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EDEMA

Dr. Alexandru Nechita

DEFINITION
Edema= increase in interstitial
volume, localised or generalised, due
to sodium and water accumulation in
the subcutaneous tissue. The normal
anatomic profile disappears and pits
appear under pressure.

TYPES OF EDEMA

Local causes: inflammatory, allergic.


General causes: cardiac, renal
mandatory generalised hidrosaline
retention.

EDEMA- general features.


Initially the skin is under tension and shiny.
In the resolution phase: fine longitudinal

folds appear, together with thickening of the


teguments.
Colour: renal edema is white, cardiac and
venous is cyanotic, inflammatory or alergic
red.
Local temperature: increased in
inflammatory edema, normal in renal,
decreased in cardiac edema.

EDEMA- general features.


Consistency: renal or starvation edema

is soft, easy pitting present,


inflammatory and venous edema pits
appear very hard, or not at all.In chronic
edema skin thickening is present.
Pain: inflammatory edema is painful, the
general cuase edema are generally not
painful.

Anasarca
Clinical syndrome characterised by

pronounced water and sodium retention.


Generalised edema fluid accumulation
in the serous spaces of the body:
hidrothorax, ascites, hidropericardium.
The liquid is clear with a green-yellow
tan. They have a small content of
proteins.

Where to look for edema ?


Retromaleolar region: by aplying digital pressure

on the area 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.

MECHANISMS OF EDEMA
Local factors: the fluid volume which

leaves the capillary at the arterial end


is superior to the resorbed volume at
the venous extremity.
Water and sodium retention, when the
local mechanism of water transudation
becomes secondary, this is associated
with a decrease in sodium, and
secondary, water excretion.

Local factors that influence the


onset of edema
Coloid-osmotic pressure
Tissue mechanical
pressure

Hidrostatic pressure
Tissue osmotic
pressure

Capillary
permeability
Lymphatic drainage

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 ( stasis
cyanosis ) due to low cardiac output.
Pits are persistent.

CARDIAC EDEMA
The presence of dyspnoea is mandatory.
Increased levels of BNP are mandatory.
Edema is much more frequent in right heart

failure.
It is produced by an increase in central
venous pressure.
There is marked sodium and water retention
due to reduced glomerular filtration rate.

RENAL EDEMA.
Nephrotic edema due to protein loss
after basal membrane
damage(albuminuria>4g/24hr.).
Nephritic edema- protein loss not so
important to justify edema, sodium
retention is much more important.
Edema is white and soft, normal
temperature, easy pits.
Face, eyelids, dorsal aspect of feet,
external genitalia.

Starvation edema
Generalised, soft, pits appear easy.
Localised at the legs and face.
General aspect similar to renal edema.
Main mechanism is hipoalbuminemia,
due to malabsorbtion, hepatocelular
failure, serumalbumin synthesis
failure.

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.

PREGNANCY EDEMA
Moderate, white, soft, localised at the
inferior limbs, determined by
multiple factors:umoral, inferior vena
cava compression.
Generalised edema after the 20th
pregnancy
week+hypertension+proteinuria=pre
eclampsia, which can lead to
eclampsia=seizures, coma, death.

CATAMENIAL OR CYCLIC EDEMA

Discreet and moderate edema of the

legs, which appears predominantly in


the second half of the menstrual
period.
They are dependent on secondary
hyperaldosteronism.

MIXEDEMA
Appears in severe hypethiroidism.
It is determined by infiltration of the
subcutatenous tissue with
mucopolyzaccharides.
The skin is thickened.

IATROGENIC EDEMA
EXCESSIVE WATER AND SODIUM
ADMINISTRATION.
CORTICOIDS.
ESTROGENS
Other drugs.

INFLAMMATORY EDEMA
Infection
Trauma
Burns.
Red,hot, painful, pit does not appear.

Quincke edema

Pruriginous, pink, easy painful.


Eyelid, superior lip.
Glotic edema can appear. bad
prognosis because respiratory
obstruction.

VENOUS EDEMA
Superficial thrombophlebitis edema

is limited beyond the thromosed vein.


Deep thrombophlebitis edema:
inferior or superior limb.
Initially moderate, then it can be
important.
Painful,white, pain in the legs.

CHRONIC VENOUS FAILURE


Consecutive to recurrent deep venous
thrombosis-posthrombotic syndrome.
Increased in orthostatic position.
Skin is often cyanotic, with brown
dermatitis, complicated with varicous
ulcer.

Limphedema
Also called in severe cases

elphantiasis.
Cause: lymphatic obstruction.