Please enable JavaScript.

Coggle requires JavaScript to display documents.

Edema (Key terms: (Lipedema: Edema caused by fluid retained in the…

- - - - Upper and lower limbs and face
        
        Think increase permeability as the cause
        
        Refer below qns to ask
      - Start from lower limbs and ascend superiorly
        
        Think Increase intravascular volume
        
        Also tend to begin in the left leg as venous pressure is higher in the left leg due to the need for the left iliac vein to cross under the aorta to join the vena cava.
      - Consider either decrease production of albumin or increase destruction
    - - Chest discomfort, shortness of breath, orthopnea, or paroxysmal nocturnal dyspnea
        
        Also for cardiac ischemia
    - - Alcohol abuse, Unprotected sex (Hep B and C), use of injection drugs (Hep C), Use of illicit drugs (eg mushrooms or ecstasy), abdominal swelling
    - - Life threatening
        
        CHF (pulmonary congestion due to heart failure rather than due to edema)
        
        Deep venous thrombosis (can lead to pulmonary embolism)
        
        Suggestive of PE
        
        Sedentary position for a prolonged time 9eg, bedridden, long travel)
        
        Smoking
        
        History of blood clots
        
        Use or oral contraceptives, especially in smokers.
        
        Loss of consciousness (syncope)
        
        Presyncope: Feel like going to pass out especially when walking
        
        Also applies for outflow tract obstruction (aortic stenosis, hypertrophic cardiomyopathy, primary pulmonary hypertension, or atrial myxoma)
        
        Anaphylaxis
        
        New medications, exposure to latex or chemicals
- - - - Are there murmurs?
        
        Yes: Aortic or mitral valve disease
        
        No: Cardiomyopathy
    - - Is the JVP elevated?
        
        Yes: Pulmonic, tricuspid or pericardial disease
        
        No: Venous obstruction(thrombus) or lymphedema
  - - - Some are formulated as an anion for a salt and must be combined with a cation such as sodium for solubility. The sodium concentration can be considerable especially for every 4 hour dosing of a medication (eg ticarcillin) Daily recommended is less than 3g of sodium, 1 liter of normal saline 0.9% has 9g
    - - Minor LL edema due to sweating triggering the release of aldosterone, elevated levels lead to edema that resolves as the patient is prone at night.
    - - High sodium in chips,salted peanut, fast food,canned food and chinese food
    - - Most steroids stimulate the aldosterone receptor resulting in sodium and water retention.
    - - Cardiac, renal, hepatic cause
    - - Cushing's syndrome: Excess cortisol stimulates the aldosterone receptor , causing sodium and water retention.
  - - - Cardiomyopathy: Decrease in Left ventricular function due to myocyte damage from hypertension, ischemic heart disease, daibetes and rarely chemotherapeutic agents, viral infections or the post partum state. The decreased LVF elevates venous pressure in the lungs (dyspnea) and the systemic veins (edema)>
    - - Mitral regurgitation or stenosis: The most common cause of mitral stenosis is RHD. The most common cause of Mitral regurg are dilation of the left ventricle due to heart failure (the dilating ventricle pulls the valve leaftlets apart), myocardial infarction involving the papillary muscles (connecting the mitral valve to the left ventricle), or infection of the valve.
    - - Cardiac tamponade: Collection of fluid btw the pericardium and the heart that impairs the heart from accommodating systemic and pulmonary venous volume.
    - - Tricuspid stenosis or insufficiency: Most common causes are endocarditis and RHD; Tricuspid regurg is also caused by any cardiomyopathy.
    - - Aortic insufficiency: The incompetent valve increases left ventricular pressure and thus pulmonary vein pressure, causing dyspnea. The msot common cause of acute aortic insufficiency is infection of the aortic valve (endocarditis).
    - - Constrictive pericarditis: Impairs the right ventricle from expanding to accommodate venous blood return to the heart. Most common causes include tuberculosis, lung or breast cancer, and previous pericarditis of any cause.
    - - Aortic stenosis: Stenosis of the aortic valve impairs forward blood flow resulting in the pooling of blood in the lungs causing dypsnea, the elevated left ventricular pressure increase myocardial works and impairs subendocardial blood flow, resulting in cardiac ischemia and chest pain. the lack of blood flow to the brain results in syncope.
    - - Pulmonary stenosis or regurg
    - - Superior vena cava syndrome: Results from a mass(infectious or malignant) that encases the SVC preventing venous blood from returning to the heart The edema is localised to the arms and face.
    - - Hx of blood clots, smoking, bedridden, oral contraceptives, past diagnosis of cancer
        
        DVT: Most common causes of hypercoagulability include smoking, estrogen use and genetic predisposition ( factor V leiden, prothrombin mutation 20210, antithrombin 111 deficiency)
      - Edema localised to the left leg
        
        May Thurner syndrome: Compression of the left iliac vein as it crosses under the aorta to get to the IVC. Definitive diagnosis made by venogram
      - Abdo swelling
        
        Abdominal mass/pregnancy that obstructs the inferior cava will prevent venous volume from returning to the right heart.
      - Prominent veins --> Varicose veins
      - Hx of cancer? Yellow nails? Travelled to tropical areas?
        
        Lymphatic obstruction: The msot cmmon cause of lymphatic insufficiency is a malignancy obstructing lymph flow. Yellow nail syndrome is a genetic syndrome composed of yellow nails and lymphatic insufficiency. Parasitic infection may also obstruct the lymphatic chain (elephantiasis due to filariasis)
- - - - Yes: Nephrotic Syndrome (most common causes in adults DM, HTM, Minimal change, focal segmented glomerulosclerosis.
      - No: Does the patient have signs of liver disease? Stigmata (Spider nevi, gynaecomastia, bruising, sclera icterus, testicular atrophy, loss of axillary hair, telengiectasia)
        
        Yes:Cirrhosis
        
        No:Does the patient have diarrhea?
        
        Yes: Protein losing enteropathy (due to impairment of the bowel ability to absorb protein. The increased oncotic pressure in the bowel lumen causes diarrhea
        
        No: Malnutrition
        
        Hx of liver disease? Alcohol? Viral hepatitis?
- - - - Yes: Anaphylaxis CCB or ACE inhibitor induced edema
        
        CCB unknown how it causes. ACE degrades circulating bradykinin released naturally from tissue injury to promote extravasation of fluid at sites of injury.
      - No: Hypothyrodism measure TSH
        
        TSH normal: Hereditary angioedema, measure C4 levels
        
        Does the edema come and go suddenly
        
        Hereditary angioedema is due to a deficiency in C1 esterase. Without this enzyme, C1 accumualtes, stimulating the complement cascade resulting in excessive histamine release and angioedema. Almost always involve the face and lips and occasionally the GIT and airway.
        
        Do you feel tired, have dry skin, coarse hair, cold intolerance?
        
        Hypothyroidism increases vessel permeability and circulating volume due to excess ADH production