Edema
cardiomyopathy
both right and left ventricles are affected causing swelling of both lungs and peripheral edema
fluid increase caused by heart disease usually
builds up in the lungs causing shortness of breath
left sided heart failure is caused by
coronary heart disease, hypertension or diseases of heart valves
the increased back pressure of the veins in varicose veins or thrombophlebitis forces
fluid to stay in the extremities
nephrotic syndrome
heavy loss of protein in the urine reducing albumin which triggers kidney the blood volume is low and to retain fluid
the fluid of ascites can be removed from the abdominal cavity by using syringe and a long needle called
paracentesis
non pitting edema usually effects
the legs or arms and does not result in persist indentation
anasarca is
the severe widespread accumulation of fluid in all the tissues and cavities at the same time
Acteazolamide
contracts the development of alkalosis
the lose of protein in the urine may be reduced by
ACE inhibitors and angiotensin receptor blockers both prompt kidneys to reduce the loss of proteins in urine
hypotension may be seen with the use of
ACE inhibitors especially if the patients is also taking diuretics
when pulmonary edema starts it also causes
accusation of fluid in legs causing pitting edema
Pitting edema
an indention that persist for some time after the release of pressure like elastic socks on the legs
diseases that impair kidney function the ability to excrete salt is limited conditions like this and heart failure
cause salt and water retention developing pitting edema
right sided heart failure is most often due to
chronic lung diseases which in severe cases cause ascites and hepatomegaly
with liver disease scaring of the liver occurs when scarring becomes advanced the condition is called
cirrhosis
chronic diuretic uses may develop
defenciacy in K. depletion of blood volume in BV kidney insufficiency or failure
In idiopathic edema giving diuretics does what
develop fluid retention as a rebound each time they discontinue diuretics
small side effects of chronic dirucetc use
diabetes, high uric acid(gout muscle crams and enlarged breast gynecomastia pancreatitis
venous insufficiency is incompetence because of
dilation or enlargement of the veins and dysfunction of their valves such as varicose veins
lymphedema
disturbance of the lymphatic circulation that may occur after mastectomy, lymph node surgery or congenitally
In patients with ascites without edema in cirrhosis
diuretics must be given with caution because if its too aggressive or rapid can lead to low blood volume
patients with impaired kidney function
do not require K supplements because damaged kidneys retain K
what is effective for non pitting edema of legs
elevation and compressive devices
ascites
excessive fluid that accumulates in the abdominal(peritoneal) cavity, it is a complication of cirrhosis
non pitting edema can be secondary to
increase in albumin content of the interstitial fluids
ascites develop because
increased pressure in the vein system that carries blood to stomach intestines, liver (portal hypertension) and because a low level of the protein albumin in the blood
Idiopathic edema
is pitting edema of unknown cause primarily in pre-menopausal women who do not have heart liver or kidney disease
albumin
is the predominant protein in the blood helping maintain blood volume is reduced in cirrhosis
idiopathic edema appear with
leaks in capillaries so fluid passes BV to the interstitial spaces which causes kidney to increase salt retention
people with idiopathic edema experience
leg edema exaggerated in standing position edema around the series periorbital emedam in the morning
impaired renal function
limitation of the kidney to excrete sodium into urine
Most potent directs are
loop diuretics furosemide tosemide bumetanide
accumulation of glycosaminoglycans with water retention cause what
non pitting edema
Diuretics used for non pitting edema of the legs are
not effective
Doctor looking at patient who has congestive heart failure with fluid retention look for
peripheral pitting edema, rale in the lungs moist crackle sounds, gallop rhythm three heart sounds, distended neck veins
why with venous insufficiency does diuretics usually not work
pooling of fluid in lower extremities make it difficult for diruetic to mobilize edema fluid
by adding a k sparing diuretic spironolactone, triamterene and amiloride may
preclude the patients need to take K supplements
the accumulation of solid materials is secondary to the
primary pathology
thiazide prevent the formation of kidney stones by
reducing urinary excretion of calcium
if blood flow to kidneys is decreased by conditions such as heart failure what do the kidneys do
retain salt
most medications that dilate blood vessels and reduce blood pressure except ace inhibitors and angiotensin receptor blockers lead to
secondary sat region by the kidneys
patients with left sided heart failure present to the doctor with
shortness of breath with exertion and when laying down Orthopnea which are caused by pulmonary edema
pretibal myxedema
swollen g over the shin in some patients with hyperthyroidism
when on loop and thiazide patients are advised to
take potassium supplements because the diuretics deplete K
edema most commonly occurs in
the feet and legs referred to as peripheral edema
people with impaired kidney function get edema when
the intake of sodium exceed the ability of the kidney
edema around the eyes does not tend to developing cardiac patients because
they keep their heads elevated at night because of shortness of breath when they lie flat
if one loop is not effective may be given with another that works more distal in tubule like
thiazide(hydrocholorthiazide) or metolazone
1+ for pitting edema
trace/ barley able to be seen 4+ when tissues are visibly swollen
patients with both edema and ascites
using diuretics is fine because the edema fluid in interstitial space serve as a buffer against low blood volume
the most common local conditions that cause pitting edema are
varicose veins and thrombophlebitis of the deep veins of the legs
