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EDEMA

Dr. Alexandru Nechita

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DEFINITION

Edema= increase in interstitial volume,localised or generalised, due to sodium

and water accumulation in thesubcutaneous tissue. The normal anatomicprofile disappears and pits appear under

pressure.

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TYPES OF EDEMA

Local causes: inflammatory, allergic.

General causes: cardiac, renal mandatory generalised hidrosaline

retention.

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EDEMA- general features.

Initially the skin is under tension and shiny.

In the resolution phase: fine longitudinal foldsappear, together with thickening of theteguments.

Colour: renal edema is white, cardiac andvenous is cyanotic, inflammatory or alergic red.

Local temperature: increased in inflammatoryedema, normal in renal, decreased in cardiacedema.

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EDEMA- general features.

Consistency: renal or starvation edema issoft, easy pitting present, inflammatory

and venous edema pits appear very hard,or not at all.In chronic edema skinthickening is present.

Pain: inflammatory edema is painful, thegeneral cuase edema are generally notpainful.

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Anasarca

Clinical syndrome characterised bypronounced water and sodium retention.

Generalised edema fluid accumulation inthe serous spaces of the body:hidrothorax, ascites, hidropericardium.

The liquid is clear with a green-yellow tan.They have a small content of proteins.

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Where to look for edema ?

Retromaleolar region: by aplying digital pressure on thearea until a pit is formed.

Anterotibial.

Over the knee articulation. Anterior abdominal wall: when you fold the skin pits and

orange like surface appear.

Sacral region- bed imobilised patients.

Breast edema- inferoexternal aspect. Upper limbs: infero-internal and posterior aspect, over

the elbow.

Face edema: compare the aspect wuth a recent photo.

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MECHANISMS OF EDEMA

Local factors: the fluid volume whichleaves the capillary at the arterial end is

superior to the resorbed volume at thevenous extremity.

Water and sodium retention, when thelocal mechanism of water transudation

becomes secondary, this is associated witha decrease in sodium, and secondary,water excretion.

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Local factors that influence theonset of edema

Hidrostatic pressureColoid-osmotic pressure

Tissue mechanical pressure

Capillary permeability

Lymphatic drainage

Tissue osmotic pressure

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CARDIAC EDEMA

Gravitation dependent.

In bedridden patients lombosacral edema

is dominant. Untreated edema develops in a cranial

direction, until anasarca appears.

Edema is cyanotic and cold ( stasiscyanosis ) due to low cardiac output.

Pits are persistent.

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CARDIAC EDEMA

The presence of dyspnoea is mandatory.

Increased levels of BNP are mandatory.

Edema is much more frequent in right heartfailure.

It is produced by an increase in central venouspressure.

There is marked sodium and water retention dueto reduced glomerular filtration rate.

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RENAL EDEMA.

Nephrotic edema due to protein loss afterbasal membranedamage(albuminuria>4g/24hr.).

Nephritic edema- protein loss not so importantto justify edema, sodium retention is much moreimportant.

Edema is white and soft, normal temperature,easy pits.

Face, eyelids, dorsal aspect of feet, externalgenitalia.

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Starvation edema

Generalised, soft, pits appear easy.

Localised at the legs and face.

General aspect similar to renal edema.

Main mechanism is hipoalbuminemia, dueto malabsorbtion, hepatocelular failure,

serumalbumin synthesis failure.

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HEPATIC EDEMA

White, soft, inferior limbs.

Appears in decomensated liver chirosis.

Ascites is not proportional with edema.

Jaundice and spider naevi are present.

Mechanisms: hipoalbuminemia,hyperaldosteronism.

Reduced liver aldosterone turnover.

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PREGNANCY EDEMA

Moderate, white, soft, localised at theinferior limbs, determined by multiple

factors:umoral, inferior vena cavacompression.

Generalised edema after the 20thpregnancy

week+hypertension+proteinuria=preeclampsia, which can lead toeclampsia=seizures, coma, death.

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CATAMENIAL OR CYCLIC EDEMA

Discreet and moderate edema of the legs,which appears predominantly in thesecond half of the menstrual period.

They are dependent on secondaryhyperaldosteronism.

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MIXEDEMA

Appears in severe hypethiroidism.

It is determined by infiltration of the

subcutatenous tissue withmucopolyzaccharides.

The skin is thickened.

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IATROGENIC EDEMA

EXCESSIVE WATER AND SODIUMADMINISTRATION.

CORTICOIDS. ESTROGENS

Other drugs.

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INFLAMMATORY EDEMA

Infection

Trauma

Burns.

Red,hot, painful, pit does not appear.

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Quincke edema

Pruriginous, pink, easy painful.

Eyelid, superior lip.

Glotic edema can appear. bad prognosisbecause respiratory obstruction.

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VENOUS EDEMA

Superficial thrombophlebitis edema islimited beyond the thromosed vein.

Deep thrombophlebitis edema: inferior orsuperior limb.

Initially moderate, then it can be

important. Painful,white, pain in the legs.

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CHRONIC VENOUS FAILURE

Consecutive to recurrent deep venous

thrombosis-posthrombotic syndrome. Increased in orthostatic position.

Skin is often cyanotic, with brown

dermatitis, complicated with varicousulcer.

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Limphedema

Also called in severe cases elphantiasis.

Cause: lymphatic obstruction.