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Edema Diagnosis and Management AAFP, July 15, 2013,volume 88, number 2 presented by Dr. Anne Zbaracki.

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Presentation on theme: "Edema Diagnosis and Management AAFP, July 15, 2013,volume 88, number 2 presented by Dr. Anne Zbaracki."— Presentation transcript:

1 Edema Diagnosis and Management AAFP, July 15, 2013,volume 88, number 2 presented by Dr. Anne Zbaracki

2 Edema Accumulation of fluid in interstitial space due to capillary filtration exceeding lymph drainage

3 Edema Capillary hydrostatic pressure and oncotic pressure is regulated by fluid between interstitial and intravascular spaces Disruption in local or systemic conditions

4 Assessment History – Timing- acute, chronic – Position – Unilateral, bilateral – Medications – Systemic diseases

5 Assessment PE Focus on medial malleoulus, bony tibia, dorsum – Pitting – Tenderness – Skin changes-temperature, color, texture

6 Assessment Kaposi-Stemmer sign, in lymphedema

7 Assessment PE – Systemic causes Heart failure-jvd, crackles Renal-proteinuria, oligouria Hepatic-jaundice, ascities, asterixis Thyroid- exopthalmus, tremor, wt loss

8 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

9 Systemic Allergic reaction, urticaria, angioedema Cardiac disease Hepatic disease Renal disease Malnutrition/malabsorption Obstructive sleep apnea Pregnancy, premenstrual

10 Cellulitis Increased capillary permeability

11 Chronic Venous insufficiency Increased capillary permeability from local venous hypertension treatment- compression, horse chest nut seed extract, skin care

12 Compartment Syndrome Increased capillary permeability from local venous hypertension

13 Complex regional pain syndrome type I Neurogenically mediated increased capillary permeability Treatment- systemic steriods, topical dimethyl sulfoxide, PT, tricyclic, ca++ blockers

14 Deep venous thrombosis Increased capillary permeability

15 Lipedema Accumulation of fluid in adipose tissue Treatment- none

16 Lymphedema Lymphatic obstruction

17 May-Thurner syndrome compression of left iliac vein by right iliac artery Increased capillary permeability from local venous hypertension from compression

18 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

19 Cardiac disease Increased capillary permeability from systemic venous hypertension, increased plasma volume

20 Hepatic disease Increased capillary permeability from systemic venous hypertension, decreased plasma oncotic pressure from reduced protein synthesis

21 Renal disease Increased plasma volume, decreased plasma oncotic pressure from protein loss

22 Malnutriton/ Malabsorption Decreased plasma oncotic pressure from reduced protein synthesis

23 Obstructive sleep apnea Increased capillary hydrostatic pressure from Pulmonary hypertension

24 Pregnancy Increased plasma volume

25 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


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