Edema/Oedema

Abnormal fluid accumulation due to increase in

extravascular fluid volume

Factors Increased hydrostatic pressure- due to

sodium & water retention by kidneys

Reduced oncotic pressure- low albumin

Increased capillary permeability- inflammation

Lymphatic or venous obstruction

Mediators Renin-Angiotensin-Aldosterone system Decreased renal blood flow renin release from JG cells converts

A’ogenAT-IAT-II efferent arteriolar constriction Na/water reabsorption in prox. tubule & ascending limb of loop of Henle

AT-II aldosterone release from adrenal cortex Na reabsorption in collecting duct

Arginine vasopressin Decreased effective arterial volume AVP release

free water absorption in distal tubule & collecting duct Endothelin Renal vasoconstriction Na retention Atrial natriuretic peptide/Brain natriuretic peptide Antagonises RAA system Resistance to ANP/BNP in edematous states

Results

Weight gainPeriorbital puffinessPitting pedal edema

Localised or organ specificInf lammation- Trauma Poisoning Infection Hypersensitivity/Allergy-

mosquito bite, bee stingLymphatic/Venous

obstruction- Chronic lymphangitis Resection of LN/lymphatics Filariasis DVT

Drugs- Steroids Thiazolidenediones Calcium-channel blockers Arteriolar vasodilators Other- Myxedema- hypothyroidism Pregnancy Immobility

Generalized edema/Anasarca Heart failure DOE/PND/orthopnea, S3/S4, crepts, raised JVP, hepatomegaly Renal failure Hematuria, proteinuria, hypertension, reduced urine output Nephrotic syndrome Massive proteinuria (>3.5 gm./day), hypolabuminemia Cirrhosis Jaundice, collateral venous channels, peripheral s/o CLD, low albumin Malnutrition Hypoproteinemia

Work-up History Examination Weight Urine output CxR Serum albumin Urine exam, 24 hour albumin excretion LFT, RFT, ECHO, TFT

Treatment

Diuretics, if symptomaticTreat underlying cause