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EDEMA1水肿EDEMA知识讲座5/9/2024DEFINITIONExpansionoftheinterstitial(间质)fluidvolume.WeightgainprecedesovertedemaMassiveandgeneralizededemaiscalledanasarca(全身性水肿)Pitting(压凹性)andnon-pitting(非压凹性)edemaSchrothBE,JAAPA2005112水肿EDEMA知识讲座5/9/2024EdemaPittingedemaNon-pittingedema3水肿EDEMA知识讲座5/9/2024Anatomyandpathophysilolgy1/3oftotalbodywaterisextracellularspace,and2/3isintracellularspace;Extracellularspaceiscomposedoftheintravascularplasmavolume(25%)andtheextravascularinterstitialspaces(75%);4水肿EDEMA知识讲座5/9/2024Starling’slaw:Extravascularandintravascularhydrostaticpressurs;Differencesinoncoticpressureswithintheinterstitialspaceandplasma;Thepermeabilityofthebloodvesselwall.AnatomyandpathophysilolgyVascularsystemInterstitialspaceHydrostaticpressure(流体静水压)
HydrostaticpressureColloidoncoticpressure(tissuetension)(胶体渗透压)
Colloidoncoticpressure5水肿EDEMA知识讲座5/9/2024ReducedPlasmaOsmoticPressureAlbuminis
theserum
proteinMOSTresponsibleforthemaintenanceofcolloidosmoticpressureAdecreaseinosmoticpressurecanresultfromincreasedproteinlossordecreasedproteinsynthesis6水肿EDEMA知识讲座5/9/20247水肿EDEMA知识讲座5/9/2024CapillaryDamageDamagetothecapillaryendotheliumIncreaseitspermeabilityandpermitsthetransferofproteinintointerstitialcompartment
Injuryagents
DrugsViral/bacterialagentsThermal/mechanicaltraumaImmuneResponsibleforinflammatoryedema
Nonpittinglocalizedrednessandtenderness8水肿EDEMA知识讲座5/9/2024ClinicalCausesofEdemaSystemicedemaCongestiveheartfailureCirrhosisNephroticsyndrome/otherhypoalbuminemiaDrug-inducedIdiopathic
LocalizededemaVenous/lymphaticobstruction9水肿EDEMA知识讲座5/9/2024SystemicEdema
Congestiveheartfailure10水肿EDEMA知识讲座5/9/2024Congestiveheartfailure
Left-sidedheartfailure:shortnessofbreathwithexertionandwhenlyingdownatnight(orthophea,端坐呼吸)--pulmonaryedemaRight-sidedheartfailure:swellinginthelegsandfeet--peripheraledemaThephysicianexaminingapatientwhohascongestiveheartfailurewithfluidretentionlooksforcertainsigns:pittingedema;ralesinthelungs,agalloprhythmanddistendedneckveins.11水肿EDEMA知识讲座5/9/2024SystemicEdema12水肿EDEMA知识讲座5/9/2024NephroticSyndrome/HypoalbuminemicstatesTheprimaryalteration:decreasedcolloidoncoticpressureproteinlossintheurine
severenutritionaldeficiencyproteinlossenteropathycongenitalhypoalbuminemialivercirrhosisPromotesfluidmoveintotheinterstitiumCauseshypovolemia
salt/waterretentionactivationRAAaxisetc13水肿EDEMA知识讲座5/9/2024IdiopathicEdemaDiurnalalterationsinweightoccurringwithorthostaticretentionofsodiumandwaterIncreaseincapillarypermeability
fluctuateinseverityaggravatedbyhotweatherReductioninplasmavolumeinthisconditionwithsecondaryactivationoftheRAAsystem14水肿EDEMA知识讲座5/9/2024Drug-inducededemaNonsteroidalanti-inflammatorydrugsAntihypertensiveagents
Directarterial/arteriolarvasodilatorsCalciumchannelantagonistsa-AdrenergicantagonistsSteroidhormones
GlucocorticoidsAnabolicsteroidsEstrogensProgestinesCyclosporineGrowthhormoneImmunotherapies
Interleukin2OKT3monoclonalantibody15水肿EDEMA知识讲座5/9/2024LocalizededemaInflammationVenous/lymphaticobstructionChroniclymphangitisResectionofregionallymphnodesFilariasis(丝虫病)16水肿EDEMA知识讲座5/9/2024DiagnosisOfparticularimportanceisexcludingmajororgansystemdysfunction,especiallycardiac,liver,andrenaldysfunction.Askquestionssuchasthefollowing:Dotheringsonyourfingersgettight?Haveyouhadtoletyourbeltout?Haveyourclothesorshoesgottentootight?Payspecialattentiontothepatient’smedications;Also,obtainathoroughdietaryhistory,payingcarefulattentiontothepatient’sdietarysodiumintake,totaldailyfluidintake;17水肿EDEMA知识讲座5/9/2024Physicalexamination&Diagnostictesting
Inadditiontothestandardphysicalexamination,chartthepatient’sweightandnotegeneralappearance,payingspecialattentiontotheedemawithrespecttolocation,symmetry,pittingornonpittingappearance,tenderness,andassociatedskinchanges.Assesstheseverityofedemawithamethodsuchasthefour-pointscale(+1,slight,to+4,verymarked);Includingachemistrypanelandurinalysistoevaluaterenalandliverfunctionandalbuminlevelstoassessnutritionalstatus.Considermeasuringthethyrotropinleveltoruleouthypothyroidism.Incaseswherescreeningforacardiacetiologyisrequired,anECGandchestradiographmaybehelpfulinassessingcardiacfunction.18水肿EDEMA知识讲座5/9/2024DifferentialdiagnosisHeartfailureRenaldiseasesCirrhosisNutritionaloriginIdiopathicOthers19水肿EDEMA知识讲座5/9/2024Differentialdiagnosis
HeartFailureEdemainitiallyoccursatlowerpartofthebody(lowerextremities)symmetriclocationThepresenceofheartdiseasescardiacenlargementgalloprhythmdyspneabasilarralesvenousdistentionhepatomegalyNoninvasivetestsmaybehelpful
echocardiographyradionuclideangiography20水肿EDEMA知识讲座5/9/2024Differentialdiagnosis
RenaldiseasesMainlyduetohypoabluminemiaandsalt/waterretentionAssociatedwithhematuria,proteinuria,
hypertentionandimpairedrenalfunctionalCharacteriasticofedemaofrenalorigin:
puffinessofthefaceprominentintheperiorbitalareas21水肿EDEMA知识讲座5/9/2024Differentialdiagnosis
Cardiac/Renaldisease
Renal
CardiacLocationonsetfromtheface,onsetfromthelowerperiobitalareaspartofthebodyProgressionprogressquicklyprogressslowlyIdentitysoftandmobilerelativelysolid,lessmobileOthersignsproteinuriasignsofheartfailure:hypertensioncardiacenlargementimpairedrenalvenousdistentionfunctionaltesthepatomegaly
22水肿EDEMA知识讲座5/9/2024Differentialdiagnosis
Liverdiseases(cirrhosis)Clinicalevidenceofhepaticdisease
jaundicespiderangiomasascitesAscites
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