Download systemic venous pressure increase right

EDEMA
Basic Course of Diagnosis
Xiaoqi XU
Renal Divison, Renji Hospital,
Shanghai Second Med.Univ.
Definition

A clinical apparent increase in
the interstitial fluid volume.

Distribution: local
general

Special form: ascites
hydrothorax
Pathogenesis
Total body water(TBW): 2/3 body weight
intracellular 2/3
TBW
Interstitial 3/4
extracellular 1/3
starling
force
intravascular 1/4
Starling force depends on : hydrostatic pressure(静水压)
colloid oncotic pressure（胶体渗透压）
Pathogenesis

Disturbed starling forces(reduced effective circulating
volume,edema formation)
systemic venous pressure increase
right-sided heart failure,constrictive pericarditis
local venous pressure increase
left-sided heart failure,vena cava obstruction, portal vein
obstruction
reduced oncotic pressure
nephrotic syndrome,decreased albumin synthesis
combined disorders
cirrhosis

Primary hormone excess
(increased effective circulating volume)
primary aldosteronism
Cushing ‘s syndrome
SIADH

Primary renal sodium retention
(increased effective circulating volume)
renal failure
SIADH: syndrome of inappropriate antidiuretic hormone production

Capillary damage
inflammation due to the bacteria
infection,allergic
reaction,immune reaction

Lymphatic obstruction
Clinical causes of edema
General edema:

Congestive Heart Failure

Nephrotic Syndrome and Other
Hypoalbuminemic States

Cirrhosis

Drug-Induced

Idiopathic Edema
Localized edema:
 Obstruction of venous (and
lymphatic) drainage of a limb
Table 37-2. Principal Causes of Generalized Edema: History,
Physical Examination, and Laboratory Findings
Organ
System
Cardiac
Hepatic
Renal
History
Physical Examination
Dyspnea with exertion
prominent-often associated
with orthopnea-or
paroxysmal nocturnal
dyspnea
Elevated jugular venous
pressure, ventricular (S3)
gallop; occasionally with
displaced or dyskinetic
apical pulse; peripheral
cyanosis, cool extremities,
small pulse pressure when
severe
Frequently associated with
Dyspnea infrequent,
ascites; jugular venous
except if associated with
pressure normal or low; BP
significant degree of
lower than in renal or
ascites; most often a
cardiac disease; jaundice,
history of ethanol abuse
palmar erythema,
Dupuytren's contracture,
spider angiomata, male
gynecomastia; asterixis and
other signs of
encephalopathy
chronic: decreased appetite,
BP may be elevated;
metallic or fishy taste, altered
hypertensive or diabetic
sleep pattern, difficulty
retinopathy in selected
concentrating, restless legs
cases; nitrogenous fetor;
or myoclonus: dyspnea can
periorbital edema may
be present, but generally less
predominate; pericardial
prominent than in heart
friction rub in advanced
failure
cases with uremia
NOTE: S3, third heart sound.SOURCE: From GM Chertow, GE Thibault, Approach to the patient
with edema, in L Goldman, E Braunwald (eds): Primary Cardiology. Philadelphia, Saunders, 1998.
Laboratory
Findings
Elevated BUN/Cr
ratio common;
elevated uric acid;
serum Na
diminished; liver
enzymes
occasionally
elevated with
reductions
in Alb,
hepatic congestion
Cho, transferrin,
fibrinogen liver
enzymes elevated,
tendency toward
hypokalemia,
respiratory alkalosis;
macrocytosis from
folate deficiency
hypoalbuminemia;
elevation of serum
creatinine and urea
hyperkalemia,
metabolic acidosis,
hyperphosphatemia,
hypocalcemia,
anemia (usually
normocytic)
Malnutrition: weight loss occurs from lower
extremities
• diet grossly deficient in protein over a
long period
• Protein-losing enteropathy
• Severe burn
Idiopathic edema: exclusive in
♀,periodic episodes of edema(unrelated
to MC)
Miscellaneous:located pretibial
region,periorbital region
•hypothyroidism(myxedema)
•Drug-induced edema
Exogenous hyperadremocortism
Estrogen
vasodilators
Localized edema:
•Local inflammation
•Thrombosis
•Thrombophlebitis
•filariasis
Accompanied symtoms




With hepatomegaly
With gross proteinuria
With dyspnea
Related with menstrual cycle
Approach to the Patient

Localized or generalized?

Hydrothorax or ascites?

Sites

accompanied symptom