Medical Terminology on Edema and Fever

Diagnostics

• Diagnostics is a discipline that applies basic theoretical knowledge, skills, and diagnostic thinking to patient care.

Types of Clinical Diagnosis

• Etiological diagnosis: Based on causative factors, ideal for disease treatment and prevention.
• Pathological diagnosis: Clarifies the location, characteristics, and micro-structural changes of a lesion.
• Pathophysiological diagnosis: Highlights the functional changes in the body.
• Symptomatic diagnosis: Identifies symptoms or signs with an undefined cause, requiring further clarification.

Diagnostic Principles

• Explaining clinical manifestations: Attempt to link all observed clinical presentations to a single disease. If not possible, consider other diseases or complications.
• Prioritizing common diseases: Begin by investigating common diseases first. Only after ruling out common conditions should rare diseases be considered. This requires significant supporting diagnostic evidence.
• Suspecting organic diseases: If differentiating abnormalities is difficult, organic diseases should be considered more seriously than milder conditions.
• Prioritizing curable diseases: During diagnosis, prioritize diseases with potential cures over those considered refractory or incurable.
• Reconciling clinical and laboratory findings: If clinical findings disagree with laboratory results, investigate and verify the history taking or testing procedure. Correct misdiagnosis.

Contents

• History Taking (Symptoms)
• Physical examination (Signs)
• Laboratory and Auxiliary examination
• etc.

History Taking

General Data

• Name
• Sex
• Age
• Marital status
• Occupation
• Birthplace
• Race
• Home Address
• Phone number
• History Taker
• Reliability
• Date of admission

Chief Complaints

• Main symptoms or signs
• Characteristics
• Duration (in concise sentences under 20 words)
• Exclude diagnostic terms and diseases

Present Illness

• Onset: When and how the problem started
• Main symptoms and their features
• Associated symptoms
• Consultation and treatment (type, dosage, duration) and effectiveness
• Problems caused by the condition

Past History

• Previous illnesses (e.g., diabetes, hypertension, infections)
• Hospitalizations (detail of conditions, dates, outcome)
• Operations (types, dates, outcomes)
• Major injuries
• Allergies (food, drugs, contact substances)

Menstrual History

• Age of menarche

Marital History

Childbearing History (Obstetric History)

• Gravida, Para, Abortion (e.g., G3P1A2)

Family History

• Health status of relatives and spouse

Systems Review

• General health status & body weight
• Mouth
• Respiratory system & Cardiovascular
• Digestive system
• Urinary system
• Hematopoietic system
• Metabolic & Endocrine system
• Musculoskeletal system
• Nervous system

Physical Examination

• Methods:

• Visual inspection

• Palpation

• Percussion

• Auscultation

• Olfaction

• Palpation: Examiner assesses local contact, body surface responses for abnormalities, especially in the abdomen. Techniques include light palpation, deep palpation, and deep pressure palpation.

• Percussion: Tapping the body surface to assess vibrations, sounds, and organ characteristics (e.g., dullness for liver/heart, tympany for lungs.) Direct and indirect methods. Percussion sounds:

• Voiceless - Normal lung

• Dullness - Heart/Liver

• Solid sound - Liver, Heart etc

• Drum sound - Gastric bubble area and abdomen

• Over voiceless - Emphysema

• Auscultation: Listening to sounds from the body's parts (heart, lungs), evaluating normalcy, use of stethoscope. Direct and indirect method.

• Smell: Detecting abnormal smells (e.g., alcohol, ketones, ammonia). Associate with specific diseases (e.g., ketoacidosis, uremia).

Laboratory and Auxiliary Examination

• Examinations of body fluids, excreta, tissue/cell samples using physical, chemical, and biological methods.
• Evaluates etiology, organ function, etc.
• Auxiliary examinations use various instruments (e.g., ECG, lung function tests, endoscopy).

Fever

Body Temperature

• Normal range: 36-37°C.
• Varies with measurement method (rectal higher than oral, axillary lower than oral).
• Influenced by factors: age, gender, time of day, ambient temperature, activity level, stress, pregnancy, etc.

Fever Pathophysiology

• Tight hypothalamic regulation of core temperature.
• Deviation of 4°C or more can cause severe cellular dysfunction.
• Hypothalamus maintains a set-point for temperature.

Fever Definition

• Elevation in core body temperature attributed to an upward resetting of the hypothalamic thermostatic set-point by pyrogens.

Fever Pathogenesis

• Pyrogens cause an elevated thermostatic set-point.
• Basal Metabolic Rate (BMR) increases by 10% (causes a 0.6°C rise in body temperature).

Fever Etiology and Classification

• Infectious causes (viral, bacterial, etc.) are common.
• Non-infectious causes (injury, autoimmune, chemical, etc.) also exist.

Infectious Fever

• Caused by various pathogens (viruses, bacteria, mycoplasma, spirochetes, fungi, parasites).
• Localized and systemic infections can induce fever.
• Exogenous pyrogens stimulate endogenous pyrogen-generating cells to create endogenous pyrogens that cause fever.

Non-infectious Fever

• Caused by various conditions, including absorption of necrotic substances, injuries, ischemic necrosis, cell necrosis, allergies, antibiotics, endocrine/metabolic disturbances (hyperthyroidism), dehydration, decreased heat elimination from skin, heart failure, extensive dermatitis, antigen-antibody reactions, rheumatic fever, serum disease, connective tissue diseases, central heat regulation dysfunction (heat stroke, chemical poisoning), vegetative nervous system dysfunction (sympathetic overactivity).

Clinical Manifestations

• Fever grades: Low, middle, high, very high (temperatures)
• Onset: Sudden, gradual
• Persistence, pattern of fever.
• Subsidence: Crisis, Lysis
• Fever patterns (continued, remittent, intermittent, recurrent, undulant, irregular).

Associated symptoms:

• Rigor
• Rash
• Mucocutaneous bleeding
• Arthralgia
• Conjunctival congestion
• Herpes

History Taking and Fever

• Onset (speed), duration, pattern (intermittent or persistent), factors influencing it (e.g., season). Associated factors: chills, sweating, night sweats.
• Review of systems (cough, sputum, hemoptysis, chest, abdominal pain, vomiting, diarrhea, urinary frequency, urgency, rash, bleeding, headache, muscle pain).
• General status (mental state, appetite, weight change, sleep, urination, defecation).
• Detail info on previous treatment, especially antibiotics, antipyretics, corticosteroids, exposure to infectious diseases, contaminated water, surgical history, miscarriage or childbirth history).
• Diagnostic points: other symptoms, duration & magnitude, contact with similar illness, occupational/travel/recreation exposure, history of diseases, current medication, allergies.

Fever of Unknown Origin (FUO)

• Defined by Petersdorf and Beeson (1961).
• Temperature ≥ 38.3°C repeatedly.
• Duration ≥ 3 weeks.
• No diagnosis after 1 week of inpatient investigation.

Edema

Definition

• Edema is the pathological accumulation of excess fluid in the interstitial spaces.
• Not associated with cellular edema.

Pathogenesis

• Fluid distribution (intracellular vs. extracellular).
• Extracellular space (intravascular plasma volume vs. extravascular interstitial space).
• Two primary causes:
  • Increased extracellular fluid volume (excess fluid in interstitial spaces)
  • Imbalance in intravascular fluid exchange (more fluid leaving than entering interstitial spaces).

Classification

• Generalized edema
  • Congestive heart failure
  • Nephrotic syndrome
  • Cirrhosis
  • Hypoalbuminemia
  • Drug-induced
  • Idiopathic
• Localized edema
  • Local inflammation/allergy
  • Limb venous thrombosis
  • Inferior vena cava obstruction syndrome

Cardiac Failure-related Edema

• Occurs in lower extremities.
• Symmetric location.
• Associated with heart disease.
• Symptoms include: cardiac enlargement, gallop rhythm, dyspnea, basilar rales, venous distention, hepatomegaly.

Renal Diseases-related Edema

• Often starts in facial periorbital areas.
• Rapid progression.
• Associated with hypoalbuminemia, retention of sodium/water, hematuria, proteinuria, hypertension and impaired renal function tests.
• Nephrotic syndrome results in decreased colloid oncotic pressure, causing fluid to shift into interstitial spaces.

Liver Disease (cirrhosis)-related Edema

• Edema can occur in other parts, often due to hypoalbuminemia/increased intra-abdominal pressure impeding venous return from the lower extremities.

Idiopathic Edema

• Cause is unknown.
• Characterized by fluctuations in severity, often worsened by hot weather.
• Potential cause: increased capillary permeability, reduced plasma volume, activation of the RAAS (renin-angiotensin-aldosterone system).

Drug-induced Edema

• Various medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs), antihypertensives, calcium channel blockers, steroid hormones (corticosteroids, androgens, estrogens, progestins), growth hormone, immunotherapies, some antibodies (e.g., OKT3).

Other Causes of Edema

• Hypothyroidism (myxedema)
• Exogenous hyper-adrenocorticism
• Pregnancy

Approach to Patients

• Determine if edema is generalized or localized.
• Evaluate possible causes (heart, liver, kidney, venous obstruction, lymphotic obstruction).

Associated Symptoms

• Edema with symptoms like proteinuria, hematuria often linked to kidney diseases (e.g., nephrotic syndrome, diabetic nephropathy).
• Edema with autoimmune diseases might also feature arthritis, skin changes, mild proteinuria in cardiogenic cases. Edema with dyspnea or cyanosis often indicates heart disease or superior vena cava syndrome.
• Edema associated with menstrual cycles common in idiopathic cases.
• Edema (in premenstrual tension syndrome) may present with insomnia, irritability, mental anxiety.

History Taking (Edema)

• Time of edema onset, triggers, precursor symptoms.
• Location and progression order, influencing factors like body position.
• Speed of edema progression, edema characteristics (e.g., pitting), any signs of infections, allergic reactions, malnutrition.
• Current treatments with adrenal cortical hormones, estrogen, or other drugs.
• Accompanying symptoms (skin color/temperature, tenderness, rash, thickness), gastrointestinal symptoms (jaundice, bleeding), and urinary changes (color, frequency), hypertension and renal function.
• Cough, expectoration, breathlessness (linked to heart/lung issues).
• Appetite/weight change, cold sensitivity, constipation (linked to hypothyroidism).
• Relationship between edema, menstruation, body position, and daytime/nighttime symptoms (specific for female patients).

Summary-Diagnosis

• Excluding major organ dysfunction (heart, liver, kidneys).
• Questioning patients about rings, belts, clothes getting tight.
• Careful dietary & medication review (especially sodium, total fluid intake).
• Physical examination of edema (location, symmetry, pitting/non-pitting, skin changes, tenderness).
• Severity assessment (e.g., four-point scale).
• Laboratory tests: chemistry panel, urinalysis (renal & liver function), albumin levels (nutritional status).
• Thyroid function tests (thyrotropin).
• ECG/chest x-ray if cardiac involvement is suspected.

This quiz covers essential medical terms related to edema and fever. It explores types of edema, causes, as well as different types of fever and their characteristics. Perfect for students in medical or healthcare courses.