common symptoms---fever and edema
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Common Symptoms---Fever and Edema
The First Affiliated Hospital of Liaoning Medical College
Nephropathy Deparment
Zhou HongLi
Fever
1 Introduction
2 Pathlogeny and sort
3 Occurrence Mechanism
4 Clinical occurrence
5 Patterns of fever
6 FUO
Intruduction
1 normal rang: 36-37℃2 higher: late afternoon, evening
maximum 8:00-10:00 pm
lower: morning
minimum 3:00-4:00 am
3measure pathway : rectum (higher 0.3-0.5)
mouth
axillia (lower 0.2-0.4)
Pathlogeny and sort
1 Infective fever-------most common cause
①bacterial
②viral
③rickettsial
④fungal
⑤parasitic
Pathlogeny and sort
2 Noninfective fever
①aseptic necrosis mass absorption : tissue ischemia and infarction,vascularitis, subarachnoid hemorrage
②antigen-antibody reaction: acute rheumatic fever, still disease ,serum sickness, systemic lupus erythematosus
③familal fever: congenital familial mediterranean fever
④endocrine disease: endocrine hyperthyroidism
⑤tissue damage:myocardial infarction, pullmonary infarction
⑥drug reaction and gout
⑦tumor: lymphomas,solid tumors
⑧neuroleptic seizures
⑨psychosocial factitious
Occurrence Mechanism
physiologic temperature elevated----fever
(elevation of hypothalamic set point)
Pathologic temperature elevated-- hyperthermia
( unregulated heat generation, impaired heat exchange)
Occurrence Mechanism--physiologic
set point (hypothalamus)
Internal temperature
cellular function
regulate
maintain
Deviation >4 ℃
cellular dysfunction
Occurrence Mechanism
increased heat production
decreased heat dissipation
failure of regulating system
Temperature deviation
fever
Set point change
exogenous pyrogen (bacterial, viral)
neutrophil, eosinophil, mononuclear macrophage
activate
endogenous pyrogen(interleukin-1(IL-1),TNF, interferon )
release
hypothalamus Set point
fever
heat production heat dissipation
Occurrence Mechanism
Specific patients: elderly patients renal failure patients high doses of corticosteriods
immunocompromised hosts fever HIV-infected fever nosocomial fever
unable to mount fever
require special consideration
Clinical occurrence
Grade
(oral reading)
low-grade fever:37.3-38℃
middle-grade fever:38.1-39℃
high-grade fever:39.1-41℃
hyperthemia: 41℃℃
Clinical occurrence
clinical features
effervescence ( heat production ,heat loss )
(chill,rigor,vasoconstriction) altithermal (reach new set point)
(warm,moist,flushed,tarchycardia)defervescence (heat production heat loss ) sweat
Patterns of fever
Continuous fever Remittent fever Intermittent fever Undulant fever Relapsing fever Episodic fever Pel-Epstein fever
Continuous fever
①temperature: 39-40 ,days or weeks;diurnal variati℃on 0.5-1.0 ℃
②disease: typhoid, acute pneumonia
Continuous fever
Remittent fever
①temperature > 38 , diurnal variation℃ > 2 ℃ ( no normal temeratrue )
②disease: sapraemia,acute rheumatic fever,
acute infectious endocarditis
Remittent fever
Intermittent fever
① suddenly reach climax, continue several hours, suddenly fall to normal, intermission 1-several days
②disease: malaria, acute pyelonephritis
Intermittent fever
Undulant fever
①slowly reach > 39 ,℃ slowly return to normal. (repeate the rhythm)
②disease: brucellosis,tumor
Undulant fever
Relapsing fever
①suddenly reach 39 ℃ , continue several days, suddenly drop to normal. bout every 5-7days
②disease: spirochetes infection
Relapsing fever
Episodic fever
①last for days or longer, then without fever for at least 2 weeks
②disease: familial periodic fever
Pel-Epstein fever
①continuous or remittent fever bouts several days
②disease: Hodgkin disease
FUO—fever of unknown origin
Diagnosis criteria:①the illness last at least 3 weeks;
②38.3 ℃ repeatedly;③no diagnosis after 1 week hospitalizationCauses:①noninfectious inflammatory disease;②infections;③malignancies (hematologic);④50% unexplained
Edema
PathophysiologyClinical occurrenceIdiopathic edemaTropical edemaangioedema
Pathophysiology hydrostatic and oncotic pressure
A Vfluid fluid
interstitial tissues
Keep in balance
filter out
resorption
equilibrating factors
capillary hydrostatic pressure
interstitial fluid colloid osmotic pressure
serum colloid osmotic pressure
interstitial tissues pressure
filtration
resorption
Filtration > resorption edema
Factors leading to edema
retention of sodium and water capillary filtration pressure ( right heart failure ) capillary permeability ( acute nephritis ) serum colloid osmotic pressure (serum albumin ) lymphatic return disturbance (filariasis)
pitting edema detectable:4.5kg fluid accumulate
identify method :
press thumb into the skin against a bony surface (anterior tibia, fibula,dorsum of foot, sacrum) to demonstrate the presence of edema. when the thumb is withdrawn, an indention persist for a short time.
Site of edema:
walking patient--feet, ankles supine patient--posterior calves, sacrum
both legs and symmetric—in the pelvis or more proximally
arms and head---superior vena cava limited one extremity-vascular channels, local
inflammation
gravity
Brawny edema:
chronic edema of the legs leads to fibrosis of the subcutaneous tissues and skin, so they no longer pit on pressure.
Clinical occurrence
Localized edema cause: local vein or lymphatic return,soft tiss
ues disturbance or capillary permeability disease: Inflammation infection
insufficiency of the venous valves
chemical or physical injuries
arteriovenous fistulas
site: above the diaphragm--superior vena cava obstruction
below the diaphragm—jugular venous press ,portal vein hypertension, loss of venous tone drugs
Generalized edema: cardiac edema renal edema hepatic edema nutritional edema (protein losing conditions) Drug (corticosteroid, NSAID) Systemic inflammatory response syndrome(SIRS)
Cardic edema
Symptoms: chest distress, short breath, dyspnea
Site: lower limbs Disease : right heart failure
renal edema
Symptoms : hematuria , proteinuria Site: eyelid , legs Disease: nephrotic syndrome
hepatic edema
Symptoms: anorexia, vomitting,liver function test abnormal
Site: first lower limbs, then spread all over the body, ascites is most common
Disease : cirrhosis, chronic liver disease
Protein losing conditions
Enteropathy Burns fistulas
Idiopathic edema
women in 30-50years old without disease,affective disorders and obesity may coexist
Mechanism :upright posture --capillary leakage
inappropriate chronic diuretic administration
-----peripheral edemaactivate
hormones involved in salt and water retention
Tropical edema
Normal adults condition:48h after traveled from temperate cli
mate to tropics or from cool and dry to warm and humid
resolve quickly in a few days of acclimatization
Angioedema
Site: face,lips,tongue, larynx----life-threateningSubcutaneous soft-tissue edema ;Erythema is not prominent.
Causes: hereditary absence of C1 esterase exposure to allergen angiotensin-converting enzyme inhibitors
1Reasons of infective fever
2Grades of fever.
3Patterns of fever.
4cause of generaliz edema
5How to distinguish cardiac edema from renal edema?
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