Remains pits for edema

Edema syndrome is an excessive accumulation of fluid in the tissues of the body and

serous cavities, manifested by an increase in the volume of tissues and changes in

capacity of the serous cavity, changes in physical properties and impaired

functions of edematous organs and tissues.

Edema is a symptom that can accompany various diseases.

Edema can be cachectic, associated with heart disease,

kidney, blood vessels, allergic, associated with liver disease,

idiopathic, etc. The definition of the type of edema is important for

differential-diagnostic search for the causes of this symptom. Required

to pay attention to many factors that will help differentiate the species

edema. With peripheral edema, there is an increase in the volume of the limb

or parts of the body, swelling of the skin and subcutaneous tissue, reducing them

elasticity. When palpation, a dough-like consistency of the dermal

cover, after pressing a finger on the skin remains a pit. Without

inflammatory complications of skin color in the area of ​​edema pale or

cyanotic. At sharply expressed edemas on the stretched shiny skin can

there are cracks, from which the edematous fluid oozes.

Factors contributing to the development of edema are:

- decrease in tissue pressure when the connective tissue is depleted by collagen

with an increase in its friability, for example, with the release of hyaluronidase, which

inflammation and toxic edema

- low pressure in the pleural cavity facilitates the development of hydrothorax at

general edema in patients with circulatory failure.

-a positive water balance of the body is basically a superfluous

retention of sodium in kidneys. The emerging hyperosmia of extracellular space

causes an increase in secretion of vasopressin, which enhances reabsorption

water in the renal tubules and leads to an excessive delay in the body.

Less often, the primary hypersecretion of vasopressin lies in the basis of edema. The main

the reason for the accumulation of sodium in edematic syndrome is hypersecretion

aldosterone, caused by hypovolemia or a decrease in cardiac output.

The associated decrease in renal blood flow increases renin secretion

kidneys, increases the formation of angiotensin II, which excites secretion

aldosterone. As a result of reabsorption of sodium in the distal nephron

increases, the osmotic pressure of the extracellular fluid rises,

The secretion of vasopressin is secondarily increased and water is excessively absorbed.

Thus, the main factors leading to a violation of local balance

water can be the following:

1. Increase of hydrostatic pressure in capillaries.

2. Reducing the oncotic pressure of the blood plasma.

3. Increased oncotic pressure of the interstitial fluid.

4. Decrease in tissue mechanical pressure.

5. Increase the permeability of capillaries.

6. Impaired lymph drainage.

There are local edema (localized), associated with a delay

fluid in a limited area of ​​body or organ tissue, and a common

(generalized) is a manifestation of the positive water balance of the organism in

whole. Generalized edema includes edema at the heart

insufficiency, cirrhosis of the liver, nephrotic and nephritic, dropsy

pregnant women, cachexical and idiopathic, as well as

chronic loss of potassium by the body

laxatives. To promote the appearance of edema or to accelerate them

development can: finylbutazone, pyrozolone derivatives, mineralocorticoids,

androgens, estrogens, licorice root preparations.

To localized edema include: cerebral edema, pulmonary edema, edema

extremities. Local edema develops in the absence of common disorders

water-elecrolitic metabolism and is associated with the presence of local disorders of hemo- and

lymphodynamics, capillary permeability and metabolism.

If after pressing a finger on the edematous skin there is no fossa, then

Swelling can be attributed to false. Such edema occurs with myxedema,

For differential diagnosis of edema of the lower limb with

Venous insufficiency with edema caused by cardiac

insufficiency, venous pressure in the ulnar vein should be measured. Edema

when the veins are mild or moderate in density, swelling of the skin is warm. When

Lymphostasis often causes irreversible subcutaneous compaction. For

recognition of hydrothorax and ascites may require both basic and

additional methods of examination (radiological, laboratory analysis

intracavitary fluid, etc.).

At objective inspection at a hydrotorax note restriction

the mobility of the chest during breathing, the weakening of vocal tremor,

blunt percussion sound above the liquid, and above its upper boundary -

blunt-tympanic. Breathing over the area of ​​blunting is weakened or

No, over the upper limit of blunting can be heard

bronchial respiration due to compression of the lung. Radiographically with

hydrothorax, homogeneous characteristic darkening in the lower part is determined

pulmonary field. With a trial pleural puncture, we get a transudate,

which is characterized by low specific gravity (less than 1015), content

protein less than 3%, lean cells.

In the presence of fluid in the abdominal cavity, the stomach is convex,

somewhat sagging in the patient's standing position and widening in the lateral

departments in the position of the patient lying down (frog stomach). The navel area

the skin of the abdominal wall is smooth, shiny, sometimes with pink

strips. When percussion of the abdomen in the patient's position on the back is determined

dull sound in the lateral parts of the abdomen. When the position of the body changes

localization of dullness changes: if the patient on the right side is dull

only on the right, if the patient stands - stupidity in the lower abdomen, etc. Percutaneous

at accumulation not less than 1,5 - 2 l of a liquid. With a small amount of liquid

sometimes you can get a dull sound in the navel area, if percussion

from below along the anterior abdominal wall in the knee-elbow position of the patient. When

Ascites of inflammatory origin, the characteristic distribution of percutaneous

sound as well as its change, with a change in the position of the body, may not

observed as a result of the fusion of the loops with the intestine between themselves and with the mesentery and

water entrapment. Diagnosis of ascites is facilitated by the appearance of fluctuations:

When applying the hand to one side of the abdomen and tapping on the abdominal

The wall with the arc side is affected by fluctuations (fluid fluctuation). For

excluding vibration of the abdominal wall

edge along the midline of the abdomen.

A nephrotic edema is characterized by a gradual onset. Edema

localized not only on the face, especially in the eyelid (puffiness of the face

more pronounced in the morning), but also on the legs, lower back, genitals,

anterior abdominal wall. Swelling quite quickly shifts when you change

positions of the body. The puffy skin is dryish, soft, pale, sometimes shiny.

Often there is ascites, less often - hydrothorax. Dyspnoea, as a rule, not

With nephritic edema, a rapid (early) onset. Edemas

pale, dense, normal temperature. Edema is localized

mainly on the face, as well as on the upper and lower extremities. Sometimes

Edema in liver cirrhosis - usually occur in the late stage

disease. Are mainly ascites, which happens more

is expressed than swelling on the legs. Sometimes there is hydrothorax (usually

right-sided). The oedematous skin is rather dense, warm. At inspection -

clinical and laboratory signs of the underlying disease.

Cough is the result of a general starvation or a sharp

deficiency in protein nutrition, as well as in diseases accompanied by loss

protein through the intestine (exudative forms of gastrointritis, ulcerative colitis,

lymphangiectasia in intestinal tumors). Severe beriberi, alcoholism.

Swelling is usually small, localized on the legs and feet, often

accompanied by a puffy face. If there is swelling of the whole body, then it is very

is mobile. The oedematous skin is of a dough consistency, dry. Characteristic of the general

depletion, hypoglycemia, hypocholesterolemia, severe hypoproteinemia,

Edema in pregnant women can be due to heart failure,

exacerbation of chronic glomerulonephritis, late toxicosis of a pregnant woman.

Dropsy of pregnant women is found after 30 weeks, rarely after 25 weeks

pregnancy. The puffy skin is soft, damp. Edema first appears on the

legs, then on the external genitalia, anterior abdominal wall, anterior

chest wall, waist, back, face. Ascites and hemothorax

Idiopathic edema. It is observed mainly in women of childbearing

age, prone to obesity and vegetative disorders. In men, there is

rarely. Sometimes after mental trauma and neuroinfections. Swelling is mild,

localized mainly on the lower legs, increases during the day and in

a hot season. Edema is often found on the eyelids and fingers.

The skin on the legs is often cyanotic. Sometimes skin hyperesthesia is noted.

Nephrotic syndrome is characterized by a low protein content in the

serum, pritheinuria, an increase in abstinence of lipids in the blood,

edema. At the heart of the pathological process are dystrophic,

degenerative processes in the kidneys. Nephrotic syndrome develops

secondary, being an integral part of many kidney diseases that occur with

defeat of the glomeruli. These include chronic glomerulonephritis,

glomerulonephritis in systemic connective tissue diseases, amyloidosis,

diabetes, kidney damage due to sensitization by allergens.

Patients with nephrotic syndrome are treated in connection with the appearance of them

edema, in the absence of edema, nephrotic syndrome can be detected by

significant proteinuria. Edema gradually increase, capture

subcutaneous tissue of the whole body (anasarca). The liquid can accumulate in

pleural area, pericardium, abdominal cavity. Urine small number, sometimes

up to 300 ml / day, sometimes dark, cloudy, specific gravity - 1030 - 1040. protein 3-

5 g / day. In the sediment urine - cells of the renal epithelium, hyaline, granular,

waxy cylinders, leukocytes. In blood, the protein is reduced, the amount

cholesterol increased, ESR accelerated.

With cardiac edema, swelling gradually increases, usually after

preceding dyspnoea. Simultaneously with the presence of edema - swelling of the cervical veins

and congestive enlargement of the liver are signs of right ventricular

insufficiency. The oedematous skin with cardiac edema is quite elastic, and

at a distal edema - condensed, can be coarsened, usually cold,

cyanotic. Cardiac edema is localized symmetrically,

ankles, shins in walking patients, tissues of the lumbar region and back.

Often there is massive ascites.