DSA Edema - Dr. Kirila Flashcards

1
Q

What are common complaints of pts presenting with edema?

A
  • leg swelling
  • dyspnea
  • PND
  • orthopnea
  • chest pain, indigestion
  • weigh changes
  • skin/hair/nail changes
  • frothy urine
  • GI changes
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2
Q

Pt. presents with “frothy urine”. What are you concerned for?

A

proteinuria

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3
Q

What can cause localized edema? generalized?

A

a. obstruction (ex. DVT)
b. HF, renal disease

*anasarca - massive generalized edema

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4
Q

Pt. presents with new onset of HF. What physical finding should you check for?

A

edema of LE (pools there first due to gravity)

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5
Q

What is the definition of edema?

A

abnormally large amounts of fluid in intercellular spaces

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6
Q

What is the definition of swelling?

A

transient abnormal enlargement or increased volume of a body part/area

  • due to increased BV in dilated vessels
  • transient, so seen with bug bites or local inflammatory rxns
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7
Q

Pt. presents to your Florida clinic with Myxedema. She also is known to have a lymphatic disease. What type of edema do you expect?

A

non- pitting

*risk factors: warm weather, thyroid dx, lymph dx

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8
Q

What causes pitting edema?

A

organ dysfunction - heart, kidney, liver

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9
Q

When is a compression sleeve helpful?

A

lymphedema - impaired fluid return to lymph system (hereditary or secondary to injury/infection)

*often seen post mastectomy

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10
Q

Filarial infection is the number one cause world wide of…

A

lymphedema

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11
Q

What is a finding of morbidly obese pts?

A

lipedema

fat cells grow/proliferate –> fluid retention around cells

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12
Q

It is helpful to know what before edema onset?

A

pts weight

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13
Q

DDX for edema

A
  1. CHF
  2. PE
  3. PE/Pneumonia (if dyspnea is primary sx)
  4. Nephrotic syndrome
  5. Venous stasis
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14
Q

Pt. presents with puffy eyes and ankles, generalized weakness, anorexia, and high cholesterol. What is causing their edema?

A

nephrotic syndrome

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15
Q

What medications can cause b/l LE edema?

A
  • Antidepressants
  • Antihypertensives
  • Hormones
  • NSAIDs
  • Thiazolidinediones
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16
Q

Lymphedema secondary to a neoplasm is likely to cause?

A

unilateral edema

*also from surgery, radiation, TB, filariasis

17
Q

What modifiable factors can you advise your pt to do to reduce their edema?

A
  • decrease alcohol intake
  • decrease Na intake
  • exercise
  • decrease weight
18
Q

What bloodwork help with dx of edema cause?

A
  • CMP
  • TSH
  • CBC
  • other tests: CXR-PA and lat, ECG, Echocardiogram
  • BNP if you suspect CHF
19
Q

What factors can affect BNP levels?

A
  • Inflammation
  • CAD
  • RV or LV dysfunction
  • Decreased clearance
20
Q

ANP/BNP is correlated with what?

A

LV dysfunction

21
Q

What diuretics should you give to a pt with lymphedema? lipedema?

A

none for either - diuretics are not helpful

22
Q

What is the best treatment for lymphedema? lipedema?

A

a. elevation, compression, gentle exercise

b. weight loss, elevation, compression, gentle exercise