Edema - PowerPoint PPT Presentation

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edema diagnosis and management aafp july 15 2013 volume 88 number 2 presented by dr anne zbaracki n.
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Edema

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  1. EdemaDiagnosis and ManagementAAFP,July 15, 2013 ,volume 88, number 2presented by Dr. Anne Zbaracki

  2. Edema • Accumulation of fluid in interstitial space due to capillary filtration exceeding lymph drainage

  3. Edema • Capillary hydrostatic pressure and oncotic pressure is regulated by fluid between interstitial and intravascular spaces • Disruption in local or systemic conditions

  4. Assessment • History • Timing- acute, chronic • Position • Unilateral, bilateral • Medications • Systemic diseases

  5. Assessment • PE • Focus on medial malleoulus, bony tibia, dorsum • Pitting • Tenderness • Skin changes-temperature, color, texture

  6. Assessment Kaposi-Stemmer sign, in lymphedema

  7. Assessment • PE • Systemic causes • Heart failure-jvd, crackles • Renal-proteinuria, oligouria • Hepatic-jaundice, ascities, asterixis • Thyroid- exopthalmus, tremor, wt loss

  8. Local • Cellulitis • Chronic venous insufficiency • Compartment syndrome • Complex regional pain syndrome type I • DVT • Iliac vein obstruction • Lipedema • Lymphedema primary or secondary • May-Thurner syndrome

  9. Systemic • Allergic reaction, urticaria, angioedema • Cardiac disease • Hepatic disease • Renal disease • Malnutrition/malabsorption • Obstructive sleep apnea • Pregnancy, premenstrual

  10. Cellulitis • Increased capillary permeability

  11. Chronic Venous insufficiency • Increased capillary permeability from local venous hypertension • treatment- compression, horse chest nut seed extract, skin care

  12. Compartment Syndrome • Increased capillary permeability from local venous hypertension

  13. Complex regional pain syndrome type I • Neurogenically mediated increased capillary permeability Treatment- systemic steriods, topical dimethyl sulfoxide, PT, tricyclic, ca++ blockers

  14. Deep venous thrombosis • Increased capillary permeability

  15. Lipedema • Accumulation of fluid in adipose tissue • Treatment- none

  16. Lymphedema • Lymphatic obstruction

  17. May-Thurner syndromecompression of left iliac vein by right iliac artery • Increased capillary permeability from local venous hypertension from compression

  18. Allergic reaction • Increased capillary permeability • Medications • Antidepressants- monoamine oxidase inhibitors, trazodone • Antihypertensives- b-blockers, calcium channel blockers, clonidine, hydralazine, methyldopa, minoxidil • Antivirals-acyclovir • Chemo- cyclophosphamide, cyclosporine, cytosine arabinoside, mithramycin • Hormones- androgen, corticosteriods, estrogen, progesterone, testoterone • Nsaids-celecoxib,ibuprofen • Diuretic- volume depletion and reflex renin angiotensin stimulation

  19. Cardiac disease • Increased capillary permeability from systemic venous hypertension, increased plasma volume

  20. Hepatic disease • Increased capillary permeability from systemic venous hypertension, decreased plasma oncotic pressure from reduced protein synthesis

  21. Renal disease • Increased plasma volume, decreased plasma oncotic pressure from protein loss

  22. Malnutriton/ Malabsorption • Decreased plasma oncotic pressure from reduced protein synthesis

  23. Obstructive sleep apnea • Increased capillary hydrostatic pressure from Pulmonary hypertension

  24. Pregnancy • Increased plasma volume

  25. Diagnostic studies • Labs-bnp, creatinine, urinalysis, lft’s, albumin, d-dimer • Ankle-brachial index • Ultrasonography- venous, compression w or w/o dopplar, duplex • Lymphoscintigraphy- radionuclide • MRI- w venography • Echo-pulmonary arterial pressures