Edema: Pendrik Tandean Internal Medicine, Medical Faculty of Hasanuddin University, Makassar
Edema: Pendrik Tandean Internal Medicine, Medical Faculty of Hasanuddin University, Makassar
Edema: Pendrik Tandean Internal Medicine, Medical Faculty of Hasanuddin University, Makassar
Pendrik Tandean
Internal Medicine, Medical Faculty of
Hasanuddin University, Makassar
Definition :
Soft tissue swelling due to abnormal
expansion of interstitial fluid volume.
Edema fluid is a plasma transudate that
accumulates when movement of fluid from
vascular to interstitial space is favored.
Since detectable generalized edema in the
adult reflects a gain of >3 L,renal retention
of salt and water is necessary for edema to
occur. Distribution of edema can be an
important guide to cause.
Types of edema
• Dependent bilateral edema
(usually“pitting”)
• Lymphedema
• Localized edema
• Myxedema
Pitting dependent
edema:
causes :
• Decreased serum protein
• Increased systemic venous pressure
• Capillary edema (increased permea-
bility).
Edema due to hypoalbuminemia:
common causes
1. Impaired protein synthesis
– Decreased protein intake: starvation, kwashiokor
– Decreased absorption of proteins: malabsorption
– Impaired hepatic synthesis due to liver disease
2. Increased loss of protein
– Skin loss: burns, weeping skin diseases
– Urinary loss: nephrotic syndrome
– Fecal loss: bowel disease
Edema due to venous pressure:
Common causes
1. Systemic venous hypertension
– Congestive heart failure
– Pericardial diseases, tricuspid valve
disease
2. Regional venous hypertension
– Inferior vena cava syndrome
– Venous thrombosis
– Lower extremity venous insufficiency
Edema due to capillary permeability
• Vasculitis
• Idiopathic cyclic edema of women
– Varies with menstrual cycle
• Post-anoxic encephalopath
Pitting recovery time
• Technique:
– Press firmly to bone
– Shine light and determine time resolution
of shadow
• Interpretation
– Acute edema (< 3 months)
– < 40 seconds associated with low serum
albumin
Rapid pitting recovery:
< 40 seconds
1. Decreased of protein synthesis :
– protein intake: dietary history
– Rapid pitting recovery: < 40 seconds
absorption of proteins: diarrhea
– hepatic synthesis due to liver disease:
History: alcohol, other hepatotoxins, hepatitis
Physical findings: spider angiomata
2. Increased loss of protein :
– Skin loss: skin lesions such as burns, ulcers
– Urinary loss: foamy urine with high protein
– Fecal loss: diarrhea, sticky, oily stools
Edema with rapid
pitting recovery:
Evaluation of etiology
• Impaired protein synthesis
– ↓protein intake: starvation, kwashiokor
– ↓absorption of proteins: malabsorption
– ↓hepatic synthesis due to liver disease
• Increased loss of protein
– Skin loss: burns, weeping skin diseases
– Urinary loss: nephrotic syndrome
– Fecal loss: bowel disease.
Slow pitting time (> 40 seconds)
normoalbuminemic edema
4. Lymphatic obstruction
Starvation
Traumatic
Obstructive
Paralytic
Consistency of Fluid
Transudate vs. Exudate
Pitting vs. Nonpitting