DRA.

MARUSA
TORRES

EDEMA

EDEM
A
GENERALIS

LOKALIS

Inflamasi
Obstruksi Limfa
Obstruksi Vena
thrombophlebitis

Jantung
Hepar
Renal
Nephrotic syndrome
Acute
glomerulonephritis
Chronic renal
insufficiency
Idiopathic edema
Other forms

HEPATIC
EDEMA

Table 01. diagnosis of hepatic edema

evidence of chronic liver disease
Spider angiomata
Palmar erythema
jaundice

Presence of portal hypertension and ascites

Prominent venous pattern on abdominal wall
Esophageal varies
Peripheral edema (usually, but not always, present)

Table 02. major findings in three forms of edema

CARDIA HEPATIC
RENAL
C
Dependent
++++
+++
++
edema
Facial edema
Presen
t
Ascites
+
++++
+
Hypoalbuminem ++
++++
ia
proteinuria
0- trace 0- trace
++++

OTHER FORMS OF
EDEMA

Table 03. other forms of generalized edema

Type

Comments

Cyclic edema

Can develop in women of childbearing age

just before the monthly menstrual period;
is self-limited and does not require
treatment other than counseling; can be
confused with idiopathic edema

myxedema

Is the characteristic brawny edema that

resists pitting; develops in patients with
hypothyroidism

Edema due to the use of

vasodilators

Edema of pregnancy

Resullts from sodium retention (with

agents such as minoxidil and hydralazine)
and may also result from altered capillary
permeability (with nifedipine and possibly
other calcium channel blockers of the
dihydropyyridine class); usually requires
the addition of a diuretic to the therapeutic
regimen
Is rarely a problem for the general
internist, but its treatment often benefits
from a nephrology consultation

INDICATIO
NS
Table 04. complications of edema and
ascites
Peripheral edema
Cellulitis
Venous thrombosis
Impaired vision from periorbital edema
Pain
Unacceptable cosmetic impact
Scrotal and penile edema
Limitation of physical activity
Pleural effusions

ascites
Impaired intestinal absorption
Esophageal reflux
Dyspnea from impaired diaphragmatic
excursion
Umbilical or inguinal hernias
Spontaneous bacterial peritonitis
From genes et al. [1*]; with permission

Table 06. treatment of edema

General measures
Treatment of the primary disease
Bed rest
Sodium restriction
Diuretic administration

specific measures
Fluid removal
Pleurocentesis (heart failure, cirrhosis, nephrosis)
Paracentesis

(heart failure, cirrhosis, nephrosis)

Plasma volume expansion

Infusion of plasma or hyperoncotic albumin
solutions (cirrhosis, nephrosis)
Ascitic fluid reinfusion

(cirrhosis)

Insertion of a peritoneovenous shunt

(cirrhosis)

Head out water immersion (cirrhosis,

nephrosis)
Pharmacologic therapy
Vasodilators (heart failure)
Angiotensin converting enzyme inhibitors (heart
failure, nephrosis)
Vasoconstrictors

(cirrhosis)

Continuous arteriovenous hemofiltration (heart

failure, nephrosis)