Oedema PDF

Oedema Related Terms Oedema Edema Pedal edema Anasarca Cerebral edema Macular edema Pulmonary edema ❑ Definition of Oedema :- It`s accumulation of interstitial fluid causes “pitting oedema”, that leaves an indentation after pressure on the affected area. It`s resulted from disruption of th...

Oedema Related Terms Oedema Edema Pedal edema Anasarca Cerebral edema Macular edema Pulmonary edema ❑ Definition of Oedema :- It`s accumulation of interstitial fluid causes “pitting oedema”, that leaves an indentation after pressure on the affected area. It`s resulted from disruption of the pressures across the capillaries leading to dictate fluid across capillary basement membrane. “Dependent oedema “ its an oedema of the lower limbs , resulting from the effect of the gravity on the venous hydrostatic pressure. So the fluids will accumulate in the ankles -during the day and the oedema will improves overnight. pitting oedema “Non – pitting “ oedema may indicate protein deposition & in chronic lymphoedema. Mechanism of leg oedema ❑ Causes of oedema : 1- (High hydrostatic Pressure): Increase the total extracellular fluid: 1. Congestive heart failure. 2. Renal failure. 3.other hypervolemic status : as iatrogenic, Conn`s syndrom High local venous pressure : 1.Deep venous thrombosis (DVT) or venous insufficiency. 2.Pregnancy. 3.Plevic tumor. 2-Low plasma oncotic pressure / low serum albumin : 1-Increase the renal loss: e.g. nephrotic syndrome. 2.Decrease the protein synthesis : e.g. liver failure 3.Malnutrition/ Malabsorption 3-Increase capillary permeability: Filtration of more protein from capillary to the interstial space Decrease plasma colloid osmotic pressure Increase Formation of interstial fluid oedema Causes -Infection -Burn -Allergic reaction -Trauma -Anoxia -Acidosis 4- Lymphatic obstruction 1.Infection : e.g. fliariasis. 2. Malignancy. 3. Radiation injury. 4. Congenital abnormality. ❑ Clinical features : Dependant regions are usually the first site of oedema formation. This is usually seen in adults. Ankle oedema is characteristic; however, oedema can be developed over the sacrum in bed – ridden patients. With increasing severity, the oedema will rise higher in the lower limbs & affect genitaila & abdomen.  Ascites is also common. Also ascites could be the earlier feature in children and young adults, and in liver disease. Pleural effusion Facial oedema & periorbital puffiness : seen in young patient and in cases of low oncotic pressure. (Anasarca) Features of low intravascular volume ( i.e. hypovolemia) are seen in case of decrease in oncotic pressure and increase in capillary permeability. Ascites Periorbital oedema ❑ Investigations : The cause of oedema can be easily detected from the history & physical examination of the CVS and the abdomen. This is combined my measuring the serum albumin , and urine examination for protein. ❑ Treatment : Treatment for specific causes ,e.g. venous thrombosis. Diuretics with restriction of sodium (sometimes fluids) is rational : In mild cases we can use thiazides , or small dose loop diuretics such as furosemide. However , a very large doses of diuretics , sometimes in combination , is required to achieve a response in severe cases.  In case of oedema caused by venous or lymphatic obstruction and oedema caused by increase in the capillary permeability , In theses cases the choice of treatment will be correction of the underlying cause and local compression (e.g. compressing stocking)