer 5

• sudden: could be DVT, anaphylaxis

- Slow: could be HF; renal failure

Question 6

What are some considerations when looking at oedema for Severity?

Answer 6

• how much?

- how bad is it?

Question 7

What are some considerations when looking at oedema for Relieving/Aggravating factors?

Answer 7

• putting it up? lying down?

- Standing?

Question 8

What are some considerations when looking at oedema for Context?

Answer 8

• could indicate MI? anaphylaxis? HF? etc.

Question 9

What are some considerations when looking at oedema for Associated Features?

Answer 9

HF: dyspnoea, fatigue, orthopnoea, paoxysmal nocturnal dyspnoea
DVT: pain (chest pain) - one leg not two

Question 10

What are some of the mechanisms of oedema?

Answer 10

• increased hydrostatic pressure due to extra fluid/no venous return –> HF
• decreased oncotic pressure because of decreased blood proteins –> cirrhosis
• increased capillary permeability –> allergy, anaphylaxis, septic shock
• obstruction of lypahtics –> lymphoedema (can be caused by lymph removal or parasitic infiltration)

Question 11

What are some typical locations of oedema?

Answer 11

• lower limbs –> volume overload ie. HF
• unilateral leg –> DVT
• generalised –> increased capillary permeability

Question 12

Explain the water within the body?

Answer 12

• the body’s water is comaprtmentalised into intracellular water (2/3 total) and extracellular water (1/3)
• extracellular water is then compartmentalised into plasma and interstitial fluid.
• capillary walls allow small amounts of fluid to cross from plasma to interstitium so that oxygen and nutrients can be transported for metabolism.
• the lymphatic system then returns that water.

Question 13

What elements control the distribution of fluid between the plasma and interstitium?

Answer 13

• permeability of capillary walls

- balance between osmotic and hydrostatic pressure (Starling)

Question 14

What is oedema?

Answer 14

• accumulation of fluid in the interstitial space between cells.

Question 15

What is oedema?

Answer 15

• accumulation of fluid in the interstitial space between cells.

Question 16

What does pitting generally suggest about oedema?

Answer 16

Pitting suggests that increased capillary permeability

Question 17

What strategy should you employ if a patient reports two symptoms with their presenting problem?

Answer 17

Characterise each symptom separately but be sure to find out how they relate to each other