Download - 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
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Fever
1 Introduction
2 Pathlogeny and sort
3 Occurrence Mechanism
4 Clinical occurrence
5 Patterns of fever
6 FUO
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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)
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Pathlogeny and sort
1 Infective fever-------most common cause
①bacterial
②viral
③rickettsial
④fungal
⑤parasitic
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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
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④endocrine disease: endocrine hyperthyroidism
⑤tissue damage:myocardial infarction, pullmonary infarction
⑥drug reaction and gout
⑦tumor: lymphomas,solid tumors
⑧neuroleptic seizures
⑨psychosocial factitious
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Occurrence Mechanism
physiologic temperature elevated----fever
(elevation of hypothalamic set point)
Pathologic temperature elevated-- hyperthermia
( unregulated heat generation, impaired heat exchange)
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Occurrence Mechanism--physiologic
set point (hypothalamus)
Internal temperature
cellular function
regulate
maintain
Deviation >4 ℃
cellular dysfunction
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Occurrence Mechanism
increased heat production
decreased heat dissipation
failure of regulating system
Temperature deviation
fever
Set point change
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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
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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
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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℃℃
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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
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Patterns of fever
Continuous fever Remittent fever Intermittent fever Undulant fever Relapsing fever Episodic fever Pel-Epstein fever
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Continuous fever
①temperature: 39-40 ,days or weeks;diurnal variati℃on 0.5-1.0 ℃
②disease: typhoid, acute pneumonia
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Continuous fever
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Remittent fever
①temperature > 38 , diurnal variation℃ > 2 ℃ ( no normal temeratrue )
②disease: sapraemia,acute rheumatic fever,
acute infectious endocarditis
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Remittent fever
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Intermittent fever
① suddenly reach climax, continue several hours, suddenly fall to normal, intermission 1-several days
②disease: malaria, acute pyelonephritis
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Intermittent fever
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Undulant fever
①slowly reach > 39 ,℃ slowly return to normal. (repeate the rhythm)
②disease: brucellosis,tumor
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Undulant fever
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Relapsing fever
①suddenly reach 39 ℃ , continue several days, suddenly drop to normal. bout every 5-7days
②disease: spirochetes infection
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Relapsing fever
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Episodic fever
①last for days or longer, then without fever for at least 2 weeks
②disease: familial periodic fever
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Pel-Epstein fever
①continuous or remittent fever bouts several days
②disease: Hodgkin disease
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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
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Edema
PathophysiologyClinical occurrenceIdiopathic edemaTropical edemaangioedema
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Pathophysiology hydrostatic and oncotic pressure
A Vfluid fluid
interstitial tissues
Keep in balance
filter out
resorption
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equilibrating factors
capillary hydrostatic pressure
interstitial fluid colloid osmotic pressure
serum colloid osmotic pressure
interstitial tissues pressure
filtration
resorption
Filtration > resorption edema
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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)
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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.
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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
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Brawny edema:
chronic edema of the legs leads to fibrosis of the subcutaneous tissues and skin, so they no longer pit on pressure.
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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
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site: above the diaphragm--superior vena cava obstruction
below the diaphragm—jugular venous press ,portal vein hypertension, loss of venous tone drugs
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Generalized edema: cardiac edema renal edema hepatic edema nutritional edema (protein losing conditions) Drug (corticosteroid, NSAID) Systemic inflammatory response syndrome(SIRS)
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Cardic edema
Symptoms: chest distress, short breath, dyspnea
Site: lower limbs Disease : right heart failure
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renal edema
Symptoms : hematuria , proteinuria Site: eyelid , legs Disease: nephrotic syndrome
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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
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Protein losing conditions
Enteropathy Burns fistulas
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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
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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
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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
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1Reasons of infective fever
2Grades of fever.
3Patterns of fever.
4cause of generaliz edema
5How to distinguish cardiac edema from renal edema?