EdemaDefinition•Theexcessiveaccumulationofintestitialfluid•Apathologicprocesscausedbydiseases•NotaccompaniedwithcellularedemaClassification•Accordingtotherangethatedemafluidspreadsto:–Generalizededema–Localizededema•Accordingtothecauseofedema:–Renaledema–Hepaticedema–Cardiacedema–Malnutritionaledema–lymphedemaClassification•Generalizededema:–Puffinessoftheface–Indentationoftheskin“pittingedema”–Ascites&Hydrothorax•LocalizededemeEdemaPittingedemaPittingedemaAscitesDifferentialdiagnosis•Heartfailure•Renaldiseases•Cirrhosis•Nutritionalorigin•Idiopathic•OthersDifferentialdiagnosisHeartFailure•Occursatlowerpartofthebody(lowerextremities)•Symmetriclocation•Thepresenceofheartdiseases–Cardiacenlargement–Galloprhythm–Dyspnea–Basilarrales–Venousdistention–HepatomegalyDifferentialdiagnosisRenaldiseases•Hypoalbuminemia&Retentionofsodiumandwater•Associated:–Hematuria–Proteinuria–Hypertention–Impairedrenalfunctionaltest•Characteristicofedema–PuffinessofthefaceDifferentialdiagnosisCardiac/RenaldiseaseRenalCardiacLocationonsetfromtheface,onsetfromthelowerperiobitalareaspartofthebodyProgressionprogressquicklyprogressslowlyIdentitysoftandmobilerelativelysolid,lessmobileOthersignsproteinuriasignsofheartfailure:hypertensioncardiacenlargementimpairedrenalvenousdistentionfunctionaltesthepatomegalyDifferentialdiagnosisLiverdiseases(cirrhosis)•Clinicalevidenceofhepaticdisease–Jaundice–Spiderangiomas–Ascites•AscitesrefractorytothetreatmentcirrhosisDifferentialdiagnosisIdiopathicedema•Exclusiveinwomen•Periodicepisodes•AccompaniedbyabdominaldistentionDifferentialdiagnosisOtherCausesofEdema•Hypothyroidism•Pregnancy•Estrogens•AngioneuroticApproachtothepatientGeneralizedGeneralizedLocalizedLocalizedorHeartLiverKidneyVenousobstructionLymphaticobstructionA50-year-oldmanhasahistoryofdiffuseedemafor5years.Hepresentstothehospitalwithworseningedemaforamonth.Theedemabeganfromthelowerlimbsandspreadeduptohechestandback,accompaniedwithdyspneaanddifficultiesinlyingdown.Thesymptomsrespondedtodiureticstherapy.Pasthistory:mitralvalvereplacementandaorticvalvereplacementforrheumatcheartdisease30yearsago.Bp:130/80mmhg.Physicalexaminationrevealsjugularvenusdistention.DullnesstopercussionanddecreasedbreathsoundsinlowerpartsofbothlungsTheliveredgeispalpated4cminferiortotheribwithtendernessandshiftingdullnessispositive.pittingedemainbothlowerlimbsandtheabdominalwall1.Whichofthefollowingisthemostlikelydiagnosisforthispatient?AEdemaofthenephroticsyndromBCardiogenicedemaCHepatogenicedemaD.VenousthrombosisEIdiopathicedema2.Whichofthefollowingisthediagnostictestofchoiceforthispatient?ADopplerultrasonographyforthekidneysBDopplerultrasonographyforlowerextremitydeepveinsCAbdomenCTD.EchocardiographhyEEStrogentest3.Whichofthefollowingtreatmentsisnotappropriate?A.limitinfusionBDiuresisCDrainageofascitesD.anti-infectionESodiumrestricteddietThanksforyourattension!
