Edema

Edema may be generalized or local (e. For example, only in a limb or part of a limb). They sometimes occur abruptly. Patients complain that a limb swells suddenly. More frequently edema develop gradually, starting with weight gain, swollen eyes at the morning awakening and tight shoes at the end of day. Slowly developing edema can grow massively before patients seek medical attention.

Edema is a swelling of the soft tissue by increased Insterstitialflüssigkeit. The liquid is predominantly water, but liquid rich in proteins and cells can accumulate when an infection or lymphatic obstruction is present. Edema may be generalized or local (e. For example, only in a limb or part of a limb). They sometimes occur abruptly. Patients complain that a limb swells suddenly. More frequently edema develop gradually, starting with weight gain, swollen eyes at the morning awakening and tight shoes at the end of day. Slowly developing edema can grow massively before patients seek medical attention. Edema of the lower extremities Peter Skinner / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: ‘/-/media/manual/professional/images/c0271080-lower-extremity-edema-science-photo-library-high_de.jpg?la=de&thn= 0 & mw = 350 ‘, imageUrl’ /-/media/manual/professional/images/c0271080-lower-extremity-edema-science-photo-library-high_de.jpg?la=de&thn=0 ‘, title:’ edema of lower extremities’ description: ” credits’ Peter Skinner / SCIENCE PHOTO LIBRARY ‘, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); Edema caused itself apart from occasional narrower or feeling of fullness few symptoms. Other symptoms can be attributed to the underlying disease usually. Patients with edema due to congestive heart failure (a common cause) often exhibit dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea. Patients with edema due to deep vein thrombosis (DVT) often have pain. Edema due to expansion of extracellular fluid volume is often dependent on position. Thus edema occur in ambulatory patients in the feet and lower legs. Patients who require bed rest, develop edema on the buttocks, on the genitals and the posterior thighs. Women lying on one side only can develop edema in the dependent breast. Lymphatic obstruction caused edema distal to the site of obstruction. Scrotal edema DR P. MARAZZI / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: ‘/-/media/manual/professional/images/c0263329-scrotal-edema-science-photo-library-high_de.jpg?la=de&thn=0&mw = 350 ‘, imageUrl’ /-/media/manual/professional/images/c0263329-scrotal-edema-science-photo-library-high_de.jpg?la=de&thn=0 ‘, title:’ Scrotal edema ‘, description ” credits ‘DR P. MARAZZI / SCIENCE PHOTO LIBRARY’, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); Pathophysiology edema resulting from increased fluid movement from the intravascular to the interstitial space or reduced water movement from interstitial space into the capillaries or lymphatics. The mechanism comprises one or more of the following properties: increased hydrostatic pressure in the capillaries Decreased oncotic pressure in the plasma increased capillary permeability obstruction of the lymphatic system, when liquid moves in the interstitial, intravascular volume is reduced. The intravascular volume depletion activates the renin-angiotensin-aldosterone Vaspressin-ADH-system, resulting in renal sodium retention. By increasing the osmolality of the renal sodium retention triggers a water retention by the kidneys and helps maintain plasma volume. An increased renal sodium retention can also be a primary cause of fluid overload and thus edema. Excessive exogenous sodium intake can also help. Less often result from edema reduced fluid movement from the interstitial space into the capillaries due to lack of adequate oncotic pressure in the plasma as in nephrotic syndrome, protein-losing enteropathy, liver failure or in starvation. Increased capillary permeability occurs with infections or as a result of toxin or inflammatory damage to the vessel walls. The lymphatic system is responsible for the removal of protein and leukocytes (along with some water) from the interstitial space. Lymphatic obstruction allows these substances to accumulate in the interstitial space. Etiology generalized edema are usually caused by heart failure, hepatic insufficiency, renal diseases (particularly, nephrotic syndrome) localized edema are usually caused by DVT or other venous disease or venous obstruction (eg., By tumors) infection angioedema Lymphatic obstruction Chronic venous insufficiency may one or both legs affect. Common causes are after primary mechanism See table: Some causes of edema listed. Some causes of edema Cause Suggestive Findings Diagnostic Approach * Increased hydrostatic pressure, fluid overload right heart failure (primary or secondary to left-sided disease or to a constrictive pericarditis), which increases the venous pressure directly. Symmetrical, dependent, painless, crushable dellige edema, often usually echocardiography pregnancy and premenstrual state seen with exertional, orthopnea and paroxysmal nocturnal dyspnea Frequently Lungenknistern, S3 or S4Galopp or both, and jugular venous expansion hepatojugulärer reflux and Kussmaul sign chest x-ray and ECG through history clinical evaluation substances (eg. as minoxidil, NSAIDs, estrogens, fludrocortisone, dihydropyridine, diltiazem, other calcium channel blockers) Symmetrical, dependent, painless, easily crushable usually dellige edema Clinical evaluation Iatrogenic (eg. B. excessive infusions) through medical history and medical history can be seen Clinical Evaluation Increased hydrostatic pressure, venous obstruction TVT Acute scarred edema in a single, lower usually limb, usually with pain; sometimes Homans sign (pain in the calf when the foot is dorsiflexed) redness, warmth and tenderness; may be less marked than in soft tissue infection Sometimes a predisposing factor (z. B. recent surgery, injury, immobilization, hormone replacement therapy, cancer) ultrasonography Chronic venous insufficiency Chronic edema in one or both lower extremities, with a brownish discoloration, discomfort, but no severe pain and sometimes skin ulcers often associated with varicose veins Clinical evaluation Extrinsic venous compression (by tumor, a pregnant uterus or marked abdominal obesity) Not painful, slowly developing edema If a tumor the superior vena cava zusammend moves, usually face congestion, stretched neck veins and lack of venous pulse waves over the obstruction Clinical evaluation sonography or CT when tumor is suspected Extended absence of skeletal muscle pump activity (in Extremitätvenen Longer immobility z. B. or bed lay driven a long flight) Painless, balanced, dependent edema Clinical evaluation Decreased oncotic pressure in the plasma † nephrotic syndrome Diffuse edema, often considerable ascites and sometimes periorbital edema 24-hour urine collection for testing for protein loss Proteinporbe from plasma protein-losing enteropathy Significant diarrhea cause tests Reduced albumin synthesis (eg. as in liver Erkrankunge n or malnutrition), often with considerable ascites causes often visible by history If the cause of chronic liver disease is often jaundice, spider nevi, gynecomastia, testicular atrophy and Palmarerytheme. I albumin. S., liver function tests, PT / PTT Increased Kapillarenpermeabilität angioedema (allergic, idiopathic, hereditary) Sudden, focal, asymmetrical, non-dependent, pink or flesh-colored edema that are sometimes unpleasant Clinical Evaluation injury (eg. As burns, chemicals, toxins , blunt trauma) (through history seen Clinical assessment Severe sepsis caused vascular endothelial leakage) obvious sepsis S yndrom with fever, tachycardia, focal infection Painless, symmetrical edema cultures If necessary, imaging studies soft tissue infection (eg. As cellulitis, necrotizing Myofasciitis) If due to cellulitis, usually redder and more painful and druckdolenter as if due to angioedema and more circumscribed than if due to TVT with necrotizing infections, severe pain, constitutional symptoms Clinical evaluation cultures Sometimes ultrasonography to rule out DVT Lymphatic Iatrogenic obstruction (z. B. by lymph node dissection in cancer surgery or radiation therapy) etiology usually by history seen First crushable, dellige edema, Clinical with later developing fibrosis Rating Congenital (rare) often onset in childhood, but some types only later onset Can familinbedingt seinl Sometimes lymphoscintigraphy Lymphatic filariasis history of residence in an endemic area in a developing country usually focal edema, sometimes the genitals on Microscopic examination of blood smear * Most patients with generalized edema require complete blood count, electrolytes, urea, creatinine, liver function tests, protein measurement i. S., and urine analysis (to check for proteinuria). † Decreased oncotic pressure in the plasma often triggers secondary sodium and water retention, which lead to fluid overload DVT = deep vein thrombosis; S3 = 3. Heartbeat; S4 =. 4 Heartbeat. Assessment history The history of the present illness should include the location and duration of edema and the presence and extent of pain or discomfort. Female patients should be asked if they are pregnant and whether the edema with the menstrual cycle seems to hang together. It is helpful to have patients with chronic edema a log of weight gain and loss result. The review of systems should cover the symptoms of causing disease, including exertional, orthopnea and paroxysmal nocturnal dyspnea (heart failure); Alcohol and Hapatotoxingebrauch, jaundice and slight bruising (liver disease); Nausea and anorexia (cancer or liver or kidney disease); and immobilization, limb injury or recent surgery (TVT). The history should include any disorder which is known to cause edema, including heart, liver and kidney disease and cancer (including all operations associated or radiotherapy). The history should include predisposing conditions for these causes, including streptococcal infection, recent viral infection (eg., Hepatitis), chronic alcohol abuse and hypercoagulable disorders. The substance history should include specific questions about substances, which are known to cause edema (see table: Some causes of edema). Patients will be asked about the amount of sodium that used in cooking and on the dining table wird.Körperliche investigation The Ödembereich is identified and tested for degree heat, redness and tenderness. Symmetry or lack of it is recorded. Presence and extent of pitting (visible and palpable depressions caused by the finger of the examiner on the edematous area, which displaces the interstitial fluid) are noted. In the general study, the skin on jaundice, bruising and Spinnennävi is (which is a liver disease suggests) was investigated. The lungs are on dullness at percussion, reduced or exaggerated breath sounds, crackles, rhonchi and pleural friction noise tested. Height, wave shape and the jugular vein reflux are noted. The heart is sensed on whirring, pushing, lifting and parasternalen asynchronous abnormal systolic bulge. A loud pulmonary auscultation on components of the second (P2), 3. (S3) or 4 (S4) heart sounds, sounds, and pericardial or -klopfen made. All suggest a cardiac origin. The abdomen is inspected, touched and tapped on ascites, hepatomegaly and splenomegaly, to check for liver disease or heart failure. The kidneys are palpated and tapped the bladder. If an abnormal abdominal mass is present, it should be handled werden.Warnzeichen Certain findings resolve the suspicion of seriously the etiology of edema from: Sudden onset Significant pain shortness history of heart disease or an abnormal Herzexamination hemoptysis, dyspnea or pleural friction noise hepatomegaly, jaundice, ascites, splenomegaly or hematemesis Unilateral leg swelling with tenderness interpretation of the findings a potential danger to life, which typically manifests itself with a sudden onset of a focal edema must be identified. Such a presentation suggests acute DVT, soft tissue infection or angioedema. Acute DVT can lead to pulmonary embolism (PE), which can be fatal. Soft tissue infections range depending on the infecting organism and the patient’s health from mild to life-threatening. Acute angioedema progresses sometimes continue to infest the air, which has serious consequences. Dyspnea with edema can for heart failure, TVT, provided LE occurred, acute respiratory distress syndrome or angioedema that affects the respiratory system, may occur. Generalized, slowly developing edema suggest a chronic heart, kidney or liver disease. Although these diseases can also be life-threatening, complications tend to develop more slowly. These factors and other clinical features help to lay the cause close (see table: Some causes of edema) .Tests In most patients with generalized edema, the tests should have a complete blood count, electrolytes i. S., BUN, creatinine, liver function tests, protein i. S. and urine analysis (in particular for detecting the presence of proteins and microscopic hematuria) include. Other tests should be based on the suspected cause (see Table: Some causes of edema) – z. B. brain-natriuretic peeptid (BNP) in case of suspected heart failure, or D-dimer in suspected pulmonary embolism. In patients with isolated swelling of the lower extremities venous obstruction should be excluded by sonography usually. Treatment Specific causes are treated. Patients with sodium retention often benefit from a sodium restriction in diet. Patients with heart failure should eliminate salt in cooking and at the dinner table and avoid ready meals with added salt. Patients with advanced cirrhosis or nephrotic syndrome usually require a more significant restriction of sodium intake (?1 g / day). Potassium salts are often used in place of sodium salts to achieve a better acceptance of sodium restriction. Caution is advised, particularly with concomitant use of potassium-sparing diuretics, ACE inhibitors or angiotensin receptor blockers and in patients with kidney disease because it can cause potentially fatal hyperkalemia. People with conditions that include a Natriumetention can also benefit from grinding or thiazide diuretics. However, diuretics should be given not only to improve the appearance caused by edema. If diuretics are used, a strong loss of potassium in some patients can be dangerous. Potassium-sparing diuretics (eg., Amiloride, triamterene, spironolactone, eplerenone) inhibit the sodium re in the distal nephron and in the headers. When used alone, they increase sodium excretion in a moderate degree. Both triamterene and amiloride have been combined with a thiazide in order to avoid loss of potassium. An ACE inhibitor-thiazide combination also reduced potassium loss. Important geriatric aspects, the use of drugs that treat the causes of edema, requires in the elderly special care, such as the following: starting doses are low and patients are fully evaluated when the dose is changed monitoring of orthostatic hypotension when diuretics, ACE inhibitors, angiotensin receptor blockers, or beta blockers are used analysis of bradycardia or atrioventricular block when digoxin, conduction time reducing calcium channel blockers or beta blockers are used Frequent testing for hypokalemia or hyperkalemia No stop the calcium channel blocker because of foot edema, which is benign a daily log of weight helps immensely in the observation of clinical improvement or deterioration. Summary edema may result from generalized or local processes. The main causes of generalized edema are chronic heart, liver and kidney disease. A sudden onset should initiate a rapid evaluation. Edema can occur anywhere in the body, including the brain. Not all are harmful edema. The consequences depend primarily on the cause.

Health Life Media Team

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