1. Definition, classification of edema
2. Differential diagnosis of edematous syndrome
3. Edema in children.
5. Principles of treatment of edematous syndrome
- Definition, pathogenesis, classification of edema
Edema Syndrome - excess fluid accumulation in tissuesbody and serous cavities, accompanied by an increase in the volume of tissues or a decrease in the serous cavity with a change in physical properties (turgor, elasticity) and the function of tissues and organs.
Normally, the amount of fluid flowing to the tissue,is equal to the amount of liquid withdrawn from it. The liquid takes the waste products out of the tissue and brings nutrients from the blood. The blood vessels have a porous wall, but these pores are so small that they do not allow the blood cells, proteins and salts to go beyond the vascular bed. The main causes of edema are the imbalance of systems for maintaining fluid exchange between tissues and blood vessels, supported by pressure gradients.
1) Depending on the etiology:
1. Cardiac edema - with CH
2. Hyponotic - kidney disease, hypoproteinemia in liver diseases, cachexia.
3. Venous edema - varicose veins of the legs, thrombophlebitis of deep
4. Lymphatic edema - lymphangitis, elephantiasis
5. Membranogenic swelling - inflammation, allergic edema, toxic edema
6. Endocrine edema - Myxedema, dropsy of pregnant women, cyclic edema with PMS
7. Iatrogenic (medicinal) - Hormones (corticosteroids, female sex hormones),
antihypertensive drugs (alkaloid rauwolfia,apricine, methyldopa, beta-adrenoblockers, clonidine, calcium channel blockers), anti-inflammatory drugs (butadione, naproxen, ibuprofen, indomethacin).
8. Other variants of benign edema: orthostatic and idiopathic.
1. Local: non-inflammatory (transudate) and inflammatory (exudate) origin, is associated with a violation of the balance of fluid in a specific area of tissue and organ.
- with diseases of veins, lymphatic vessels, allergic conditions.
2. Generalized develop due to the general hyperhidrosis of the body, divided into peripheral and cavitary (hydrothorax, hydropericardium, ascites).
1. Cardiac edema -</ i> with cardiac edema usually in anamnesis are availableindications of heart disease or cardiac symptoms: dyspnea, orthopnea, palpitations, chest pain. Edema in heart failure develops gradually, usually after the previous dyspnoea. Simultaneous with swelling, swelling of the cervical veins and stagnant liver enlargement are signs of right ventricular failure. Cardiac edema is localized symmetrically, mainly on the ankles and legs in walking patients and in the tissues of the lumbar and sacral regions - in bedridden patients. Skin over the area of edema is cold, cyanotic. In severe cases, ascites and hydrothorax are observed. Often there is nocturia.
2. Hyponotic</ i> occur with hypoproteinemia, especially albumin deficiency.
With kidney disease this type of edema is characterized by a gradual(nephrosis) or rapid (glomerulonephritis) development of edema often on the background of chronic glomerulonephritis, diabetes, lupus erythematosus, nephropathy of pregnant women, syphilis, thrombosis of renal veins, some poisoning. Edema is localized not only on the face, especially in the eyelid region (facial swelling is more pronounced in the morning), but also on the legs, lower back, genitals, anterior abdominal wall. Often ascites develops. Dyspnea, usually does not happen. When acute glomerulonephritis is characterized by an increase in blood pressure and possibly the development of pulmonary edema. There are changes in the analysis of urine. With a long-term kidney disease, hemorrhages or exudates on the fundus can occur. With tomography, ultrasound examination, a change in the size of the kidneys is detected. Study of renal function was shown.
Diseases of the liver lead to edema usually in the late stagepostnecrotic and portal cirrhosis. They are mostly ascites, which is often more pronounced compared with edema on the legs. The examination reveals clinical and laboratory signs of the underlying disease. Most often there is a previous alcoholism, hepatitis or jaundice, as well as symptoms of chronic liver failure: arterial arachnid hemangiomas ("stars"), hepatic palms (erythema), gynecomastia and developed venous collaterals in the anterior abdominal wall. The characteristic signs are ascites and splenomegaly.
Edema, associated with malnutrition developwith general starvation (cachectic edema) or with a sharp lack of protein in the diet, as well as in diseases accompanied by loss of protein through the intestine, heavy beriberi beriberi and in alcoholics. Usually there are other symptoms of nutritional deficiency: cheilosis, red tongue, weight loss. With edemas due to bowel diseases, there is often a history of intestinal pain or profuse diarrhea in the anamnesis. Edema is usually small, localized mainly on the legs and feet, often there is a puffy face.
Depending on the cause, venous edema canbe both acute and chronic. For acute deep vein thrombosis pain and soreness are typical for palpation of the affected vein. When thrombosis of larger veins is usually observed, and strengthening the surface venous pattern. If chronic venous insufficiency is caused by varicose veins or insolvency (postphlebitic) deep veins, the symptoms of chronic venous stasis are added to orthostatic edema: stagnant pigmentation and trophic ulcers.
This type of swelling refers to localedema; they are usually painful, prone to progression and are accompanied by symptoms of chronic venous stasis. With palpation, the area of edema is dense, the skin thickened ("pig skin" or orange peel "), while lifting the limb, puffiness decreases more slowly than with venous edemas. Isolate idiopathic and inflammatory formsedema (the most common cause of the latter is dermatophytosis), as well as obstructive (as a result of surgery, scarring with radiation damage or with neoplastic process in lymph nodes) leading to lymphostasis. Prolonged lymphatic edema leads to the accumulation of protein in the tissues, followed by the proliferation of collagen fibers and deformation of the organ - elephantiasis.
5. Membraneogenic edema.</ i> Due to the increased permeability of capillary membranes.
Allergic edema. It develops so quickly that it canthreaten human life if appears in the neck and face. Because of the excessive reaction of the body to the penetration of a foreign substance (allergen), the vessels in the interstitial area sharply expand, which leads to the release of fluid into the surrounding tissues. In the neck area, this edema leads to compression and swelling of the larynx and vocal cords, trachea - it is difficult or completely stops the flow of air into the lungs and the patient may die from suffocation. This condition is usually called Quincke's edema.
Traumatic edema - Puffiness after mechanical trauma is accompanied by pain and painfulness during palpation and is observed in the area of the transferred trauma (bruise, fracture, etc.)
Inflammatory swelling. accompanied by pain, redness, increasetemperature. The reason for this is in the overstretch of venous vessels due to increased blood flow, a decrease in the effectiveness of their work to remove fluid from the inflamed area and increase the permeability of their walls under the action of proteins that react to inflammation.
Toxic edema occurs when bites snakes, insects, when exposed to warfare agents.