Pathophysiology Edema Week 5
surrounding a wound
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Inflammatory response (Pathophysiologic Condition) The immune system draws fluid in and around an injury to send white blood cells and other immune mediators to fight any type of infection. (cause)
abdomen
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Liver disease (Pathophysiologic Condition) As the liver fails, elevated pressure in the portal vein of the liver circulation combined with reductions in protein causes movement of fluid into the abdomen causing ascites (edema). (cause)
ways to quantify the type, location, and amount of edema
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Physical Assessment of Edema Weight Radiograph (X-Ray) Laboratory Testing Ultrasound
Upper or lower extremities
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Removal of non-functioning lymph nodes(Pathophysiologic Condition) The lymph removes fluid and cells that have reached the end of their usefulness. When these lymph nodes which are located all over our bodies stop functioning or are removed, lymphedema occurs. (cause)
Generalized
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Renal disease (Pathophysiologic Condition) Failure of the kidneys can cause increased generalized edema as the kidneys are not able to eliminate any excess fluid that has already been metabolized. (cause)
Lymphatic Node Dysfunction
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) The lymphatic system is responsible for collecting, filtering, and removing used and extraneous material from the blood and tissues. If one or more of the lymph nodes are not able to collect these materials, they get caught in the interstitial areas, causing a type of edema called lymphedema.
Persistent edema
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) can eventually lead to skin breakdown and delayed wound healing. This is seen most often by venous stasis ulcers caused by venous insufficiency.
treatment of edema
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) correct the underlying cause -Strategies, like the administration of medications, are used to assist the body in removing excess fluid. Some medications used include diuretics. These medications cause a change in elimination patterns by moving more fluid into the urinary system for excretion. -increasing direct pressure externally on the area. For edema in the legs, this is done using compression stockings. Sometimes, flexible bandage wraps are used to compress the extremity. -Gravity is also used to treat edema. If someone has edema in the legs, then propping the legs up above the level of the heart will decrease leg swelling by moving excess fluid towards the heart and the dispersed fluid moves within the collateral circulation.
Location of Edema
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) lower extremities abdomen Location of Edema Upper or lower extremities Generalized
ascites
(Describe common renal disorders: causes, clinical manifestations, diagnostic tests, and treatments.) edema in the abdomen caused by liver failure; Edema may also be classified by the cause. For example
Pulmonary edema
(Describe common renal disorders: causes, clinical manifestations, diagnostic tests, and treatments.) inside the lung and is usually caused by heart failure
pleural effusion
(Describe common renal disorders: causes, clinical manifestations, diagnostic tests, and treatments.) edema under the lung usually caused by infection or cancer. Not all edema is visible in the body.
Older adults
(Examine responses to aging and its impact on pathophysiologic changes in the renal and digestive systems) more likely to experience edema. This is related to reduced kidney function with age and a lack of elasticity in veins and arteries. Older adults are also more likely to have conditions leading to increased edema. These can include vascular disease, venous insufficiency, heart disease, and electrolyte imbalances. Hormone imbalances can also lead to increased edema
signs or symptoms consistent with edema.
Weight gain, swollen ankles, and shortness of breath
Edema
Weight gain: An increase in fluid will cause an increase in weight. Swelling of lower extremities (pitting edema +3): Increased fluid in the intestinal compartment. There is usually a decrease in hematocrit. This decrease is related to increased fluid diluting the blood. There is usually a decrease in serum sodium.
Older adults
a history of heart failure ,high-sodium meals
Edema, or swelling
a potential sign of fluid imbalance. It can occur anywhere in the body due to a disruption of the homeostatic environment and/or underlying pathology.
Edema
accumulation of excess fluid in the interstitial spaces. Edema can be classified as generalized edema or localized edema. Generalized edema occurs all over the body and can include the arms, legs, trunk, torso, and face. Localized edema is specific to a body part or organ.
Environmental factors
can cause increased edema as well. Climate differences, including places with higher levels of heat, can cause venous dilation and increases in edema. Fluid replacement products that are ingested on hot days can sometimes contain increased sodium as well, which again increases edema. -Diet also plays a role, especially high levels of salt intake. In fact, one of the treatment strategies for high blood pressure is reducing salt in the diet.
Hydrostatic pressure
caused by an increase in force exerting pressure on the wall of the vessel. This can occur with increases in blood pressure or blockages.
Osmotic pressure
caused when there is a change in concentration between one fluid and another, causing diffusion (the movement of fluid from a high concentration to a lower one).
An increase in permeability
change in the wall of a membrane to allow more material to pass through it.
Excessive sodium levels
in the extracellular fluid promote accumulation of fluid in the interstitial compartment. This happens because of increasing osmotic pressure. Blood pressure is usually elevated, too.
Cause of Edema
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments) Due to low blood albumin, fluid moves out of the vascular space and enters into the interstitial space causing edema.
Change in Osmotic Pressure
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Change in osmotic pressure occurs when the concentration of the blood or interstitial fluid changes. The difference in the concentration or the osmolarity affects osmotic fluid shifts between compartments, including the cell.
Signs and Symptoms of Edema
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Excess fluid retained in tissues Localized swelling (feet, hands, periorbital area, ascites) Pale, gray, or red skin color Weight gain Slow, bounding pulse, high blood pressure Pulmonary congestion, cough, and rales Laboratory values:Decreased hematocritDecreased serum sodiumUrine: low specific gravity, high volume Pitting edema: Applying pressure to the swollen area causes an indentation that persists for some time.
lower extremities
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Heart failure, blood clot (Pathophysiologic Condition) The decreased circulatory pressure caused by a failing heart or vascular blockage leads to increased pressure in the venous system. This intravascular pressure pushes fluid into the interstitial spaces and gravity causes that fluid to settle in the feet and legs.(cause)
four causes of edema
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Increased Vascular Permeability Increased Hydrostatic Pressure Change in Osmotic Pressure Lymphatic Node Dysfunction
Increased Hydrostatic Pressure
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Increased hydrostatic pressure occurs when there is a blockage or backup in the vascular system, causing increased pressure against the vessel walls and the movement of fluid into interstitial spaces.
Increased Vascular Permeability
(Compare and contrast common renal conditions: causes, clinical manifestations, diagnostic tests, and treatments.) Increased vascular permeability occurs when chemicals and proteins change the size of the vessel walls to allow fluid to travel into or out of the vascular system. This is seen in an immune response when the body needs to get white blood cells and other materials to the site of a wound.
Cause of Edema
Edema related to the loss of plasma proteins, particularly albumin, results in a decrease in plasma osmotic pressure. Plasma proteins remain inside the capillary and seldom move through the semipermeable capillary membrane. The presence of fewer plasma proteins in the capillary allows more fluid to leave the capillary and less fluid to return to the venous end of the capillary. -Water increases edema, -cortisol causes edema and fluid retention -Histamines increase edema through inflammatory response.
Causes of Edema
Remember: "The leak of veins" THE: Tumor Heart failure Enteropathy (protein-losing) LEAK: Liver failure Endocrine (hypothyroidism, aldosterones, diabetes) Altitude sickness Kidney disease (renal failure, nephrotic syndrome) OF: Obstruction of lymphatics Filariasis VEINS: Venous thrombosis Eclampsia/pregnancy Iatrogenic Nutritional deficiency Sepsis/capillary leakages
