CLINICAL FEATURES OF EDEMA

GENERALISED EDEMA-ANASARCA

Fluid accumulation in tissues and body fluids

•Cardiac failure•Renal disease•Liver disease •Hypoproteinemia

•Pericardial effusion

•Constrictive pericarditis

•Myxedema•Idiopathic•Epidemic dropsy•Drugs

CARDIAC EDEMA

• Right sided heart failure-systemic congestion and generalised edema• Left sided heart failure-initially pulmonary congestion and edema later generalised edema• Pitting• Dependent Ambulant-maximal over ankles & feet(pedal) -worse towards end of day -clears up with recumbence Bedridden-maximal over sacrum

•Legs face ascites•Early-nocturnal polyuria (clears up at

night)•Later-established at all times•Clears with Diuretic therapy•Other signs of cardiac failure -exertional dysnea -engorged jugulars -tender hepatomegaly

RENAL EDEMA

•Nephrotic ,Nephritic, Renal failure

•Nephrotic -severe, generalised,dependent -loose connective tissue, subcutaneous tissue, visceral organs -face(periorbital) legs

ascites (with scrotal swelling)

Other features -massive proteinuria -hypoalbuminemia -

hypercholesterolemia

•Acute nephritic -mild -loose connective tissue-

eyelids and face ,ankles,genitalia -moderate proteinuria•Both -more on waking up after sleep -generalised,pitting

LIVER DISEASE

•Liver Cirrhosis•Chronic liver disease -decreased protein synthesis -Ascites legs face

NUTRITIONAL EDEMA

•Protein losing enteropathy• Starvation

•Dependent•Hypoproteinemia

Albumin<2.5g/dL

DRUG INDUCED EDEMA

•Nifedipine-ankle edema•Corticosteroids•Estrogen•NSAIDs

ENDOCRINE

•Myxodema- hypothyroidism, infiltrative edema due to deposition of mucinous material, nonpitting•Pretibial myxodema- Grave’s disease, swelling over shins, nonpitting•Cushing’s disease- hyperaldosteronism

Pretibial myxodema

EPIDEMIC DROPSY

•Ingestion of edible oil contaminated with oil from seeds of argemone mexicana

•Bilateral pitting edema of lower limbs generalised edema•Pigmentation of skin over edema•Fever,diarrhoea,abdominal pain,malaise

IDIOPATHIC EDEMA

•Young menstruating women, not cyclical•Periodic episodes of edema with pain and

discomfort•Sitting and standing-abdomen and legs•On lying down-face and eyelids•Diurnal weight changes•Has to be differentiated from cyclical

edema

LOCALISED EDEMA

Redistribution of edema fluid, no accumulation

•Cellulitis•DVT•Lymphedema•Angioneurotic•Trauma•Milroy’s edema•Nifedipine

CELLULITIS,TRAUMA,COMPARTMENT SYNDROME,DVT

•Localised•Sudden onset•Painful edema

ANGIONEUROTIC EDEMA

•Hypersensitivity•Solid edema-involves deeper layers of skin•Localised-Tongue,lips,face,eyelids•Develops rapidly,pale or faint pink, itching•Threatens life by suffocation•ACE inhibitor induced•Congenital-C1 esterase inhibitor deficiency

LYMPHADEMA

•Surgery, radiation, chemotherapy•Filariasis•Nonpitting edema•localised

MILROY’S EDEMA

•Lymphedema at birth due to congenital absence of lymphatic tissue•Autosomal dominant inheritance•Unilateral limb edema

progressive both legs

REFEEDING EDEMA

•Edema occurring following feeding after prolonged starvation•Increased salt intake•Insulin release sodium reabsorption

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