Edema Flashcards

1
Q

This is the term for a clinically apparent increase in interstitial fluid that can expand by several liters before the abnormality is evident.

A

Edema

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2
Q

This is the term for edema resulting from hypothyroidism.

A

Myxedema

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3
Q

This is the term for extreme generalized edema.

A

Anasarca

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4
Q

This is the term for abnormal accumulation of fluid in the peritoneal cavity.

A

Ascites

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5
Q

This is the term for the accumulation of serous fluid in one or both pleural cavities or pericardial space.

A

Hydrothorax/Hydropericardium

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6
Q

____ of water in the body is intracellular, and _____ of all the water in the body is extracellular.

A

2/3; 1/3

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7
Q

75% of the Extracellular Space is composed of ___________. The remaining 25% of the Extracellular Space is composed of _________.

A

Interstitial Fluid; Plasma

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8
Q

Define Starling’s Law

A

The exchange of fluid between the plasma and the interstitium is determined by the hydrostatic and colloid oncotic pressures in each compartment.

Net Filtration = Capillary Wall Porosity x (Hydrostatic Pressure - Oncotic Pressure)

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9
Q

Hydrostatic Pressure is a function of:

A
  1. Blood Pressure
  2. Intravascular Volume
  3. Venous Outflow
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10
Q

This is the term for the ability of albumin to form covalent bonds with water and retain fluid in a particular compartment.

A

Oncotic Pressure

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11
Q

Extracellular fluid normally moves from the _________ across ________ into the __________ and is then returned to the circulation via the lymphatic’s

A

Vascular Space; Capillary Walls; Interstitium

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12
Q

Production of Edema (could be a combination):

A
  1. Increased plasma volume
  2. Elevation in capillary hydrostatic pressure
  3. Increased Capillary Permeability
  4. Reduction in the Plasma Oncotic Pressure
  5. Lymphatic Obstruction
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13
Q

The increase in capillary pressure is generally due to _________. Why?

A

Increased Venous Pressure; Because the pre-capillary arteriole autoregulates capillary pressure.

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14
Q

What could cause increased capillary pressure?

A
  • Venous Obstruction (Venous Thrombosis)

- Expanded Venous Blood Volume (Heart Failure or Kidney Failure)

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15
Q

Cause of Decreased Plasma Oncotic Pressure

A
  • Hypoalbuminemia (< 2 g/dL)
  • Nephrotic Syndrome
  • Liver Failure
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16
Q

What causes Increased Capillary Permeability?

A

Augments transit of proteins into interstitium, therefor decreases oncotic pressure gradients.

Ex:

  • Burns
  • Angioedema
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17
Q

What can cause lymphatic obstruction?

A

Secondary to Tumor

*Rare

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18
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Pressure via:

Increased plasma volume due to renal Na+ Retention

A
  1. Heart Failure, including Cor Pulmonale
  2. . Primary renal sodium retention:
    a. Renal disease, including nephrotic syndrome
    b. Drugs: minoxidil, NSAIDS, estrogens
    c. Early hepatic cirrhosis
  3. Pregnancy and premenstrual edema
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19
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Pressure via:

Venous Obstruction

A
  1. Cirrhosis or Hepatic Venous Obstruction

2. Local Venous Obstruction

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20
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Pressure via:

Decreased Arteriolar Resistance

A
  1. Calcium Channel Blockers

2. Idiopathic Resistance

21
Q

Clinical conditions Assc with Edema Development Caused by:

Hypoalbuminemia via:

Protein Loss

A
  1. Nephrotic Syndrome

2. Protein-Losing Enteropathy

22
Q

Clinical conditions Assc with Edema Development Caused by:

Hypoalbuminemia via:

Reduced Albumin Synthesis

A
  1. Liver Dz

2. Malnutrition

23
Q

Clinical conditions Assc with Edema Development Caused by:

Increased Capillary Permeability

A
  1. Idiopathic Edema
  2. Burns
  3. Trauma
  4. Inflammation or Sepsis
  5. Allergic Reactions
  6. DM
  7. IL2 Therapy
  8. Malignant Ascites
24
Q

Clinical conditions Assc with Edema Development Caused by:

Lymphatic Obstruction or Inc. Interstitial Oncotic Pressure

A
  1. Post-mastectomy
  2. Nodal Enlargement Due to Malignancy
  3. Hypothyroidism
  4. Malignant Ascites
25
Classifying Edema
1. Unilateral --> Localized vs. Limb | 2. Bilateral --> Generalized
26
This type of edema is generally due to a systemic cause and is manifested by bilateral leg edema or ascites.
Bilateral/Generalized Edema
27
Cardiovascular Causes of Bilateral/Generalized Edema
- Systolic and/or Diastolic Failure - Constrictive Pericarditis - Pulmonary HTN
28
Hepatic Causes of Bilateral/Generalized Edema
Hepatocellular Injury - Cirrhosis - Hepatitis
29
Renal Causes of Bilateral/Generalized Edema
- Renal Failure | - Nephrotic Syndrome
30
This type of edema is due to venous or lymphatic cause and manifested by unilateral (possibly bilateral) limb edema.
Unilateral/Limb Edema
31
Venous Disease Causing Unilateral/Limb Edema
Obstruction 1. DVT 2. Lymphadenopathy 3. Pelvic Mass 4. Venous Insufficiency
32
Lympathic Obstruction Causing Unilateral/Limb Edema | AKA Lymphedema
1. Congenital 2. Neoplasm 3. Surgery 4. Radiation 5. Parasite
33
Other Causes of Unilateral/Limb Edema
- Burns - Angioedema/Hives - Infection/Trauma
34
Questions to ask when taking a history about Edema
1. When did swelling begin? 2. How has it gotten worse? 3. Weight gain? 4. How do clothes fit? 5. What is your medical history? (Heart/Liver/Thyroid/Kidney)
35
Rule of Thumb with Edema Presentation?
Think about Serious Diagnoses First!!!
36
Serious Dx causing Edema to consider
- CHF - Anaphylaxis - Liver Failure - DVT leading to PE
37
If a patient says they: recently started a new medication before edema occurred, what should you think?
Anaphylaxis
38
If a patient says they: were recently exposed to latex or chemicals before edema occurred, what should you think?
Anaphylaxis
39
If a patient says they: had associated symptoms of chest discomfort, SOB, Orthopnea, or Paroxysmal Nocturnal Dyspnea with edema, what should you think?
- Valve Stenosis - Valve Insufficiency - Cardiac Ischemia
40
If a patient says they: had assc symptoms of loss of consciousness (syncope), or feeling like they were going to pass out esp. when walking (presyncope) with new onset edema, what should you think?
1. Outflow tract obstruction - -- Aortic stenosis - -- Hypertrophic CM - -- Primary Pulm HTN - -- Atrial Myxoma 2. Pulmonary embolus
41
If a patient says they: had hx of alcohol abuse, unprotected sex, use of injective drugs, use of illicit drugs, or abdominal swelling with new onset edema, what should you think?
1. Liver Failure 2. Outflow tract obstruction - -- Aortic stenosis - -- Hypertrophic CM - -- Primary Pulm HTN - -- Atrial Myxoma 3. Pulmonary embolus 4. Constrictive Pericarditis
42
If a patient says they: had assc symptoms with sedentary position for prolonged time, smoking, hx of blood clots, or use of oral contraceptives with new onset edema, what should you think?
Pulmonary Embolism
43
What does 1+ Pitting Edema mean?
- Pitting Lasts 0 to 15 sec OR - Mild Pitting, Slight Indentation, No perceptible swelling of the leg
44
What does 2+ Pitting Edema mean?
- Pitting lasts 16 to 30 sec OR - Moderate Pitting, Indentation Subsides Rapidly
45
What does 3+ Pitting Edema mean?
- Pitting lasts 31 to 60 seconds OR - Deep Pitting, Indentation remains for a short time, legs look swollen
46
What does 4+ Pitting Edema mean?
- Pitting Lasts 60+ seconds OR - Very deep pitting, indentation lasts a long time, leg is very swollen
47
What causes the pitting in pitting edema?
Reflects Movement of Excess Fluid Into Interstitial Space
48
Physiology of Systolic Dysfunction in Left Sided Heart Failure
- Commonly due to CAD or HTN - Weakened Myocardium - Unable to Contract Forcefully enough to meet Systemic Demands * Large dilated heart
49
Physiology of Diastolic Dysfunction in Left Sided Heart Failure
- Impaired ability or mycardium filling due to hypertrophic changes - Smal LV cavity - Concentric LB Hypertrophy