DYSPNEA, CYANOSIS,

DYSPNEA, CYANOSIS,
EDEMA
EDEMA
Differential diagnostic aspects
Differential diagnostic aspects
Prof. Mrta Hgye
Prof. Mrta Hgye

DYSPNEA
DYSPNEA
Definition: Definition: dyspnea is an abnormally uncomfortable awareness of dyspnea is an abnormally uncomfortable awareness of
breathing. breathing.
Normal: Normal: 14 breaths/min 14 breaths/min
- Hyperventillation - Hyperventillation
- Tachypnoe - Tachypnoe
- Hyperpnoe - Hyperpnoe
Dyspnea is a symptom! Dyspnea is a symptom!
mportant to define the mportant to define the circumstances! circumstances! in which the dyspnea occurs in which the dyspnea occurs
Quantitation of dyspnea: Quantitation of dyspnea: "degree of dyspnea# "degree of dyspnea#
- breathlessness on strenuous e$ertion - breathlessness on strenuous e$ertion
- breathlessness on light activity - breathlessness on light activity
- breathlessness at rest - breathlessness at rest
- orthopnoe - orthopnoe
%&H' st. -(. %&H' st. -(.
Dyspnea: Dyspnea: principle symptom of cardiac and pulmonary diseases principle symptom of cardiac and pulmonary diseases

CLASSIFICATION OF DYSPNOE
CLASSIFICATION OF DYSPNOE
1. inspiratory 1. inspiratory e$spiratory e$spiratory
). sudden onset ). sudden onset chronic presence chronic presence
*. e$ertional *. e$ertional at rest at rest

DYSPNEA
DYSPNEA
There is a reasonally good correlation between the severity There is a reasonally good correlation between the severity
of dyspnoe and the disturbances of of dyspnoe and the disturbances of pulmonary pulmonary or or cardiac cardiac
function function
Dyspnea in attacks: Dyspnea in attacks:
- +aro$ismal nocturnal dyspnea - +aro$ismal nocturnal dyspnea
"+%D# , cardiac asthma "wee- .(# "+%D# , cardiac asthma "wee- .(#
- /heyne 0 1to-es respiration 0 "periodical# - /heyne 0 1to-es respiration 0 "periodical#
- /ardiogenic pulmonary edema - /ardiogenic pulmonary edema

Dyspnoe in acut heart
failure
"pulmonary congestion#

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
I. I. Ostructi!e disease of air"ays Ostructi!e disease of air"ays
II. II. Diffuse parenc#ymal lung diseases Diffuse parenc#ymal lung diseases
III. III. Pulmonary !ascular occlusi!e diseases Pulmonary !ascular occlusi!e diseases
I$. I$. Heart diseases Heart diseases
$. $. %n&iety. Neurosis %n&iety. Neurosis
$I. $I. Neuromuscular diseases Neuromuscular diseases

'dema pulmonum

Pneumonia loaris

Disseminated metastases of pulmonum
(adenocarcinoma)

*irosis pulmonum

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
I. Ostructi!e disease of air"ays: I. Ostructi!e disease of air"ays:
+. ,pper air"ay ostruction: +. ,pper air"ay ostruction:
%cut: %cut:
- aspiration of food or foreign body - aspiration of food or foreign body
- glottis edema - glottis edema
needs medical emergency needs medical emergency!! !!
-#ronic: -#ronic:
- tumors with fibrotic stenosis - tumors with fibrotic stenosis
The cardinal symptoms are2 dyspnea and inspiratorical The cardinal symptoms are2 dyspnea and inspiratorical
stridor stridor! and ! and rectraction of the supraclavicular fossae with rectraction of the supraclavicular fossae with
inspiration inspiration! !

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
.. Intrat#oracic air"ays ostruction: .. Intrat#oracic air"ays ostruction:
/o"er air"ay ostruction: /o"er air"ay ostruction:
%cut: %cut:
- asthma bronchiale! - asthma bronchiale!
-#ronic: -#ronic:
- chronic bronchitis - chronic bronchitis
- bronchiectasy - bronchiectasy
1ymptoms2 1ymptoms2 cough with or without e$pectoration. ntercurrent cough with or without e$pectoration. ntercurrent
infection results in worsening of the cough! increased infection results in worsening of the cough! increased
e$pectoration of purulent sputum and more severe dyspnea. e$pectoration of purulent sputum and more severe dyspnea.
- - obstructive emphysema obstructive emphysema2 dilatation of the terminal air 2 dilatation of the terminal air
sacs with disruption of alveloar septa. sacs with disruption of alveloar septa.
0esult 0esult

cor pulmonale c#ronicum1 cor pulmonale c#ronicum1

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
II. Diffuse parenc#ymal lung diseases: II. Diffuse parenc#ymal lung diseases:
This category includes a large number of diseases ranging from This category includes a large number of diseases ranging from
acut pneumonia acut pneumonia to chronic disorders! such as to chronic disorders! such as sarcoidosis sarcoidosis! and ! and
tne various forms of tne various forms of pneumoconiosis! pulmonary fibrosis pneumoconiosis! pulmonary fibrosis. .
- - Hystory Hystory
- +hysical findings - +hysical findings Diagnosis Diagnosis
- 3adiographic abnormalities - 3adiographic abnormalities

DIFFEENTIAL DIA!NOSIS
DIFFEENTIAL DIA!NOSIS
Hystory: Hystory:
- -nown illnesses2 - -nown illnesses2 asthma bronchiale! st. p. '4! /HD! asthma bronchiale! st. p. '4! /HD!
heart valve disease! hypertension! deep heart valve disease! hypertension! deep
vein thrombosis vein thrombosis
- onset of dyspnoe2 - onset of dyspnoe2 asthma bronchiale often at 4-5 o6cloc- asthma bronchiale often at 4-5 o6cloc-
in the morning but cardiac in the morning but cardiac
asthma begins in sleeping period. asthma begins in sleeping period.
- other complaints2 - other complaints2 chest pain! etc. chest pain! etc.
- dependence on position2 - dependence on position2 cardiac origin cardiac origin

P"YSICAL E#AMINATION
P"YSICAL E#AMINATION
- e$spiratorical s7uee8ing over both sides is typical for - e$spiratorical s7uee8ing over both sides is typical for
asthma bronchiale asthma bronchiale
- pulmonary rales! . or (. heart sounds! gallop rhythm! - pulmonary rales! . or (. heart sounds! gallop rhythm!
enlarged heart borders! murmurs! distended 9ugular veins! enlarged heart borders! murmurs! distended 9ugular veins!
peripheral edema peripheral edema cardiac origin cardiac origin! !
- pleural friction rub - pleural friction rub +:! pleuropneumonia +:! pleuropneumonia
- crepitation! dullness during percussion - crepitation! dullness during percussion pneumonia pneumonia

E#AMINATIONS
E#AMINATIONS
2 0adiograp#ic anormalities: 2 0adiograp#ic anormalities: chest ;-ray! /T! 43 chest ;-ray! /T! 43
2 'c#ocardiograp#y: 2 'c#ocardiograp#y: e$act cardiac cause2 pericardial effusion! e$act cardiac cause2 pericardial effusion!
heart valve diseases! systolic dysfunction! .<-wall heart valve diseases! systolic dysfunction! .<-wall
segmental dys-inesis segmental dys-inesis
2 '-3: 2 '-3: '4! .(H! atrial fibrillation! atrial overload '4! .(H! atrial fibrillation! atrial overload
2 Ot#er e&ams: 2 Ot#er e&ams: bronchoscopy! comple$ lung function test! bronchoscopy! comple$ lung function test!
perfusion. lung-scintigraphy perfusion. lung-scintigraphy

DIFFUSE PAENC"YMAL DISEASES
DIFFUSE PAENC"YMAL DISEASES
+atient is +atient is tachypneic tachypneic! !
arterial arterial P P
-O. -O.
and and P P
O. O.
below normal below normal
:$ertion further recudes the art. + :$ertion further recudes the art. +
=) =)
.ung volumes .ung volumes
.ungs are stiffer .ungs are stiffer less compliant less compliant
nfiltrates nfiltrates of the lung are usually either of the lung are usually either cellular cellular "inflammatory! "inflammatory!
neoplastic# or neoplastic# or noncellular noncellular "infiltration by edema fluid! collagen or "infiltration by edema fluid! collagen or
other substances. other substances.
:$tensive fibrosis :$tensive fibrosis with lung destruction2 with lung destruction2
- diffuse idiopathic pulmonary fibrosis - diffuse idiopathic pulmonary fibrosis

CAUSES OF DIFFUSE INFILTATI$E
CAUSES OF DIFFUSE INFILTATI$E
DISEASES OF T"E LUN!S
DISEASES OF T"E LUN!S
. . %>:/T=%12 %>:/T=%12 virus! bact.! fungi virus! bact.! fungi
. . =//?+'T=%'.2 =//?+'T=%'.2 silicosis! asbestosis! siderosis silicosis! asbestosis! siderosis
. .%:=+.'1T/2 %:=+.'1T/2 bronchoalveolar cc! lymphoma bronchoalveolar cc! lymphoma
(. (. /=%@:%T'. or >'4.'.2 /=%@:%T'. or >'4.'.2 cystic fibrosis cystic fibrosis
(. (. 4:T'A=./2 4:T'A=./2 uraemic pneumonia uraemic pneumonia
(. (. +H1/'. '@:%T12 +H1/'. '@:%T12 postirradiation fibrosis postirradiation fibrosis
(. (. 44?%=.=@/'.2 44?%=.=@/'.2 1.: 1.:
(. (. ?%B%=< =3@%2 ?%B%=< =3@%2 histiocytosis! sarcoidosis histiocytosis! sarcoidosis

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
III. Pulmonary !ascular occlusi!e diseases: I. III. Pulmonary !ascular occlusi!e diseases: I.
+. Pulmonary t#romoemolism (P4'): +. Pulmonary t#romoemolism (P4'): 1CD of all +T: results death! 1CD of all +T: results death!
/onditions with high ris- /onditions with high ris- for +T:2 for +T:2
'rterial 'rterial blood gases blood gases
abnormal but abnormal but
lung volumes lung volumes
normal or normal or
minimally minimally
abnormal abnormal
- postoperative period - postoperative period
- pregnancy
- postpartum period
- use of anovulatory drugs
- congestive heart failure
- chr. pulmonary disease
- fractures or other in9uries of the lower
e$tremities
- chronic deep venous insuff. of the legs
- prolonged bed rest
- carcinomas

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
Pulmonary !ascular occlusi!e diseases: II. Pulmonary !ascular occlusi!e diseases: II.
%ote %ote2 2 - 3(H - 3(H
- 1igns of right ventricular failure - 1igns of right ventricular failure
- 3epeated episodes of dyspnoe at rest - 3epeated episodes of dyspnoe at rest
- 1ource for emboli - 1ource for emboli
Diagnostic features Diagnostic features2 2
- 1udden onset of une$plained dyspnoe - 1udden onset of une$plained dyspnoe
- +leuritic chest pain - +leuritic chest pain
- Haemoptysis! acut cyanosis and tachycardia - Haemoptysis! acut cyanosis and tachycardia
with acut right ventricle overload with acut right ventricle overload
+. Primary pulmonary #ypertension +. Primary pulmonary #ypertension
young female young female
(asoconstriction of pulm. wessels (asoconstriction of pulm. wessels
- 1.:! anticoncipient drugs! 3aynaud disease - 1.:! anticoncipient drugs! 3aynaud disease
pulmonary pulmonary
thromboembolism thromboembolism

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
I$. Heart disease: I$. Heart disease:
'&ertional dyspnea: '&ertional dyspnea:
-ause: -ause: - - elevated pulmonary capillary pressure elevated pulmonary capillary pressure
- left ventrical dysfunction - left ventrical dysfunction
/ardiac dyspnea /ardiac dyspnea usually begins as breathlessness on e$ertion! and over the usually begins as breathlessness on e$ertion! and over the
course of years progresses until the patient is dyspnoic at rest. course of years progresses until the patient is dyspnoic at rest.
- - =rtopnoe =rtopnoe , dyspnea in recumbent position , dyspnea in recumbent position
- - +aro$ismal "nocturnal# dyspnea +aro$ismal "nocturnal# dyspnea , cardiac asthma! attac- of dyspnea! which , cardiac asthma! attac- of dyspnea! which
generally occurs at night. generally occurs at night.
- - /heyne /heyne - 1toc-es respiration - 1toc-es respiration
- - +ulmonary edema +ulmonary edema2 2 :levated pulmonary venous pressure :levated pulmonary venous pressure
- 'lveloar edema - 'lveloar edema
- nterstitial edema - nterstitial edema

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
Paro&ysmal dyspnea: (Diff.) Paro&ysmal dyspnea: (Diff.)
ast#ma ronc#iale (pulmon.) ast#ma ronc#iale (pulmon.) ast#ma cardiale (cardiol.) ast#ma cardiale (cardiol.)
1. e$piration is prolonged! 1. e$piration is prolonged!
spastic breathing spastic breathing
). in young ages
*. no cardiac disease
4. cough "improductive#
E. outcome is not severe
5. daytime
F. 4orphin must not be administered
- inspiratorical
dyspnea! rales
- in elderly pts
- cardiac underlying diseases2
HD! '=1! '=! hypertension
- cough "stertorous#
- severe condition
- at night! lying
- 4orphin is useful!

CAUSES OF DYSPNEA
CAUSES OF DYSPNEA
$. %n&iety. Neurosis $. %n&iety. Neurosis
'cut and chronic. Hyperventillation 'cut and chronic. Hyperventillation
Ai8arr! irregular breathing. Ai8arr! irregular breathing.
G G%eurocirculatoric astheniaH %eurocirculatoric astheniaH
$I. Neuromuscular diseases $I. Neuromuscular diseases
- Dystrophia musculorum progressiva - Dystrophia musculorum progressiva
- Aec-er6s dystrophy - Aec-er6s dystrophy
- +olyomyelitis - +olyomyelitis

CYANOSIS
CYANOSIS

CYANOSIS
CYANOSIS
G G 4ore sign! than a symptomH 4ore sign! than a symptomH
- - 5luis# color 5luis# color of the s-in and mucous of the s-in and mucous
membranes! resulting from an increased membranes! resulting from an increased
amount of reduced hemoglobin amount of reduced hemoglobin
- .ips - .ips
- %ail beds - %ail beds
- :ars - :ars
G G 3ed cyanosisH 3ed cyanosisH , polycytaemia vera , polycytaemia vera
G G /herry-coloredH flush /herry-coloredH flush , carbo$yhaemoglobin , carbo$yhaemoglobin
G G 'rgyriaH 'rgyriaH - subcutaneous deposition of the silver salts - subcutaneous deposition of the silver salts

-yanosis

-yanosis

CYANOSIS
CYANOSIS
/yanosis /yanosis , the level of reduced-Hgb is elevated! more , the level of reduced-Hgb is elevated! more
than E g/1CC ml in the main capillary veins than E g/1CC ml in the main capillary veins
- - +eripheral +eripheral cyanosis cyanosis "local! cold effect# "local! cold effect#
- - /entral /entral cyanosis cyanosis arterial = arterial =
) )
satur. satur.

CENTAL CYANOSIS
CENTAL CYANOSIS
n lung diseases n lung diseases2 2 - obstructive emphysema - obstructive emphysema
- pulm. emboli - pulm. emboli
- cor pulm. chr. - cor pulm. chr.
- pulmonary edema - pulmonary edema

CENTAL CYANOSIS
CENTAL CYANOSIS
In -ardiac diseases: In -ardiac diseases:
0ig#t 6 to 6 left s#unts 0ig#t 6 to 6 left s#unts
1./ +D' I coarctation 1./ +D' I coarctation
)./ +D' I :isenmenger syndr. )./ +D' I :isenmenger syndr.
*./ >allot tetralog. "(1DI+1I3(HI'= de$tr. position# *./ >allot tetralog. "(1DI+1I3(HI'= de$tr. position#
4./ (1D I :isenmenger syndr. 4./ (1D I :isenmenger syndr.
E./ >allot trilogia E./ >allot trilogia
5./ '1D 5./ '1D
F./ T@' F./ T@'


PEIP"EAL CYANOSIS
PEIP"EAL CYANOSIS

3educed cardiac output "heart failure# 3educed cardiac output "heart failure#

/old e$posure /old e$posure

3edistribution of blood flow from e$tremities 3edistribution of blood flow from e$tremities

'rterial obstruction "'1=! emb.# 'rterial obstruction "'1=! emb.#

(enous obstruction "thromb.# (enous obstruction "thromb.#

3aynaud6s phenomen 3aynaud6s phenomen

(ena cava sup. syndr. "1to-es collar# (ena cava sup. syndr. "1to-es collar#

CAUSES OF CYANOSIS% SUMMAY
CAUSES OF CYANOSIS% SUMMAY
I. -entral cyanosis I. I. -entral cyanosis I.
%. 0educed O %. 0educed O
. .
2satur. of arteries 2satur. of arteries
1. =n high altitude - decreased air pressure 1. =n high altitude - decreased air pressure
). mpaired lung-functions ). mpaired lung-functions
a. alveolar hypoventillation a. alveolar hypoventillation
b. hypoventillated and hypoperfused alveoli b. hypoventillated and hypoperfused alveoli
c. reduced diffusion of = c. reduced diffusion of =
) )
*. 'natomical abnormal pathways2 shunts *. 'natomical abnormal pathways2 shunts
a. congenital heart diseases a. congenital heart diseases "not all of them# "3 "not all of them# "3 . shunt# . shunt#
b. pulmon. '(-fistulas b. pulmon. '(-fistulas
c. multiple small intrapulmonary shunts c. multiple small intrapulmonary shunts
4. Dysfunction of o$ygen-binding at the haemoglobine 4. Dysfunction of o$ygen-binding at the haemoglobine

CAUSES OF CYANOSIS% SUMMAY
CAUSES OF CYANOSIS% SUMMAY
I. -entral cyanosis II. I. -entral cyanosis II.
5. %normal #aemogloins 5. %normal #aemogloins
1. 4ethaemoglobinaemia 1. 4ethaemoglobinaemia hereditaer hereditaer
a7uired a7uired
). 1ulfhaemoglobinemia ). 1ulfhaemoglobinemia a7uired a7uired
*. /arbo-mono$i haemoglobinaemia *. /arbo-mono$i haemoglobinaemia
"/=-Hgb# 0 not really cyanosis "/=-Hgb# 0 not really cyanosis

CAUSES OF CYANOSIS% SUMMAY
CAUSES OF CYANOSIS% SUMMAY
II. Perip#eral cyanosis II. Perip#eral cyanosis
'. 3educed cardiac output "in heart failure# '. 3educed cardiac output "in heart failure#
A. /old effect! frie8ing A. /old effect! frie8ing
/. 3edistribution of blood from the e$tremities /. 3edistribution of blood from the e$tremities
D. 'rterial obstruction "embol.# D. 'rterial obstruction "embol.#
:. (enouose obstruction "thromb.# :. (enouose obstruction "thromb.#

EDEMA
EDEMA
&S'(pto(e)
&S'(pto(e)

EDEMA
EDEMA
The The e$tracellular volume e$tracellular volume of the body increased of the body increased
The edema fluid a palpable! visible The edema fluid a palpable! visible fluid retention fluid retention
under the s-in-surface under the s-in-surface
The edema-fluid an isotonic saltvater! the specific The edema-fluid an isotonic saltvater! the specific
gravity is in beetwen 1CC5-1C1) gravity is in beetwen 1CC5-1C1)

'dema 'dema

'D'M%: 'D'M%: generalised generalised causes causes2 2
- cardiac origin - cardiac origin
- renal origin - renal origin
- hepatic origin - hepatic origin
- hypoproteinaemia - hypoproteinaemia
localised localised causes2 causes2
- inflammation - inflammation
- angioneurotic edema - angioneurotic edema
- local obstruction of the - local obstruction of the
circulation in thrombophilebitis circulation in thrombophilebitis
- posoperative lymphatic - posoperative lymphatic
obstruction e.g. obstruction e.g.

!enous t#romosis of
left lo"er e&tremities
localised edema

PAT"OP"YSIOLO!ICALLY I*
PAT"OP"YSIOLO!ICALLY I*
'. '. elevation of the hydrostatic-pressure elevation of the hydrostatic-pressure
in the venous part of the capillary system and in the in the venous part of the capillary system and in the
larger veins larger veins phlebohypertension "cardiac edema! phlebohypertension "cardiac edema!
varicositas# varicositas#
A. A. reduction of the colloid-osmotic pressure reduction of the colloid-osmotic pressure of the plasma of the plasma
proteins! due to hypoproteinaemia or hypoalbuminaemia proteins! due to hypoproteinaemia or hypoalbuminaemia
"low oncotic pressure# "low oncotic pressure# [ [nephrosis syndrome! hepatic nephrosis syndrome! hepatic
disorders! e$udative enteropathies disorders! e$udative enteropathies] ]. .

PAT"OP"YSIOLO!ICALLY II*
PAT"OP"YSIOLO!ICALLY II*
/. /. 1alt retention 1alt retention
- in case of renal and cardiac origin of edema! secundary - in case of renal and cardiac origin of edema! secundary
hyperaldosteronism hyperaldosteronism
D. D. increase in the permeability of the capillaries increase in the permeability of the capillaries
- in case of nephritis! allergic processes! inflammations - in case of nephritis! allergic processes! inflammations
:. :. disturbances of the lymphatic-circulation disturbances of the lymphatic-circulation
- in case of posthrombotic sydrome! lymphangitis! - in case of posthrombotic sydrome! lymphangitis!
lymphoedema lymphoedema
>. >. overproduction of 'DH secretion overproduction of 'DH secretion
- in case of hepatic edema! praemenstrual edema! - in case of hepatic edema! praemenstrual edema!
primaer olyguria primaer olyguria

PACTICALLY
PACTICALLY
'dema can e: 'dema can e:
- generalised or localised - generalised or localised
- symmetric or assymetric - symmetric or assymetric
- transudate or e$sudate - transudate or e$sudate

!ENEALISED EDEMA
!ENEALISED EDEMA
-ardiac origin7 mainly due to congesti!e #eart failure -ardiac origin7 mainly due to congesti!e #eart failure
:dema is a cardinal manifestation of congestive heart failure. :dema is a cardinal manifestation of congestive heart failure.
"transsudation# "transsudation#
n patients with n patients with chronic left ventricular failure chronic left ventricular failure and a and a low cardiac low cardiac
output output! e$tracellular fluid volume becomes e$panded. ! e$tracellular fluid volume becomes e$panded.
'bout E l fluid in adults usually ta-es place before peripherial 'bout E l fluid in adults usually ta-es place before peripherial
edema is manifested "latent edema# edema is manifested "latent edema#

!ENEALISED EDEMA
!ENEALISED EDEMA
-ardiac edema -ardiac edema
is usually: is usually: - symmetric - symmetric
- pitting - pitting
- generally occurs first in the dependent - generally occurs first in the dependent
position of the body! where the systemic position of the body! where the systemic
venous pressure rises to its highest levels venous pressure rises to its highest levels
,sually ,sually first noted first noted in the feet or an-les at the end of the in the feet or an-les at the end of the
day and resolves after a night6s rest. day and resolves after a night6s rest.
'nasarca develops later. 'nasarca develops later.

-#ronic #eart
failure
(rig#t #eart failure)
- cardiac edema
- central cyanosis
- hepatomegaly
- elevated venous pressure

!ENEALISED EDEMA
!ENEALISED EDEMA
Hydrot#ora&: Hydrot#ora&: "pleural effusion# "pleural effusion#
usually bilateral! or right sided "transsudatum# usually bilateral! or right sided "transsudatum#
%scites: %scites: due to increased pressure in the hepatic veins due to increased pressure in the hepatic veins
n case of organic tricuspid valve disease! chronic n case of organic tricuspid valve disease! chronic
constrictive pericarditis ascites may be more constrictive pericarditis ascites may be more
prominent than subcutaneouse edema prominent than subcutaneouse edema

ascites

5ilateral pleural
effusion
(#ydrot#ora& l.d.)

!ENEALISED EDEMA
!ENEALISED EDEMA
Pulmonary edema Pulmonary edema
the most dramatic symptom of heart failure "left ventricle :> the most dramatic symptom of heart failure "left ventricle :> # #
-auses of cardiac edema: -auses of cardiac edema:
- phlebohyperten8ion - phlebohyperten8ion
- hyperaldosteronism - hyperaldosteronism
- salt and vater retention - salt and vater retention
- left ventricular failure - left ventricular failure

!ENEALISED EDEMA
!ENEALISED EDEMA
0enal edema 0enal edema on the face on the face
- palpebrae - palpebrae
- hypoproteinaemia - hypoproteinaemia
- nephrosis syndrome amyloidosis - nephrosis syndrome amyloidosis
Malnutrition Malnutrition
My&edema: My&edema:
- hypothyreosis - hypothyreosis

EDEMA% Algor+'t( of diff* dg*
EDEMA% Algor+'t( of diff* dg*
:dema :dema
localisedJ localisedJ
albumin albumin
K )!E g/de K )!E g/de
distended distended
v. 9ugul. or /= v. 9ugul. or /=
a8otaemia a8otaemia
or abnormal or abnormal
urine-finding urine-finding
L
venouose or lymphatic obstruction venouose or lymphatic obstruction
L
local impairment! in9ury local impairment! in9ury
"heat "heat immunol.! infections! mechanic# immunol.! infections! mechanic#
L
cirrhosis hepatis cirrhosis hepatis
L
nephrosis syndrome nephrosis syndrome
L
heart failure heart failure
L
renal insuffitienty renal insuffitienty
%=T:2 %=T:2 edema caused by drugs "steroids! oestrogens! vasodilators# edema caused by drugs "steroids! oestrogens! vasodilators#
hypothyreosis "my$oedema# hypothyreosis "my$oedema#
yes yes
yes yes
yes yes
yes yes
no no
no
no no
no no
/=,cardiac output /=,cardiac output

T+an, 'o- for 'o-r attention.