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Edema Diagnosis and Management AAFP, July 15, 2013,volume 88, number 2 presented by Dr. Anne Zbaracki
Edema Accumulation of fluid in interstitial space due to capillary filtration exceeding lymph drainage
Edema Capillary hydrostatic pressure and oncotic pressure is regulated by fluid between interstitial and intravascular spaces Disruption in local or systemic conditions
Assessment History – Timing- acute, chronic – Position – Unilateral, bilateral – Medications – Systemic diseases
Assessment PE Focus on medial malleoulus, bony tibia, dorsum – Pitting – Tenderness – Skin changes-temperature, color, texture
Assessment Kaposi-Stemmer sign, in lymphedema
Assessment PE – Systemic causes Heart failure-jvd, crackles Renal-proteinuria, oligouria Hepatic-jaundice, ascities, asterixis Thyroid- exopthalmus, tremor, wt loss
Local Cellulitis Chronic venous insufficiency Compartment syndrome Complex regional pain syndrome type I DVT Iliac vein obstruction Lipedema Lymphedema primary or secondary May-Thurner syndrome
Systemic Allergic reaction, urticaria, angioedema Cardiac disease Hepatic disease Renal disease Malnutrition/malabsorption Obstructive sleep apnea Pregnancy, premenstrual
Cellulitis Increased capillary permeability
Chronic Venous insufficiency Increased capillary permeability from local venous hypertension treatment- compression, horse chest nut seed extract, skin care
Compartment Syndrome Increased capillary permeability from local venous hypertension
Complex regional pain syndrome type I Neurogenically mediated increased capillary permeability Treatment- systemic steriods, topical dimethyl sulfoxide, PT, tricyclic, ca++ blockers
Deep venous thrombosis Increased capillary permeability
Lipedema Accumulation of fluid in adipose tissue Treatment- none
Lymphedema Lymphatic obstruction
May-Thurner syndrome compression of left iliac vein by right iliac artery Increased capillary permeability from local venous hypertension from compression
Allergic reaction Increased capillary permeability Medications – Antidepressants- monoamine oxidase inhibitors, trazodone – Antihypertensives- b-blockers, calcium channel blockers, clonidine, hydralazine, methyldopa, minoxidil – Antivirals-acyclovir – Chemo- cyclophosphamide, cyclosporine, cytosine arabinoside, mithramycin – Hormones- androgen, corticosteriods, estrogen, progesterone, testoterone – Nsaids- celecoxib,ibuprofen – Diuretic- volume depletion and reflex renin angiotensin stimulation
Cardiac disease Increased capillary permeability from systemic venous hypertension, increased plasma volume
Hepatic disease Increased capillary permeability from systemic venous hypertension, decreased plasma oncotic pressure from reduced protein synthesis
Renal disease Increased plasma volume, decreased plasma oncotic pressure from protein loss
Malnutriton/ Malabsorption Decreased plasma oncotic pressure from reduced protein synthesis
Obstructive sleep apnea Increased capillary hydrostatic pressure from Pulmonary hypertension
Pregnancy Increased plasma volume
Diagnostic studies Labs-bnp, creatinine, urinalysis, lft’s, albumin, d-dimer Ankle-brachial index Ultrasonography- venous, compression w or w/o dopplar, duplex Lymphoscintigraphy- radionuclide MRI- w venography Echo-pulmonary arterial pressures
EDEMA PWM Olly Indrajani Edema = Increased fluid in the interstitial tissue spaces Anasarca: Generalized edema + profound subcutaneous swelling.
Oedema Caused by increasing capillary filtration: - Increased capillary hydrostatic pressure: - Decreased oncotic pressure - Increase capillary permeability.
APPROACH TO A CASE OF ANASARCA Presented By Prof. Arvind Mishra Department of Medicine.
Dr. Eman El Eter. Functions of capillaries Exchange between blood & tissues: Nutrients, Oxygen Drainage of waste products: tissues….to blood Capillary.
Edematous states & Diuretics. 2 basic steps in edema formation –Alteration in capillary haemodynamics that favors the movement of fluid from the vascular.
Cardinal Manifestation of Disease: EDEMA Dr. Meg-angela Christi Amores.
Leicester Warwick Medical School Tissue Fluid Formation and Oedema Dr. Kevin West Department of Pathology.
The physiology of edema.. Edema: The abnormal accumulation of fluid in a specific organ vs generalized. The abnormal accumulation of fluid in a specific.
Capillary Circulation & Edema Formation Dr. Eman El Eter.
60% of lean body weight = water (2/3) intracellular. (1/3)extracellular (interstitial fluid) 5% blood plasma. edema = an accumulation of interstitial.
Hemodynamic Disorders, Thrombosis & Shock Edema Hyperemia and Congestion Hemorrhage Hemostasis & Thrombosis Embolism Infarction Shock Edema Edema.
Interstitial Fluid Formation and Oedema By DR QAZI IMTIAZ RASOOL.
1 Fluid and Electrolyte Imbalances. 2 3 Body Fluid Compartments 2/3 (65%) of TBW is intracellular (ICF) 1/3 extracellular water –25 % interstitial fluid.
DIURETICS How do they work? What do they do? WHEN DO I USE THEM? How do I use them?
1 EDEMA PROF. DR. YESARİ KARTER % of total body weight is water - 50 % - Intracellular volume - 20 % - Interstitial volume - 5 % - Intravascular.
Glenda is a 48 year-old woman who presents to you (her GP) saying that her legs have been swollen for a month. On examination you find that she has.
Edema Excess fluid in the tissues Intracellular Edema Extracellular Edema.
ברקע: סכרת מסוג II, ידועה 20 שנה, אינה מאוזנת היטב מחלת לב איסכמית, עברה אוטם שריר הלב לפני 5 שנים עישון של חפיסת סיגריות ליום מזה 40 שנה בחודשים האחרונים.
Edema, Hyperemia and Congestion. Cardiovascular disease Most important cause of morbidity and mortality in developed nations In US, 81 million affected.
EDEMA Leyi Gu Renal Division, Renji Hospital. DEFINITION Expansion of the interstitial （间质） fluid volume. Weight gain precedes overt edema Massive and.
EVALUATION OF LOWER EXTREMITY SWELLING David Southwick DO Medical Director Wound Healing Center Union Hospital Terre Haute Indiana.
Dr Irfan Elahi Assistant Professor Nephrology (1hr) 12:30-1:30 pm.
Differentiate Pulmonary arterial hypertension from pulmonary venous congestion.
Monday, July 25 th, Diagnostic Evaluation COST Confirm the diagnosis Organize a diagnostic approach Determine the Severity of the HTN.
Lymphatic Disorders. References Therapeutic Exercise: Foundations and Techniques by Kisner and Colby. 5 th Edition, Pages Goodman and Snyder,
Lymphedema By Christina Hankins PT, CLT, CWS. Objective Identify form and function of circulatory and lymph systems Describe various factors that affect.
Hemodynamic Disorders د. بنان برهان محمد ماجستير / هستوباثولوجي.
Chronic Venous Insufficiency The Challenge of Edema S. Lakhanpal MD, FACS President & CEO Center for Vein Restoration.
Fluid and Hemodynamic Disorders Where’s my water? Intracellular Ions Ion specific gates in cell membrane Cellular proteins Extracellular Interstitial.
Compression 1. Effects of External Compression Improved Venous and Lymphatic Circulation Limits the Shape and Size of Tissue 2.
1 The Cellular Environment: Fluids and Electrolytes, Acids and Bases Chapter 3.
Complications of Fractures Non-union DVT Damage to Nerves and Blood Vessels Compartment Syndrome Fat Emboli Infection (Osteomyelitis)
CARDIAC FAILURE 1 TOPICS INTRODUCTION CAUSES LEFT HEART FAILURE RIGHT HEART FAILURE CONGESTIVE CARDIAC FAILURE DIAGNOSIS DYSPNOEA AGE EFFECTS HIGH OUTPUT.
An approach to a child with oedema Pushpa Raj Sharma Professor of Child Health Institute of Medicine.
Nephrotic syndrome. Nephrotic syndrome characterized by four components both clinical & biochemical *Generalized Oedema *Massive Proteinuria: above 1g/m.
ascites Pulmonary edema Edema Definition Pathogenesis Treatment.
EDEMA Xiaoqi XU Renal Divison, Renji Hospital, Shanghai Second Med.Univ. Basic Course of Diagnosis.
Disorders of water balance. Outline Introduction of water and sodium balance Edema Alterations in isotonic fluid volume isotonic fluid volume deficit.
Happy Year. Awatif Jamal, MD, MSc, FRCPC, FIAC Consultant & Associate Professor Department of Pathology King Abdulaziz University Hospital.
Cardiovascular Physiology Dr. Abdulhalim Serafi, MB ChB,MSc,PhD,FESC Assistant Professor & Consultant Cardiologist Faculty of Medicine Umm Al-Qura University.
Heart Failure, HF CHF develops when plasma volume increases and fluid accumulates in the lungs, abdominal organs (liver especially), and peripheral tissues.
Capillary Circulation & Edema Formation. Functions of capillaries.
Question 1 Which of the following is NOT true of the parasympathetic control of the heart? A. It affects muscarinic receptors. B. It decreases heart rate.
PULMONARY BLOOD FLOW CHAPTER 6 DR. CARLOS ORTIZ BIO-208.
Manual lymph drainage It is the treatment that encourages the lymph flow to decrease the plasma proteins contents in the interstitial spaces and therefore.
Case 1 49 yo male with hypertension on a potassium-sparing diuretic.
Nutrition & Diet Therapy, 7 th Edition Protein-, Mineral- & Fluid- Modified Diets for Kidney Diseases Chapter 23.
Hemodynamic Disorders. Fluid Distribution ~60% of lean body weight is water ~2/3 is intracellular ~1/3 is extracellular (mostly interstitial) ~5% of total.
LYMPHEDEMA, VENOUS STASIS AND THE IMPORTANCE OF COMPRESSION Timothy A. Hursh, MD Medical Director, Wound Care Kindred Hospital San Antonio.
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