Medical sem book 100-200

Fluid Thrill: Elicited only if the fluid-filled lesion is very large.
- Examination: Tap on one side and feel the impulse on the other.
- Pulsatility: Check if a pulse can be felt in the lump.
  - Determine if the pulse is from an underlying structure or if the lump itself is pulsating.
  - Use two fingers to feel pulsations: if the lump is pulsating, fingers will move up and outwards; if pulse is transmitted from below, fingers will move upwards without outward motion.

Compressibility: Attempt to compress the lump until it disappears.
- Release pressure to see if the lump reforms.
- Compressible lumps may be fluid-filled or vascular malformations.
- Note this is not reducibility, which refers to hernias.
Reducibility: For hernias, try to reduce the lump by maneuvering its contents into another space.
- Ask the patient to cough; watch for lump reforming.

Always listen with a stethoscope over any lump; important clues about its origin and contents include:
- Vascular Bruits: Abnormal sounds indicating blood flow.
- Bowel Sounds: May indicate communication with the gastrointestinal tract.

Definition: Swelling of tissues due to an increase in interstitial fluid.
Extracellular Fluid Composition:
- About one-third of total body water is extracellular; 25% of that is plasma, remainder is interstitial fluid.
Common Accumulations:
- Peripheral edema: usually in legs (ankle edema).
- Pulmonary edema: fluid in the lungs.
- Ascites: fluid in the abdomen.
- Pleural effusion: fluid in the chest cavity.
Anasarca: Severe, widespread accumulation of fluid in all tissues.
Fluid movement in capillaries is influenced by hydrostatic and colloid oncotic pressures, potentially leading to oedema if the balance is disrupted.

Generalized Oedema: Caused mainly by hypoproteinaemia and fluid overload.
- Distinction made by Jugular Venous Pulse (JVP): elevated in fluid overload but not in hypoproteinaemia.

Mechanism: Ions cross vascular endothelium; osmotic pressure in capillaries is largely due to plasma proteins (albumin). Reduced albumin predisposes to oedema.
Characteristics of Oedema: White and soft, often in the legs and facial areas (periorbital edema).
Causes:
- Inadequate protein intake/absorption: Kwashiorkor, pancreatic dysfunction, malabsorption syndromes.
- Inadequate protein production: Chronic liver disease leading to reduced synthesis.
- Excessive protein loss: Nephrotic syndrome or protein-losing enteropathy.

Causes:
- Cardiac: Decreased renal blood flow, increased venous pressure, hormonal adaptations.
  - Conditions include congestive heart failure, chronic constrictive pericarditis.
- Renal: Conditions like acute glomerulonephritis can lead to fluid overload.
- Iatrogenic: Too much IV fluid can cause overload.

Causes: May originate from venous, lymphatic, inflammatory, or allergic issues.
- Venous: Increased pressure in veins can lead to localized swelling; investigate for blockages or obstructions.
- Lymphatic: Impaired lymph flow can lead to lymphoedema (e.g., after surgeries).
- Inflammatory: Associated with infection; will also exhibit redness, heat, and pain.
- Allergic: Non-painful localized swelling that may include redness and itching (angio-oedema).

Distribution can suggest potential causes. Gravity influences these in standing or lying patients.
Common sites include legs, abdomen, face, and areas depending on position.
Weight Gain: Often indicative of fluid retention.

Inspection: Compare limbs for swelling; shiny skin indicates significant edema.
Palpation:
- Check for pitting: press firmly and observe return of indentations back to normal.
- Localize swelling levels, checking for specific areas.
Day-to-Day Changes: Reliable index of fluid changes; significant weight variations indicate fluid retention.

Inspect for quantity, distribution, and texture:
- Sparse hair suggests hypothyroidism; silky hair indicates hyperthyroidism.
Alopecia: can be diffuse, patchy, or total. Note onset (sudden/gradual) and other symptoms.

Patterns of loss (male pattern baldness), excessive hair growth (hirsutism, hypertrichosis).

Changes indicative of systemic conditions:
- Look for onycholysis, pitting, Beau's lines, koilonychia, paronychia, and splinter hemorrhages.
Color changes may reflect different conditions (yellow in jaundice, cyanosis, etc.).

Always take a detailed history regarding the onset, duration, and any treatments.
Inspect full body; focus on abnormal formations.
Lymph nodes must be checked in cases of suspected malignancy or systemic disease.
Document findings systematically for accuracy.