EDEMA

Dr. Alexandru Nechita

DEFINITION
Edema= increase in interstitial volume,
localised or generalised, due to sodium
and water accumulation in the
subcutaneous tissue. The normal anatomic
profile disappears and pits appear under
pressure.

TYPES OF EDEMA

Local causes: inflammatory, allergic.

General causes: cardiac, renal
mandatory generalised hidrosaline
retention.

EDEMA- general features.

Initially the skin is under tension and shiny.
In the resolution phase: fine longitudinal folds

appear, together with thickening of the

teguments.
Colour: renal edema is white, cardiac and
venous is cyanotic, inflammatory or alergic red.
Local temperature: increased in inflammatory
edema, normal in renal, decreased in cardiac
edema.

EDEMA- general features.

Consistency: renal or starvation edema is

soft, easy pitting present, inflammatory

and venous edema pits appear very hard,
or not at all.In chronic edema skin
thickening is present.
Pain: inflammatory edema is painful, the
general cuase edema are generally not
painful.

Anasarca
Clinical syndrome characterised by

pronounced water and sodium retention.

Generalised edema fluid accumulation in
the serous spaces of the body:
hidrothorax, ascites, hidropericardium.
The liquid is clear with a green-yellow tan.
They have a small content of proteins.

Where to look for edema ?

Retromaleolar region: by aplying digital pressure on the

area until a pit is formed.

Anterotibial.
Over the knee articulation.
Anterior abdominal wall: when you fold the skin pits and
orange like surface appear.
Sacral region- bed imobilised patients.
Breast edema- inferoexternal aspect.
Upper limbs: infero-internal and posterior aspect, over
the elbow.
Face edema: compare the aspect wuth a recent photo.

MECHANISMS OF EDEMA
Local factors: the fluid volume which

leaves the capillary at the arterial end is

superior to the resorbed volume at the
venous extremity.
Water and sodium retention, when the
local mechanism of water transudation
becomes secondary, this is associated with
a decrease in sodium, and secondary,
water excretion.

Local factors that influence the

onset of edema
Coloid-osmotic pressure
Tissue mechanical pressure

Hidrostatic pressure
Tissue osmotic pressure

Capillary permeability
Lymphatic drainage

CARDIAC EDEMA
Gravitation dependent.
In bedridden patients lombosacral edema
is dominant.
Untreated edema develops in a cranial
direction, until anasarca appears.
Edema is cyanotic and cold ( stasis
cyanosis ) due to low cardiac output.
Pits are persistent.

CARDIAC EDEMA
The presence of dyspnoea is mandatory.
Increased levels of BNP are mandatory.
Edema is much more frequent in right heart

failure.
It is produced by an increase in central venous
pressure.
There is marked sodium and water retention due
to reduced glomerular filtration rate.

RENAL EDEMA.
Nephrotic edema due to protein loss after

basal membrane
damage(albuminuria>4g/24hr.).
Nephritic edema- protein loss not so important
to justify edema, sodium retention is much more
important.
Edema is white and soft, normal temperature,
easy pits.
Face, eyelids, dorsal aspect of feet, external
genitalia.

Starvation edema
Generalised, soft, pits appear easy.
Localised at the legs and face.
General aspect similar to renal edema.
Main mechanism is hipoalbuminemia, due
to malabsorbtion, hepatocelular failure,
serumalbumin synthesis failure.

HEPATIC EDEMA
White, soft, inferior limbs.
Appears in decomensated liver chirosis.
Ascites is not proportional with edema.
Jaundice and spider naevi are present.
Mechanisms: hipoalbuminemia,
hyperaldosteronism.
Reduced liver aldosterone turnover.

PREGNANCY EDEMA
Moderate, white, soft, localised at the

inferior limbs, determined by multiple

factors:umoral, inferior vena cava
compression.
Generalised edema after the 20th
pregnancy
week+hypertension+proteinuria=preecla
mpsia, which can lead to
eclampsia=seizures, coma, death.

CATAMENIAL OR CYCLIC EDEMA

Discreet and moderate edema of the legs,

which appears predominantly in the
second half of the menstrual period.
They are dependent on secondary
hyperaldosteronism.

MIXEDEMA
Appears in severe hypethiroidism.
It is determined by infiltration of the
subcutatenous tissue with
mucopolyzaccharides.
The skin is thickened.

IATROGENIC EDEMA
EXCESSIVE WATER AND SODIUM
ADMINISTRATION.
CORTICOIDS.
ESTROGENS
Other drugs.

INFLAMMATORY EDEMA
Infection
Trauma
Burns.
Red,hot, painful, pit does not appear.

Quincke edema

Pruriginous, pink, easy painful.

Eyelid, superior lip.
Glotic edema can appear. bad prognosis
because respiratory obstruction.

VENOUS EDEMA
Superficial thrombophlebitis edema is

limited beyond the thromosed vein.

Deep thrombophlebitis edema: inferior or
superior limb.
Initially moderate, then it can be
important.
Painful,white, pain in the legs.

CHRONIC VENOUS FAILURE

Consecutive to recurrent deep venous
thrombosis-posthrombotic syndrome.
Increased in orthostatic position.
Skin is often cyanotic, with brown
dermatitis, complicated with varicous
ulcer.

Limphedema
Also called in severe cases elphantiasis.
Cause: lymphatic obstruction.