Anasarca

Things to ask when obtaining history

Timing positional changes unilateral vs bilateral medication list Has this happened before Associated symptoms

Unilateral Chronic Le edema causes

Venous disease lymphedema

Unilateral ACUTE LE edema causes

DVT MSK injury lymph obstruction cellulitis venous insufficiency

Truly widespread edema causes

MC: CHF, Renal disease, Cirrhosis, pregnancy others: Neoplasm compressions vena cava, allergic reaction, malnutrition, Drugs

If placing patient on diuretics should you place foley cath?

No -try to avoid catheters at all costs -Consider condom cath or pure wick

Physical exam findings edema

Pitting vs non-pitting Acities Pulmonary edema Periorbital edema, scrotal edema JVD, distant heart sounds, liver boarder, peripheral muscle wasting

Medications that can cause edema include

Steroids Dihydropyridine CCBs Endrocrine modulators - steroids, estrogens Anticonvulsants Antidepressants Other: PPI, NSAIDs

Increased capillary permeability can be caused by

burns/trauma- histamine Inflammatory states- allergic, sepsis ARD- ischemic or sepsis Malnourished Diabetes

Edema in Peds- biliary causes

cirrhosis-wilson's, alpha 1 antripsin def, cystic fibrosis, biliary atresia, budd chiari

palpable swelling secondarily to expansion of interstitial fluid volume is called

edema

Pathophysiology of edema includes

elevation in capillary hydraulic pressure increased capillary permeability Lymphatic obstruction Hypoalbuminemia

Causes of refractory edema

incorrect diuretic dosing decreased GI absorption sodium reabsorbed eating lots of salt

When diruretics are given where is fluid lost

intravascular fluid -reduce venous pressure -reduce capillary hydraulic pressure

What is only life threatening form of edema that needs correction?

pulmonary edema

Physical exam findings for pulmonary edema

rales, hypoxia, tactile fremitis

Management of edema

treat underlying cause diuresis with loop diuretics-nephrotic syndrome needs high amount due to less functioning nephrons compression sodium restriction

Severe and generalized edema is called

Anasarca

Work up for EDEMa in ED may include

CBC CMP BNP PT/INR VBG- if respiratory problem Sepsis w/u urinalysis - protein, albumin EKG Imaging

Bilateral LE edema Acute

CHF, nephrotic syndrome, bilateral DVT, medication

Edema in Peds - Renal causes

Glomerulonephritis- post strep infection immune mediated- IGA nephropathy minimal change disease renal failure

Edema in Peds- cardiac

Heart Failure congenital heart disease

elevated capillary pressure can be caused by

Heart failure Renal Disease Pregnancy Venous obustrction/Insufficiency

What are some causes of non-pitting edema

lymphedema, myxedema