DEFINITION OF EDEMA

The Accumulation of Abnormal

Amounts of Extravascular,
Extracellular Fluid.

ANASARCA : Severe, widely

distributed pitting edema.

TYPES OF EDEMA
GENERALIZED
LOCALIZED
Inflammation
Lymphatic Obstruction
Venous Obstruction
Thrombophlebitis

CARDIAC
HEPATIC
RENAL
NEPHROTIC SYNDROME
ACUTE GN
CRF
IDIOPATHIC
Other
Cyclic
Myxedema
Vasodilator-induced
Pregnancy-induced
Capillary leak syndrome

MECHANISMS OF
EDEMA FORMATION

of
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F
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l
Sta r

P cap
IS

P IS
cap

(Capillary Permeability)
nterstitial Space
Filtration < or = Lymphatic Drainage

odema

Filtration > Lymphatic Drainage

DEMA

CARDIAC EDEMA
Diagnosis
History of Heart Disease
Evidence of Pulmonary Edema
Orthopnea
SOB
Exertional Dyspnea
Evidence of Volume Expansion
Hepatic Congestion
Hepatojugular Reflux
Ventricular Gallop Rhythm

CARDIAC EDEMA
Pathophysiology
HEART DISEASE
Left Ventricular
Dysfunction

Increased
Pulmonary
Venous Pressure

Pulmonary Edema

Right Ventricular
Dysfunction

Hypotension
Renal Na Retention
Systemic Edema

HEPATIC EDEMA
Diagnosis
History of Liver Disease
Diminished CrCl (Normal Serum Cr)
Evidence of Chronic Liver Disease
Spider Angiomata
Palmar Erythema
Jaundice
Hypoalbuminemia
Evidence of Portal Hypertension
Venous Pattern on Abdominal Wall
Esophogeal Varices
Ascites

LIVER DISEASE
Liver Cirrhosis

HEPATIC EDEMA
Pathophysiology

Increased Pressure in Hepatic Sinusoids

Exudation of Fluid Into Peritoneal Cavity

Ascites

Neurohumoral Activation
(Increased Volume Hormones)

Functional Renal Insufficiency

(Hepatorenal Syndrome)

Renal Na Retention

Systemic Edema

RENAL EDEMA
Diagnosis
History of Renal Disease
Evidence of Albumin Loss
Narrow, pale transverse bands in nail beds
Proteinuria (3+ to 4+)
Hypoalbuminuria
Renal Imaging
Enlarged Kidneys
Shrunken Kidneys

Nephrotic Syndrome or AGN

CKD ( chronic kidney disease )

RENAL EDEMA
Diagnosis
An abnormality in the kidney can be detected by the following :
1. Changes in the serum creatinine concentration, reflected by
GFR
2. Abnormalities urinalysis
3. Altered renal homeostasis mechanism; hypertension,
abnormal volume regulation , hyperphosphatemia, anemia
4. Abnormal renal imaging study

RENAL EDEMA
Diagnosis

Urinalysis

Nephrotic Syndrome
Hyaline Casts
Oval Fat Bodies
Lipid Droplets/Casts
Acute Glomerulonephritis
Hematuria
Erythrocyte Casts
Leukocyte Casts
Pyuria
Chronic Kidney Dissease
Broad Waxy Casts

C
RO
TI

Urinary Loss of Albumin

Reduced GFR

Hypoalbuminemia

Renal Na Retention

Altered Starling Forces

Systemic Edema

AY
W
TH
PA

NE
PH

RENAL DISEASE

C
TI
RI
PH
NE

PA
TH
W
AY

RENAL EDEMA
Pathophysiology

IDIOPATHIC EDEMA
Diagnosis

Women of Childbearing Age

Associated with Eating Disorders
Dependent Edema
Facial Edema
Abdominal Bloating

IDIOPATHIC EDEMA
Pathophysiology

of
e
c
n
a
l
a

rces
o
F
g
n
i
l
Sta r

P cap
IS

P IS
cap

(Capillary Permeability)
nterstitial Space

Filtration > Lymphatic Drainage

DEMA

Classification of diuretic
Proximal diuretics

Loop diuretics

DCT diuretics

CCT diuretics

CAI ( diamox )

bumetadin
furosemid
edecrin

hygroton

aldacton etc

Edema pulmonum / over hydration

1.
2.
3.
4.

Large dose , 40 mg/hr - 12 hr

Dopamin / dobutamin + furosemid
Dialysis, haemofiltration, CAVH
hBNP ( nesitirid ), CHF