Edema

Nephrotic Syndrome

Usually glomerular process whereby massive protienuria exists Primary mechanism is diminished colloid oncotic pressure Less protein in blood (filtered out by kidneys) Fluid leaves vessels and enters tissues under oncotic pressure of solutes in tissues

Labs for Edema

UA/24 hour urine collection for protein, microalbumin in diabetics, serum albumin, LFTs, BrNP

Sx of renal edema

Uremia, decreased appetite, metallic or fishy sense of taste, altered mental status

Edema definition

palpable swelling produced by expansion of the interstitial fluid volume. When massive and generalized, the excess fluid accumulation is called anasarca.

When you see Edema think

Nephrotic syndrome Cirrhosis - decreased production of plasma proteins Protein losing enteropathy Myxedema, Anaphylaxis - angioneurotic edema Meds

Transudate

Non-inflammatory edema

Why edema for cirrhosis

Portal hypertension causes ascites - Generalized edema usually late after hypoalbuminemia (decreased protein in blood) occurs

Hydropericardium

- fluid in pericardial sac

Hydrothorax

Accumulation of excess fluid in chest cavity

Labs for renal edema

Albumninuria, hypoalbuminemia, sometimes elevated creatinine, hyperkalemia, metabolic acidosis, normocytic anemia

Signs of hepatic edema

Ascites, B/P lower than in renal or cardiac causes, can have jaundice, palmar erythema, asterixis (flapping hands)

Increased hydrostatic pressure can be caused by

CHF, Constrictive pericarditis Ascites (liver cirrhosis) Venous obstruction/compression (thrombosis, external pressure, inactivity/prolonged dependency), heat

Images for Edema

CXR, Echocardogram, U/S EKG

Drugs that can cause generalized edema

Ca+ channel blockers used for HTN, switch to an ACE inhibitor or ARB, IVP dye (iodine based)

Causes of Edema

Cardiac, Hepatic, Renal

REduced Plasma Osmotic Pressure - hypoproteinemia caused by

Cirrhosis, malnutrition, nephrotic syndrome

Labs for Hepatic edema

Decreased albumin, cholesterol Elevated liver enzymes

Dependent Edema what is it and Tx

Due to a failure of the valves in the veins and the blood pools in the veins. Less severe, goes away at night b/c legs up at night. Tx w/ compression stockings, restrict Na+, no diuretics b/c mechanical problem

Idiopathic cyclic edema

Edema that occurs on a relatively predictable cycle Possibly related to hormonal cycles, Normally female. Restrict Na+

Signs of renal edema

Elevated B/P, periorbital edema, pericardial friction rub in severe cases of uremia

Labs for cardiac edema

Elevated BUN/Creatinine ratio, decreased sodium, elevated uric acid, elevated BNP (secreted by ventricles w/ fluid overload)

Increased CAP Permeability/sodium retention

Excessive salt intake

Red flags for Edema

Excessive weight gain that doesn't go away at night

Four major causes of ademia

High Capillary Hydrostatic Pressure, . Loss of Plasma Proteins/Low Capillary Osmotic Pressure - caused by decreased plasma proteins from liver disease and malnutrition, lymphatic obstruction, increased CAP permeability

Exudate

Inflammatory edema

Signs of cardiac reasons for Edema

JVD, S3 gallop, displaced apical pulse, peripheral cyanosis, cool extremities

Ibprofen and Motrin hurt

Kidneys

Acetaminophen hurts

Liver

Brawny edema

Red, thickened skin w/ edema. Usually DM for PVD

PM edema that gets better over night

cardiac/dependent/cyclic

Unilateral edema why

mechanical obstruction of veins or lymphatics if limited to one extremity. Non pitting.

Anasarca

refers to extreme generalized edema (liver or renal failure and/or severe malnutrition/protein deficiency)

If edema is worse in the AM think

renal/hypoalbumin states

Facial edema think

renal/myxedema/allergic