Edema

Edema

palpable swelling produced by expansion of the interstitial fluid volume.

Starling's Forces

The two opposing forces responsible for water movement across capillary walls

Hydrostatic Pressure

the pressure within a blood vessel that tends to push water out of the vessel

Oncotic Pressure

The pressure of water to move, typically into the capillary, as the result of the presence of plasma proteins.

What changes to Starling's Forces lead to fluids moving into intestitium?

• Increase hydrostatic capillary
• Decrease hydrostatic interstitial
• Decreases oncotic capillary
• Increased oncotic interstitial

What are the main water compartments of the body?

• Intracellular (2/3)
• Extracellular (1/3)

What are the sections of extracellular fluid?

• Interstitial Fluid (2/3 of EC - 2/9 of total)
• Intravascular Fluid (1/3 of EC - 1/9 of total)

Semipermeable Membrane

allows the passage of some particles while blocking the passage of others

Osmosis

Diffusion of water through a selectively permeable membrane

How does water move in osmosis?

low solute concentration to high solute concentration

Tonicity

the concentration of dissolved substances that cannot cross the semipermeable membrane

IV D5W

Intravenous solution of 5% dextrose in water.

• Does not replete intravascular volume as it is hypotonic

0.9% NS

isotonic solution used to replete IV bolume

Ascites

accumulation of fluid in the peritoneal cavity

Anasacra

severe generalized edema

Where are some areas we can note edema?

• LE
• UE
• Head and Chest
• Periorbital
• Peritoneal
• Presacral
• Everywhere

When do we see presacral edema

Bedridden Patients

What are some causes of LE edema?

• DVT*
• Cellulitis
• Lymphedema
• Venous Insufficiency
• CHF
• Pregnant
• Medications
• Idiopathic

Until proven otherwise, LE/UE edema is…

DVT

What are the causes of UE edema?

• DVT*
• Cellulitis
• Lymphedema
• SVC Syndrome

What typically causes head and chest wall edema

SVC syndrome

What typically cause periorbital edema?

Nephrotic Syndrome

What typically causes ascites?

Liver Failure

What are some causes of localized edema?

• DVT
• Cellulitis
• Pregnancy
• Lymphedema
• SVC syndrome
• Venous Insufficiency (Ex)

What are some causes of systemic edema?

• CHF
• Liver Failure
• Nephrotic Syndrome
• Medications
• Idiopathic

How does DVT present?

• Acute unilateral extremity pain and swelling
• May be erythemaous

Virchow's Traid

1. venous stasis
2. intimal injury
3. hypercoaguability

What can cause venous stasis?

• Recent surgery
• Recent travel
• Recent prolonged bedrest
• Obesity
• Pregnancy
• Paralysis
• Casts

What can cause vessel wall injury?

• Recent vascular surgery
• Local venous trauma
• Central Lines
• Prior DVT

What can cause hypercoagulable state?

• Cancer
• OCP
• Congenital Clotting Disorders
• Pregnancy
• Post-Partum

Cellulitis

Inflammation of cellular or connective tissue

How does cellulitis present?

• Fever and Chills
• Pain w/ Swelling, Erythema, and Warmth
• Central Lesion
• Lymphangitic Streaking
• Promixal Lymphadenopathy
• History of local trauma, infections, or prior episdoe

Who typically gets cellulitis more often?

• Diabetics
• Immunosupression

What conditions cause immunosupression?

• DM
• HIV
• Cancer
• Sickle Cell
• End-Stage Organ Disease

What surgical procedures cause immunosuppression

• Splenectomy
• Organ Transplant

What meds cause immunosupression

• Steroids
• Chemo
• Immunosuppressants

What social history can cause immunosuppression

ETOH Abuse
Drug Abuse
Malnutrition

Lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

How does lymphedema presentation?

Non-Tender Pitting Edema

What causes lymphedema

• Radical mastectomy
• Lymph Node Dissection
• Local Tumor
• Prior XRT

Superior Vena Cava (SVC) Syndrome

Progressive occlusion of the superior vena cava

How will SVC syndrome present?

• Headaches
• Facial Fullness
• Forehead + Facial + Bilateral UE Edema
• Venous Distension in Neck + Chest

What is the most common cause of SVC syndrome

Lung Cancer

How does pregnancy cause edema

Increased venous pressure due to enlarging uterus

How does pregnancy edema present

Bilateral LE edema with varicositis

Venous Insufficiency

inadequacy of the venous valves and impairment of venous return from the lower limbs

How does venous insufficiency present?

• Unilateral or bilateral LE edema
• Brown Hemosiderin

Brown Hemosiderin

a brown skin deposit that forms on the lower leg
Sign of venous insufficiency

What are the risk factors for venous insufficiency

Age
Wheelchair Bound

How does CHF present?

• Bilateral LE swelling that progresses to groin/gential area
• SOB + DOE + Orthopnea + PND
• Nocturia
• JVD
• S3 heart sound
• Bilateral Rales
• Hepatomegaly

How will liver failure present?

• RUQ pain
• Clay colored stool
• Dark Urine
• Easy Bruising
• Confusion
• Jaundice
• Scleral icterus
• Hepatomegaly
• Ascites

What causes nephrotic syndrome

severe proteinuria

How does nephrotic syndrome cause edema?

Decreases oncotic capillary pressure

Foamy Urine can be sign of…

Nephrotic Syndrome

What conditions may someone with nephrotic syndrome also have

DM
CT Disorders

What medications cause edema

• CCBs
• NSAIDs
• Steroids

What group gets idiopathic edema most frequently?

Menstruating Women 20s and 30s

How does idiopathic edema present?

• Swelling persists through menstrual cycle
• Facial + Hand + LE swelling