水肿---EDEMA
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• Extracellular space is composed of the intravascular plasma volume (25%) and the extravascular interstitial spaces (75%);
Anatomy and pathophysilolgy
aggravated by hot weather • Reduction in plasma volume in this condition with secondary activation of the RAA system
Drug-induced edema
Nonsteroidal anti-inflammatory drugs
• Including a chemistry panel and urinalysis to evaluate renal and liver function and albumin levels to assess nutritional status. Consider measuring the thyrotropin level to rule out hypothyroidism. In cases where screening for a cardiac etiology is required, an ECG and chest radiograph may be helpful in assessing cardiac function.
Drugs
Viral/bacterial agents
Thermal/mechanical trauma
Immune
• Responsible for inflammatory edema
• Nonpitting localized redness and tenderness
Clinical Causes of Edema
• Vascular system Hydrostatic pressure （流体静水压） Colloid oncotic pressure （胶体渗透压）
Interstitial space
Hydrostatic pressure (tissue tension)
Colloid oncotic pressure
Systemic Edema
Congestive heart failure
Congestive heart failure
• Left-sided heart failure: shortness of breath with exertion
and when lying down at night (orthophea,端坐呼吸)－－ pulmonary edema
echocardiography
radionuclide angiography
Differential diagnosis
Renal dΒιβλιοθήκη Baiduseases
• Mainly due to hypoabluminemia and salt/water retention
• Associated with hematuria, proteinuria, hypertention and impaired renal functional
Diagnosis
• Of particular importance is excluding major organ system dysfunction, especially cardiac, liver, and renal dysfunction.
• Ask questions such as the following: Do the rings on your fingers get tight? Have you had to let your belt out? Have your clothes or shoes gotten too tight?
Systemic edema Localized edema
• Congestive heart failure • Cirrhosis • Nephrotic syndrome/other
hypoalbuminemia • Drug-induced • Idiopathic
• Venous/lymphatic obstruction
• Pay special attention to the patient’s medications; • Also, obtain a thorough dietary history, paying careful
attention to the patient’s dietary sodium intake, total daily fluid intake;
Cyclosporine
Growth hormone
Immunotherapies
Interleukin 2 OKT3 monoclonal antibody
Localized edema
• Inflammation • Venous/lymphatic obstruction • Chronic lymphangitis • Resection of regional lymph nodes • Filariasis (丝虫病)
Antihypertensive agents
Direct arterial/arteriolar vasodilators Calcium channel antagonists
Steroid hormones
a-Adrenergic antagonists
Glucocorticoids Anabolic steroids Estrogens Progestines
edema
Schroth BE, JAAPA 2005 11
Edema
Pitting edema
Non-pitting edema
Anatomy and pathophysilolgy
• 1/3 of total body water is extracellular space, and 2/3 is intracellular space;
Reduced Plasma Osmotic Pressure
Albumin is the serum protein MOST responsible for the maintenance of colloid osmotic pressure
A decrease in osmotic pressure can result from increased protein loss or decreased protein synthesis
Idiopathic Edema
• Diurnal alterations in weight occurring with orthostatic retention of sodium and water
• Increase in capillary permeability fluctuate in severity
Differential diagnosis
• Heart failure • Renal diseases • Cirrhosis • Nutritional origin • Idiopathic • Others
Differential diagnosis
Heart Failure
• Edema initially occurs at lower part of the body (lower extremities)
• symmetric location
• The presence of heart diseases
cardiac enlargement gallop rhythm dyspnea basilar rales venous distention hepatomegaly
• Noninvasive tests may be helpful
• Characteriastic of edema of renal origin: puffiness of the face
EDEMA
DEFINITION
• Expansion of the interstitial （间质）fluid volume.
• Weight gain precedes overt edema • Massive and generalized edema is called
anasarca（全身性水肿） • Pitting (压凹性) and non-pitting (非压凹性)
• Right-sided heart failure: swelling in the legs and feet－－ peripheral edema
•The physician examining a patient who has congestive heart failure with fluid retention looks for certain signs: pitting edema; rales in the lungs, a gallop rhythm and distended neck veins.
Starling’s law: • Extravascular and intravascular hydrostatic pressurs; • Differences in oncotic pressures within the interstitial
space and plasma; • The permeability of the blood vessel wall.
Physical examination & Diagnostic testing
• In addition to the standard physical examination, chart the patient’s weight and note general appearance, paying special attention to the edema with respect to location, symmetry, pitting or nonpitting appearance, tenderness, and associated skin changes. Assess the severity of edema with a method such as the four-point scale (+1, slight, to +4, very marked) ;
protein loss enteropathy liver cirrhosis
congenital hypoalbuminemia
• Promotes fluid move into the interstitium
• Causes hypovolemia
salt/water retention activation RAA axis etc
Capillary Damage
• Damage to the capillary endothelium
• Increase its permeability and permits the transfer of protein into interstitial compartment
• Injury agents
Systemic Edema
Nephrotic Syndrome/Hypoalbuminemic states
• The primary alteration: decreased colloid oncotic pressure
protein loss in the urine
severe nutritional deficiency
Anatomy and pathophysilolgy
aggravated by hot weather • Reduction in plasma volume in this condition with secondary activation of the RAA system
Drug-induced edema
Nonsteroidal anti-inflammatory drugs
• Including a chemistry panel and urinalysis to evaluate renal and liver function and albumin levels to assess nutritional status. Consider measuring the thyrotropin level to rule out hypothyroidism. In cases where screening for a cardiac etiology is required, an ECG and chest radiograph may be helpful in assessing cardiac function.
Drugs
Viral/bacterial agents
Thermal/mechanical trauma
Immune
• Responsible for inflammatory edema
• Nonpitting localized redness and tenderness
Clinical Causes of Edema
• Vascular system Hydrostatic pressure （流体静水压） Colloid oncotic pressure （胶体渗透压）
Interstitial space
Hydrostatic pressure (tissue tension)
Colloid oncotic pressure
Systemic Edema
Congestive heart failure
Congestive heart failure
• Left-sided heart failure: shortness of breath with exertion
and when lying down at night (orthophea,端坐呼吸)－－ pulmonary edema
echocardiography
radionuclide angiography
Differential diagnosis
Renal dΒιβλιοθήκη Baiduseases
• Mainly due to hypoabluminemia and salt/water retention
• Associated with hematuria, proteinuria, hypertention and impaired renal functional
Diagnosis
• Of particular importance is excluding major organ system dysfunction, especially cardiac, liver, and renal dysfunction.
• Ask questions such as the following: Do the rings on your fingers get tight? Have you had to let your belt out? Have your clothes or shoes gotten too tight?
Systemic edema Localized edema
• Congestive heart failure • Cirrhosis • Nephrotic syndrome/other
hypoalbuminemia • Drug-induced • Idiopathic
• Venous/lymphatic obstruction
• Pay special attention to the patient’s medications; • Also, obtain a thorough dietary history, paying careful
attention to the patient’s dietary sodium intake, total daily fluid intake;
Cyclosporine
Growth hormone
Immunotherapies
Interleukin 2 OKT3 monoclonal antibody
Localized edema
• Inflammation • Venous/lymphatic obstruction • Chronic lymphangitis • Resection of regional lymph nodes • Filariasis (丝虫病)
Antihypertensive agents
Direct arterial/arteriolar vasodilators Calcium channel antagonists
Steroid hormones
a-Adrenergic antagonists
Glucocorticoids Anabolic steroids Estrogens Progestines
edema
Schroth BE, JAAPA 2005 11
Edema
Pitting edema
Non-pitting edema
Anatomy and pathophysilolgy
• 1/3 of total body water is extracellular space, and 2/3 is intracellular space;
Reduced Plasma Osmotic Pressure
Albumin is the serum protein MOST responsible for the maintenance of colloid osmotic pressure
A decrease in osmotic pressure can result from increased protein loss or decreased protein synthesis
Idiopathic Edema
• Diurnal alterations in weight occurring with orthostatic retention of sodium and water
• Increase in capillary permeability fluctuate in severity
Differential diagnosis
• Heart failure • Renal diseases • Cirrhosis • Nutritional origin • Idiopathic • Others
Differential diagnosis
Heart Failure
• Edema initially occurs at lower part of the body (lower extremities)
• symmetric location
• The presence of heart diseases
cardiac enlargement gallop rhythm dyspnea basilar rales venous distention hepatomegaly
• Noninvasive tests may be helpful
• Characteriastic of edema of renal origin: puffiness of the face
EDEMA
DEFINITION
• Expansion of the interstitial （间质）fluid volume.
• Weight gain precedes overt edema • Massive and generalized edema is called
anasarca（全身性水肿） • Pitting (压凹性) and non-pitting (非压凹性)
• Right-sided heart failure: swelling in the legs and feet－－ peripheral edema
•The physician examining a patient who has congestive heart failure with fluid retention looks for certain signs: pitting edema; rales in the lungs, a gallop rhythm and distended neck veins.
Starling’s law: • Extravascular and intravascular hydrostatic pressurs; • Differences in oncotic pressures within the interstitial
space and plasma; • The permeability of the blood vessel wall.
Physical examination & Diagnostic testing
• In addition to the standard physical examination, chart the patient’s weight and note general appearance, paying special attention to the edema with respect to location, symmetry, pitting or nonpitting appearance, tenderness, and associated skin changes. Assess the severity of edema with a method such as the four-point scale (+1, slight, to +4, very marked) ;
protein loss enteropathy liver cirrhosis
congenital hypoalbuminemia
• Promotes fluid move into the interstitium
• Causes hypovolemia
salt/water retention activation RAA axis etc
Capillary Damage
• Damage to the capillary endothelium
• Increase its permeability and permits the transfer of protein into interstitial compartment
• Injury agents
Systemic Edema
Nephrotic Syndrome/Hypoalbuminemic states
• The primary alteration: decreased colloid oncotic pressure
protein loss in the urine
severe nutritional deficiency