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Oedema

Protocols

Edema:

Abnormal & Excessive acculmulation of free fluid within the intestitial space or body cavities .

Note: 10% fluid accumulation is clinically edema detected

 

Site : 

1) over the distal end of tibia 

2)over the sacrum 

3)Malar prominence 

 Time:-- Pressure on edema site 30 sec for clinical examination

 Differential diagnoses are (causes of generalized oedema):

  •  Nephrotic syndrome.
  • Hypoproteinaemia due to any cause.
  •  CKD (in advanced stage).
  •  Decompensated cirrhosis of liver (advanced stage).
  • Congestive heart failure (advanced stage).

How can you differentiate oedema of cardiac, renal and liver disease clinically?

 Cardiac: In congestive heart failure, oedema is usually dependent, mostly in the leg, associated

with engorged and pulsatile neck veins, enlarged tender liver. Other features of cardiac disease

are usually present (e.g., Mitral stenosis or regurgitation).

Renal: In nephrotic syndrome, oedema usually starts from the face or periorbital, then descends,

later becomes generalized. Urine shows massive proteinuria. In acute glomerulonephritis, oedema

is periorbital, associated with scanty, frothy, smoky urine.

 Liver disease: In cirrhosis of liver, there is ascites, in advanced stage there may be generalized

oedema. Stigmata of CLD are present.


Types of oedema:

  • 1) pitting 
  • 2)non-pitting.

causes of non-pitting oedema:

  • 1. Myxoedema.
  • 2. Chronic lymphatic obstruction or lymphoedema due to any cause (see below).

causes of pitting oedema:

  • Congestive cardiac failure (CCF).
  • Nephrotic syndrome.
  •  Hypoproteinaemia due to any cause (protein loosing enteropathy or less protein intake).
  •  Deep venous thrombosis.
  • Compression of large veins by tumour or lymph nodes.
  •  Chronic venous insufficiency (varicose vein).
  •  Drugs (calcium channel blockers—e.g., nifedipine, amlodipine, some NSAIDs).
  •  Idiopathic (also called ‘fluid retention syndrome’, common in women).


 causes of periorbital oedema or puffiness:

  •  Nephrotic syndrome.
  •  Acute glomerulonephritis (or AKI).
  •  Myxoedema.
  •  Cushing’s syndrome.
  •  SVC obstruction.
  • Angioneurotic oedema.
  • Surgical emphysema.
  •  Orbital cellulitis.
  • Malignant exophthalmos (in Graves disease).
  •  Dermatomyositis.

 investigate a patient with generalized oedema:

  • Nephrotic syndrome: Urine for R/E, blood for total protein, 24 hours urinary protein. Other investigations according to suspicion of cause.
  •  CCF: Chest X-ray, ECG, echocardiogram.
  • Cirrhosis of liver: LFT (total protein, A:G ratio, prothrombin time, ultrasonography etc.). Other investigations according to suspicion of cause (e.g., test for hepatitis B, C etc.).
  •  Hypoproteinaemia: Serum total protein and A:G ratio, other investigation according to the history and suspicion of cause.
  •  Hypothyroidism: FT3, FT4, TSH. Other investigations to find out the cause.