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APPROACH TO A CASE OF ANASARCA

APPROACH TO A CASE OF ANASARCA. Presented By Prof. Arvind Mishra Department of Medicine. Anasarca. Defined as gross generalised edema Edema is defined as a clinically apparent increase in the interstitial fluid volume, which may expand by several liters before the abnormality is evident.

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APPROACH TO A CASE OF ANASARCA

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  1. APPROACH TO A CASE OF ANASARCA Presented By Prof. Arvind Mishra Department of Medicine

  2. Anasarca Defined as gross generalised edema Edema is defined as a clinically apparent increase in the interstitial fluid volume, which may expand by several liters before the abnormality is evident

  3. Causes of anasarca Cardiac -cardiac failure, -pericardial effusion, -constrictive pericarditis Renal -chronic renal failure -nephrotic syndrome Hepatic- cirrhosis

  4. Malnutrition/malabsorption(i.e. celiac disease,crohn’s disease etc) Drug-induced Thyroid disorder

  5. Clinical feature Puffiness of face Pedal edema(pitting/non-pitting) Abdominal wall edema(by pressing with palm) Sacral edema

  6. STARLING FORCES IN SHIFTING THE FLUID IN DIFFERENT COMPARTMENTS The hydrostatic pressure within the vascular system and the colloid oncotic pressure in the interstitial fluid tend to promote movement of fluid from the vascular to the extravascular space. By contrast, the colloid oncotic pressure contributed by plasma proteins and the hydrostatic pressure within the interstitial fluid promote the movement of fluid into the vascular compartment.

  7. Mechanism of anasarca Decreased plasma oncotic pressure Lymphatic obstruction Increased capillary permeability Increased hydrostatic pressure

  8. Drugs causing edema

  9. HYPOTHYROIDISM

  10. INVESTIGATIONS Serum protein & albumin Urine analysis -protein, sugar -cast Kidney function test -s.urea -s.creatinine

  11. Liver function test -SGOT/SGPT -ALP -S.bilirubin Fecal fat estimation -to rule out malabsorption Thyroid function test ECG and echocardiography -LVEF -Valvular lesion -Regional wall motion abnormality

  12. Treatment Treatment of the underlying cause(cardiac, renal, hepatic, thyroid abnormality) Stop and replace the drug causing edema Diuretics Restricting salt and fluid intake and monitoring input-output Protein rich diet (in hypoalbuminemic state)

  13. MCQs

  14. 1)Causes of non pitting edema are all except a)Myxoedema b)Filariasis c)Angioneurotic edema d)Nephrotic syndrome

  15. 2)Pattern of edema(Legs ->face ->ascitis) in the given manner occurs in a)Cirrhosis b)Cardiac failure c)Nephrotic syndrome e)Nutritional edema

  16. 3)Drugs causing edema are all except a)Cilnidipine b)Hydralazine c)Amlodipine d)Clonidine

  17. 4)Milroy’s disease refers to a)Absence of thymus b)Congenital hypoplasia of lymphatics c)Post mastectomy lymphedema of upper limb d)Chylous pleural effusion

  18. 5)Angioneurotic edema is due to deficiency of a)C1 esterase inhibitor deficiency b)C5 convertase (C3bBbC3b) c)C1 esterase deficiency d)Factor H–related protein 1 (CFHR1)

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