1. APPROACH TO A CASE OF ANASARCA
Presented By
Prof. Arvind Mishra
Department of Medicine

2. Anasarca Defined as gross generalised edema
Edema is defined as a clinically apparent increase in the interstitial fluid volume, which may expand by several liters before the abnormality is evident

3. Causes of anasarca Cardiac -cardiac failure, -pericardial effusion,
-constrictive pericarditis
Renal
-chronic renal failure
-nephrotic syndrome
Hepatic- cirrhosis

4. Malnutrition/malabsorption(i.e. celiac disease,crohn’s disease etc)
Drug-induced
Thyroid disorder

5. Clinical feature Puffiness of face Pedal edema(pitting/non-pitting)
Abdominal wall edema(by pressing with palm)
Sacral edema

6. STARLING FORCES IN SHIFTING THE FLUID IN DIFFERENT COMPARTMENTS
The hydrostatic pressure within the vascular system and the colloid oncotic pressure in the interstitial fluid tend to promote movement of fluid from the vascular to the extravascular space.
By contrast, the colloid oncotic pressure contributed by plasma proteins and the hydrostatic pressure within the interstitial fluid promote the movement of fluid into the vascular compartment.

7. Mechanism of anasarca Decreased plasma oncotic pressure
Lymphatic obstruction
Increased capillary permeability
Increased hydrostatic pressure

17. Drugs causing edema

18. HYPOTHYROIDISM

19. INVESTIGATIONS Serum protein & albumin Urine analysis -protein, sugar
-cast
Kidney function test
-s.urea
-s.creatinine

20. Liver function test
-SGOT/SGPT
-ALP
-S.bilirubin
Fecal fat estimation
-to rule out malabsorption
Thyroid function test
ECG and echocardiography
-LVEF
-Valvular lesion
-Regional wall motion abnormality

21. Treatment
Treatment of the underlying cause(cardiac, renal, hepatic, thyroid abnormality)
Stop and replace the drug causing edema
Diuretics
Restricting salt and fluid intake and monitoring input-output
Protein rich diet (in hypoalbuminemic state)

22. MCQs

23. 1)Causes of non pitting edema are all except a)Myxoedema b)Filariasis c)Angioneurotic edema d)Nephrotic syndrome

24. 2)Pattern of edema(Legs ->face ->ascitis) in the given manner occurs in a)Cirrhosis b)Cardiac failure c)Nephrotic syndrome e)Nutritional edema

25. 3)Drugs causing edema are all except a)Cilnidipine b)Hydralazine c)Amlodipine d)Clonidine

26. 4)Milroy’s disease refers to a)Absence of thymus b)Congenital hypoplasia of lymphatics c)Post mastectomy lymphedema of upper limb d)Chylous pleural effusion

27. 5)Angioneurotic edema is due to deficiency of a)C1 esterase inhibitor deficiency b) C5 convertase (C3bBbC3b) c)C1 esterase deficiency d) Factor H–related protein 1 (CFHR1)