DEFINITION

Edema is defined as a clinically apparent increase in

the interstitial fluid volume. Anasarca refers to gross, generalized edema. Ascites and hydrothorax refer to accumulation of excess fluid in the peritoneal and pleural cavities, respectively, and are considered to be special forms of edema.

SIGNS OF EDEMA
a weight gain of several kilograms
puffiness of the face, which is most readily apparent in

the periorbital persistence of an indentation of the skin following pressure; pitting edema ring on a finger fits more snugly than in the past a patient complains of difficulty in putting on shoes, particularly in the evening

PATHOGENESIS
Increased hydrostatic pressure
Decreased colloid oncotic pressure Increased capillary permeability

Retension of water and salt

CAUSES OF EDEMA
Obstruction of Venous (and Lymphatic) Drainage of a Limb
Congestive Heart Failure

Nephrotic Syndrome
Severe nutritional deficiency states Severe, chronic liver disease

DIFFERENTIAL DIAGNOSIS
LOCALIZED EDEMA Inflammation Venous obstruction Lymphatic obstruction GENERALIZED EDEMA Cardiac Hepatic Renal Nutritional

CARDIAC EDEMA
Dyspnea with exertion prominent, often associated

with orthopnea, or paroxysmal nocturnal dyspnea. Elevated jugular venous pressure, ventricular (S3) gallop, basilar rales. Distribution:
More extensive in the legs and to be accentuated in the

evening. When patients with heart failure have been confined to bed, edema may be most prominent in the presacral region.

HEPATIC EDEMA
Dyspnea infrequent
Frequently associated with ascites; jugular venous

pressure normal or low; blood pressure lower than in renal or cardiac disease; one or more additional signs of chronic liver disease (jaundice, palmar erythema, spider angiomata, male gynecomastia) Distribution:
Ascites

RENAL EDEMA
Usually chronic: may be associated with uremic signs

and symptoms, including decreased appetite, altered (metallic or fishy) taste, altered sleep pattern, difficulty concentrating. Blood pressure elevated Distribution
periorbital edema predominate

NUTRITIONAL EDEMA
Hipoproteinemia (hipoalbuminemia)
Edema resulting from hypoproteinemia

characteristically is generalized, but it is especially evident in the very soft tissues of the eyelids and face and tends to be most pronounced in the morning because of the recumbent posture assumed during the night.