KALVAKOTA MANNITHYA

16-O444-152|
6epeBember bath
Bloc 6
Case al
edema
13/Male presentd wrih duspnea and 71ecurel bipedal
Duspoea disomfort that tonsist o
Dehined as a Subjective enptemenct 0 brtachinq
qualitahvely distincd sensations that vary in iHnsity
Cavdiac and
Duspnea tan arise from a diverse anay o pulmonany.
nunlogic underling Cousts, and eucida hn opatiulas Sumpoms
may Point towaid a specijic ehioloqu and Dr
mechanism
driving
dnving
dyspneo
*Approach t the patient wh dyspnco-
wil Usuallu addiuss
he inHal DCuS o the waluaion) and appmch
whethey a
or
the Known wndmon has prqresbed
deka mtnin.q
Qetamini.q wneher
Dew process has dvdped that is causing dyspnea
caust or an undcilyingetiology, i} passible
the underlyinq
Det mining based up
as the
htadment may vany dramatically
is enhemels ímpotant,
the pedispbsíng tomdittn to he
fundamental 4to
tundamental
enaminati enaîn
jenain
and physiual
iniial histony
hístony
diagposhic i n g
as indicatd thad might
by inítal
evaluatiun follwed
promt Subs peialty

History words. wha enactly il feek

o deseriot in hís/ hes Oun
and envimmental shimuli
Ask the pahen and e n i m m e n t l shimu

as well as posrtins, injtchions

ike, distomsut
bn dyspnea
bnchoconshmctun
Chest hghiness- Sgqest possoilty o
toYTelat wth dynamic hypeninlahiy
dep breath may
Inability to toke
tominan for onqeshive hart fuiluye)
m COPD, Othopn
 onsthve hunt failuve CHF)
or aslhma
Nocturnal duspnea sugqusis
Aoute epispdes o cuspn ta elech muptardial ischemia, bronchospasm
Pulmonany embo lism
Or
mmic persistent duspneo ís mDre typiuol oCOPD, Intnshitial lung
distase and chmic hrmlopembolic distas
disease
Kisk fochors o ocupational lung
druq induced (o)

COrmany artmy distase showldbe icitd

Shuld be onsidend
et amal my noma Cor) he patopulmonary 64ndome
whun patet mplains o platypnea e , dyspneo in the upnaht

Position with zjelie in suptne pusition-

Physitol EMaminathen)
.
in tuad
TDY
husiol Enaminatan vital stgns might be hephul pointing
an undedylng enidogy

hesence o wer mighi print towaids an underlyinq inlschtns )

inlammator poces
resence ok hupestunslun in the seting o a hat ilure might
N
Print toward diastoic dyundtonm
be assouiaBed with many dijerent
Presence o tchuchardia miaht
fwr, cavdiac dusunction, deunditioninq
undelng
underlying procses incuding
to speak in tull sentn ces belore otoppinq
Inability the paie
a COndition hal lunds to stimulatin
qet a deep eath sugqess
educed
othe tontoller or impairment othe ventilaton pump with
Vit apacity. An eNevhional onygen saturation 8hould be rbtained
tviden ce o haased wok o bruathing is fodiuative o meetased
anway esistance o SHnen o he lunas and chest wal
Duingthe qenenal xamination, Siqns o anmia, yanosis and Gnbosi's
shuld be Sbuqni
naminatiom chest should focus on Sy meneny ombvement; perusain
and ausuHaion
Clubbing o the diqt may be an inditahi inen stihial pulmonany
Hbnsis oY bonehitectasis
Kdema
Fdena 7epsenu on ences oh intnshhial Hwd that has beume evident
abnoima acmulai on in the inkrstihal space that emeecs
clinitallyhe Intrshtial fuid space is
the tapacty plugsiologitod lumphahe dranaqe
o he
udnstatic and
ontotic pressuve aradient acmss
dependent on te

Capilanes and also the lumphatic dnano

dnannge

pprmach to ne Patien voth tdema

qeneralred
Detumine whethe the edema is docabed or be
ena that may be espurnsi
the dema is Jocalized, the loua phenom
Shbuld be ldentihed. the distibutim o edem,
is inpDYtant to quide its

the edema is qeneralited, dekmrine theve s Sendus hypo albuminaia

eq 8erum albumin 23:0 qldi
hypoalbuminenia is preserd- the hicton phyaia enamination, urnalysis
and othe laboiatomy da will hep evalualu the questior o anhosis,
Sevue mal nuition Dr the nphwtic sundrome as the unde lying disorder

ís not it shmuld be dekumined theve is

- hypoalbuminemia pesert,
evidence oheail failure Swere ehnugh to pmo qtnnali? ed edema

it shruld be ascertained as whet.u 0v not he pathent ha

to
finally,
an adequat wine uipul o1, i there is Siqiiiont oli quwia o1 anunia
 ovide a alaohm toyu pach,gve ep by slpP
eplanaisn:

tlistony and Physical enaminahorn, plus:

As descnbed, the appnadh walkinq oimemu
Should beqin uwth aa Peak lo asseas ment
detailed bistovy and
Diaonosis obtained Tooat
Phuslcol enaminatim
No
+ollowed by pDqesive
turther shinq CPhase 4)
Huhng and ultimatly Chest XRay
move invasive tuting
and Subspediality emal
Spinomey
ECG
as is nditakd to CBC, Basic Metubolic panel

dekamine the undeiluing

cause o duspnea Yes
Diagnosis obtained +|at
No

Furtha Hsting (Phase -a)

.Chest CT CUmSid agiopia phy
for tmombo embblic diaaae)
ung volume, DLCo,tests uf
nud musuular funchin,
Echouaidiooram,
Cavdiac shess tating

e
Dannosis obtained T7eat
No
fuythe Hsttng CPhaye-3)
unsidu cadlspulmamany eneiaise
Hetng (and subspeciality attal
Algothm foY appojp ach o edena

tdema

dsocalited eneraited

Tdertihy lota Senous flypo albuminaia

phenmena Serum albumin < 3 b9ld|

No
thiston, PE, unnalysis ) Eidene o teat tailure
(Sevene enomgh to promolt
othe lab daB
qeneralited edema
Sevexe Malnumtim
Adequat unne output (o)
Cirhosis Not
Anuvia
Nephrotc Sundtom 3) Atny 0liquna Coi)