Review of systems should include symptoms of causative disorders, including dyspnea during exertion, orthopnea, and paroxysmal nocturnal dyspnea heart failure ; alcohol or hepatotoxin exposure, jaundice, and easy bruising a liver disorder ; malaise and anorexia cancer or a liver or kidney disorder ; and immobilization, extremity injury, or recent surgery DVT.
Past medical history should include any disorders known to cause edema, including heart, liver, and kidney disorders and cancer including any related surgery or radiation therapy. The history should also include predisposing conditions for these causes, including streptococcal infection, recent viral infection eg, hepatitis , chronic alcohol abuse, and hypercoagulable disorders.
Drug history should include specific questions about drugs known to cause edema see table Some Causes of Edema Some Causes of Edema Edema is swelling of soft tissues due to increased interstitial fluid. Patients are asked about the amount of sodium used in cooking and at the table.
The area of edema is identified and examined for extent, warmth, erythema, and tenderness; symmetry or lack of it is noted. In the general examination, the skin is inspected for jaundice, bruising, and spider angiomas suggesting a liver disorder. Lungs are examined for dullness to percussion, reduced or exaggerated breath sounds, crackles, rhonchi, and a pleural friction rub.
The heart is palpated for thrills, thrust, parasternal lift, and asynchronous abnormal systolic bulge. Auscultation for loud pulmonic component of 2nd heart sound P2 , 3rd S3 or 4th S4 heart sounds, murmurs, and pericardial rub or knock is done; all suggest cardiac origin. The abdomen is inspected, palpated, and percussed for ascites, hepatomegaly, and splenomegaly to check for a liver disorder or heart failure.
The kidneys are palpated, and the bladder is percussed. An abnormal abdominal mass, if present, should be palpated. Potential acute life threats, which typically manifest with sudden onset of focal edema, must be identified. Acute DVT may lead to pulmonary embolism Pulmonary Embolism PE Pulmonary embolism PE is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis.
Risk factors for pulmonary embolism are Acute angioedema sometimes progresses to involve the airway, with serious consequences. Dyspnea may occur with edema due to heart failure, DVT if PE has occurred, acute respiratory distress syndrome, or angioedema that involves the airways.
Generalized, slowly developing edema suggests a chronic heart, kidney, or liver disorder. Although these disorders can also be life threatening, complications tend to take much longer to develop.
These factors and other clinical features help suggest the cause see table Some Causes of Edema Some Causes of Edema Edema is swelling of soft tissues due to increased interstitial fluid.
For most patients with generalized edema, testing should include complete blood count CBC , serum electrolytes, blood urea nitrogen BUN , creatinine, liver tests Laboratory Tests of the Liver and Gallbladder Laboratory tests are generally effective for the following: Detecting hepatic dysfunction Assessing the severity of liver injury Monitoring the course of liver diseases and the response to treatment Other tests should be done based on the suspected cause see table Some Causes of Edema Some Causes of Edema Edema is swelling of soft tissues due to increased interstitial fluid.
Patients with isolated lower-extremity swelling should usually have venous obstruction excluded by ultrasonography. Patients with sodium retention often benefit from restriction of dietary sodium. Patients with heart failure should eliminate salt in cooking and at the table and avoid prepared foods with added salt. There are People with conditions involving sodium retention may also benefit from loop or thiazide diuretics.
However, diuretics should not be given only to improve the appearance caused by edema. When diuretics are used, potassium wasting can be dangerous in some patients; potassium-sparing diuretics eg, amiloride , triamterene , spironolactone , eplerenone inhibit sodium reabsorption in the distal nephron and collecting duct.
When used alone, they modestly increase sodium excretion. Both triamterene and amiloride have been combined with a thiazide to prevent potassium wasting. An ACE inhibitor—thiazide combination also reduces potassium wasting. In older people, use of drugs that treat causes of edema particularly heart failure requires special caution, such as the following:. Monitoring for orthostatic hypotension if diuretics, ACE inhibitors, angiotensin II receptor blockers, or beta-blockers are used.
Evaluating for bradycardia or heart block if digoxin , rate-limiting calcium channel blockers, or beta-blockers are used. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. In many forms of edema, despite the increase in extracellular fluid volume, the effective arterial blood volume, a parameter that Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'.
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Davis AT Collection. Davis PT Collection. Murtagh Collection. About Search. Intracranial edema can occur due to several causes including generalized hypoxia, injury, abscesses, or tumors. Fluid in the body cavities is another clinical cause of edema. Etiologies include pleural effusion such as heart failure, inflammation, or tumors , pericardial effusion such as in inflammation or tumors , or ascites due to cirrhosis, heart failure, or tumors.
Ascites will typically present with abdominal distention, shifting dullness, and a fluid wave on percussion of the abdomen. The treatment for generalized edema largely depends on the etiology. The first step in treatment is to treat the underlying cause. Certain instances, such as pulmonary edema, can be a life-threatening condition requiring immediate therapy. In other cases, the reduction of interstitial fluids can be accomplished more slowly. If retention occurs because of compensatory causes, such as in cirrhosis or heart failure, then fluid removal with diuretics needs to be well-balanced since arterial blood volume, and thus tissue perfusion, can be compromised during treatment [27].
When edema is caused by heart failure, nephrotic syndrome, or sodium retention, mobilization of edema fluid can occur rapidly [28]. Specifically, when a patient has anasarca, removal of two to three liters of fluid in 24 hours is acceptable without clinically significant changes in plasma volume [29].
Diuretics, specifically loop diuretics such as furosemide, bumetanide, and torsemide, can reduce edema fluid. Caution needs to be taken when using diuretics in patients with cirrhosis and ascites of the liver with no peripheral edema or with localized edema due to venous of lymphatic obstruction, or malignancy [30]. The American journal of medicine. News in physiological sciences : an international journal of physiology produced jointly by the International Union of Physiological Sciences and the American Physiological Society.
Cardiovascular research. Reed RK,Rubin K, Transcapillary exchange: role and importance of the interstitial fluid pressure and the extracellular matrix.
Woodcock TE,Woodcock TM, Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. British journal of anaesthesia. The Journal of clinical investigation. Renkin EM, B. Zweifach Award lecture. Regulation of the microcirculation. Microvascular research. Taylor AE, Capillary fluid filtration. Starling forces and lymph flow.
Circulation research. Annals of internal medicine. Deitch EA, The management of burns. The New England journal of medicine. Kidney international. Lancet London, England. Studies on sodium, potassium and water excretion on a constant electrolyte and fluid intake. The Journal of clinical endocrinology and metabolism. Swollen lower limb general assessment and deep vein thrombosis. BMJ Clinical research ed. Pettinger WA,Keeton K, Altered renin release and propranolol potentiation of vasodilatory drug hypotension.
Russell RP, Side effects of calcium channel blockers. Hypertension Dallas, Tex. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Pockros PJ,Reynolds TB, Rapid diuresis in patients with ascites from chronic liver disease: the importance of peripheral edema. Wilcox CS, New insights into diuretic use in patients with chronic renal disease. Boyer TD, Removal of ascites: what's the rush? Brater DC, Diuretic therapy.
Physiology, Edema. Free Review Questions. Introduction The definition of edema is a swelling due to the expansion of interstitial fluid volume in tissues or an organ. Issues of Concern The average human is made up of between 50 to 60 percent water.
Cellular Edema is believed to be the outward filtration predominating the arterial end of the capillary, and as hydrostatic pressures fall, fluid reverts to the capillary from the interstitium driven by the oncotic pressure gradient. Organ Systems Involved Several organs play a role in edema.
Mechanism Edema formation occurs into two fundamental steps.
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