Download Approach To A Case Of Anasarca

APPROACH TO A CASE OF
ANASARCA
Presented By
Prof. Arvind Mishra
Department of Medicine
Anasarca
• Defined as gross generalised edema
• Edema is defined as a clinically apparent
increase in the interstitial fluid volume, which
may expand by several liters before the
abnormality is evident
Causes of anasarca
• Cardiac
-cardiac failure,
-pericardial effusion,
-constrictive pericarditis
• Renal
-chronic renal failure
-nephrotic syndrome
• Hepatic- cirrhosis
• Malnutrition/malabsorption(i.e. celiac
disease,crohn’s disease etc)
• Drug-induced
• Thyroid disorder
Clinical feature
• Puffiness of face
• Pedal edema(pitting/non-pitting)
• Abdominal wall edema(by pressing with palm)
• Sacral edema
STARLING FORCES IN SHIFTING THE FLUID IN
DIFFERENT COMPARTMENTS
• The hydrostatic pressure within the vascular
system and the colloid oncotic pressure in the
interstitial fluid tend to promote movement of
fluid from the vascular to the extravascular
space.
• By contrast, the colloid oncotic pressure
contributed by plasma proteins and the
hydrostatic pressure within the interstitial
fluid promote the movement of fluid into the
vascular compartment.
Mechanism of anasarca
• Decreased plasma oncotic pressure
• Lymphatic obstruction
• Increased capillary permeability
• Increased hydrostatic pressure
Drugs causing edema
HYPOTHYROIDISM
INVESTIGATIONS
• Serum protein & albumin
• Urine analysis
-protein, sugar
-cast
• Kidney function test
-s.urea
-s.creatinine
• Liver function test
-SGOT/SGPT
-ALP
-S.bilirubin
• Fecal fat estimation
-to rule out malabsorption
• Thyroid function test
• ECG and echocardiography
Treatment
• Treatment of the underlying cause(cardiac,
renal, hepatic, thyroid abnormality)
• Stop and replace the drug causing edema
• Diuretics
• Restricting salt and fluid intake and
monitoring input-output
• Protein rich diet (in hypoalbuminemic state)
MCQs
1)Causes of non pitting edema are all except
a)Myxoedema
b)Filariasis
c)Angioneurotic edema
d)Nephrotic syndrome
2)Pattern of edema(Legs ->face ->ascitis)
in the given manner occurs in
a)Cirrhosis
b)Cardiac failure
c)Nephrotic syndrome
e)Nutritional edema
3)Drugs causing edema are all except
a)Cilnidipine
b)Hydralazine
c)Amlodipine
d)Clonidine
4)Milroy’s disease refers to
a)Absence of thymus
b)Congenital hypoplasia of lymphatics
c)Post mastectomy lymphedema of upper limb
d)Chylous pleural effusion
5)Angioneurotic edema is due to deficiency of
a)C1 esterase inhibitor deficiency
b) C5 convertase (C3bBbC3b)
c)C1 esterase deficiency
d) Factor H–related protein 1 (CFHR1)