EDEMAEDEMADEFINITION•Expansionoftheinterstitial（间质）fluidvolume.•Weightgainprecedesovertedema•Massiveandgeneralizededemaiscalledanasarca（全身性水肿）•Pitting(压凹性)andnon-pitting(非压凹性)edemaSchrothBE,JAAPA200511EdemaPittingedemaPittingedemaNon-pittingedemaNon-pittingedemaAnatomyandpathophysilolgy•1/3oftotalbodywaterisextracellularspace,and2/3isintracellularspace;•Extracellularspaceiscomposedoftheintravascularplasmavolume(25%)andtheextravascularinterstitialspaces(75%);Starling’slaw:•Extravascularandintravascularhydrostaticpressurs;•Differencesinoncoticpressureswithintheinterstitialspaceandplasma;•Thepermeabilityofthebloodvesselwall.Anatomyandpathophysilolgy•VascularsystemInterstitialspaceHydrostaticpressure（流体静水压）HydrostaticpressureColloidoncoticpressure(tissuetension)（胶体渗透压）ColloidoncoticpressureReducedPlasmaOsmoticPressureAlbuministheserumproteinMOSTresponsibleforthemaintenanceofcolloidosmoticpressureAdecreaseinosmoticpressurecanresultfromincreasedproteinlossordecreasedproteinsynthesisCapillaryDamage•Damagetothecapillaryendothelium•Increaseitspermeabilityandpermitsthetransferofproteinintointerstitialcompartment•InjuryagentsDrugsViral/bacterialagentsThermal/mechanicaltraumaImmune•Responsibleforinflammatoryedema•NonpittinglocalizedrednessandtendernessClinicalCausesofEdemaSystemicedema•Congestiveheartfailure•Cirrhosis•Nephroticsyndrome/otherhypoalbuminemia•Drug-induced•IdiopathicLocalizededema•Venous/lymphaticobstructionSystemicEdemaCongestiveheartfailureCongestiveheartfailure•Left-sidedheartfailure:shortnessofbreathwithexertionandwhenlyingdownatnight(orthophea,端坐呼吸)－－pulmonaryedema•Right-sidedheartfailure:swellinginthelegsandfeet－－peripheraledema•Thephysicianexaminingapatientwhohascongestiveheartfailurewithfluidretentionlooksforcertainsigns:pittingedema;ralesinthelungs,agalloprhythmanddistendedneckveins.SystemicEdemaNephroticSyndrome/Hypoalbuminemicstates•Theprimaryalteration:decreasedcolloidoncoticpressureproteinlossintheurineseverenutritionaldeficiencyproteinlossenteropathycongenitalhypoalbuminemialivercirrhosis•Promotesfluidmoveintotheinterstitium•Causeshypovolemiasalt/waterretentionactivationRAAaxisetcIdiopathicEdema•Diurnalalterationsinweightoccurringwithorthostaticretentionofsodiumandwater•Increaseincapillarypermeabilityfluctuateinseverityaggravatedbyhotweather•ReductioninplasmavolumeinthisconditionwithsecondaryactivationoftheRAAsystemDrug-inducededemaNonsteroidalanti-inflammatorydrugsAntihypertensiveagentsDirectarterial/arteriolarvasodilatorsCalciumchannelantagonistsa-AdrenergicantagonistsSteroidhormonesGlucocorticoidsAnabolicsteroidsEstrogensProgestinesCyclosporineGrowthhormoneImmunotherapiesInterleukin2OKT3monoclonalantibodyLocalizededema•Inflammation•Venous/lymphaticobstruction•Chroniclymphangitis•Resectionofregionallymphnodes•Filariasis(丝虫病)Diagnosis•Ofparticularimportanceisexcludingmajororgansystemdysfunction,especiallycardiac,liver,andrenaldysfunction.•Askquestionssuchasthefollowing:Dotheringsonyourfingersgettight?Haveyouhadtoletyourbeltout?Haveyourclothesorshoesgottentootight?•Payspecialattentiontothepatient’smedications;•Also,obtainathoroughdietaryhistory,payingcarefulattentiontothepatient’sdietarysodiumintake,totaldailyfluidintake;Physicalexamination&Diagnostictesting•Inadditionto...
