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Thread: Cardiovascular Symptoms - Edema

  1. #1

    Default Cardiovascular Symptoms - Edema

    Alarm Symptoms
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-24-15-pm-png

    Open-Ended Questions
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-25-17-pm-png

    Focused Questions - Increased Permeability
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-26-22-pm-png
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-26-53-pm-png

    Focused Questions - Increased Intravascular Pressure - A.Volume Overload
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-29-03-pm-png

    Focused Questions - Increased Intravascular Pressure - B.Venous or Lymphatic Obstruction
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-32-40-pm-png
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-32-54-pm-png
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-33-06-pm-png

    Focused Questions - Decreased Oncotic Pressure
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-35-32-pm-png

    Differential Diagnosis
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-41-17-pm-png
    Last edited by CheneyHsiung; Tue 19th July '16 at 7:44pm.
    Clinical Pharmacy Specialist - Hematology

  2. #2

    Default Re: Cardiovascular Symptoms - Edema

    Diagnostic Approach
    Cardiovascular Symptoms - Edema-screen-shot-2016-07-19-at-7-40-06-pm-png
    Clinical Pharmacy Specialist - Hematology

  3. #3

    Default Re: Cardiovascular Symptoms - Edema

    Factors Determining GFR

    Direct determinants for GFR include:

    • Kf
      • ​Glomerular disease
      • Contraction of glomerular mesangial cells

    • Glomerular capillary hydrostatic pressure
      • Renal artery pressure
      • Renal blood flow
      • Changes in the resistance of the AAs and EAs

    • Hydrostatic pressure in Bowman's capsule
      • Urinary obstruction

    • Oncotic pressure in glomerular capillary plasma
      • Arterial plasma protein concentration
      • Renal plasma flow


    References:
    1.Factors That Affect GFR
    http://www.tomhsiung.com/wordpress/2...at-affect-gfr/
    Last edited by Janis.Y.Chen; Sat 23rd July '16 at 4:30pm.
    Clinical Pharmacy Specialist - Infectious Diseases

  4. #4

    Default Re: Cardiovascular Symptoms - Edema

    Regulation of Sodium Excretion

    • Major controllers of sodium excretion
      • GFR (in extreme conditions, i.e., hypovolemic shock)
      • Sympathetic stimulation
      • The renin-angiotensin system
      • Dopamine

    • Other controllers of sodium excretion
      • ADH
      • Glomerulotubular balance
      • Pressure natriuresis and diuresis
      • Natriuretic peptides

    References:
    1.Regulation of Sodium Excretion
    http://www.tomhsiung.com/wordpress/2...ium-excretion/
    Last edited by Janis.Y.Chen; Sat 23rd July '16 at 4:17pm.
    Clinical Pharmacy Specialist - Infectious Diseases

  5. #5

    Default Re: Cardiovascular Symptoms - Edema

    Control of The Circulating RAAS

    • Sympathetic input
    • Pressure in the afferent arteriole
    • Tubuloglomerular feedback/TG feedback


    References:
    1.Control of The Circulating RASS
    http://www.tomhsiung.com/wordpress/2...culating-raas/
    Clinical Pharmacy Specialist - Infectious Diseases

  6. #6
    PharmD Year 1 TomHsiung's Avatar
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    Default Differential Diagnosis of Edema

    Constructing A Differential Diagnosis


    Edema is defined as an increase in the interstitial fluid volume
    and is generally not clinically apparent until the interstitial volume has increased by at least 2.5 - 3 L. It is useful to review some background pathophysiology before discussing the differential diagnosis:

    • Distribution of total body water
      • 67% intracellular; 33% extracellular
      • Extracellular water: 25% intravascular; 75% interstitial

    • Regulation of fluid distribution between the intravascular and interstitial spaces
      • There is a constant exchange of water and solutes at the arteriolar end of the capillaries.
      • Fluid is returned from the interstitial space to the intravascular space at the venous end of the capillaries and via the lymphatics.
      • Movement of fluid from the intravascular space to the interstitium occurs through several mechanisms:
        • Capillary hydrostatic (hydraulic) pressure pushes fluid out of the vessels.
        • Interstitial oncotic pressure pulls fluid into the interstitium.
        • Capillary permeability allows fluid to escape into the interstitium.

      • Movement of fluid from the interstitium to the intravascular space occurs when opposite pressure predominate.
        • Intravascular (plasma) oncotic pressure from plasma proteins pulls fluid into the vascular space.
        • Interstitial hydrostatic pressure pushes fluid out of the interstitium.

      • In skeletal muscle, the capillary hydrostatic pressure and the intravascular oncotic pressure are the most important factors.
      • There is normally a small gradient favoring filtration out of the vascular space into the interstitium; the excess fluid is removed via the lymphatic system.

    • Edema formation occurs when there is
      • An increase in capillary hydrostatic pressure (for example, increased plasma volume due to renal sodium retention).
      • An increase in capillary permeability (for example, burns, angioedema).
      • An increase in interstitial oncotic pressure (for example, myxedema).
      • A decrease in plasma oncotic pressure (for example, hypoalbuminemia).
      • Lymphatic obstruction.

    Although it is possible to construct a pathophysiologic framework for the differential diagnosis of edema, it is more useful clinically to use the distribution of the edema as the pivotal point:
    • Bilateral leg edema
      • Due to a systemic cause (with or without presacral edema, ascites, pleural effusion, pulmonary edema, periorbital edema)
        • Cardiobascular
          • Systolic or diastolic heart failure (HF)
          • Constrictive pericarditis
          • Pulmonary hypertension

        • Hepatic (cirrhosis)
        • Renal
          • Advanced kidney disease of any cause
          • Nephrotic syndrome

        • Hematologic: anemia
        • GI
          • Nutritional deficiency or malabsorption leading to hypoalbuminemia
          • Refeeding edema

        • Medications
          • Antidepressants: Monoamine oxidase inhibitors
          • Antihypertensives
            • Calcium channel blockers, especially dihydropyridines
            • Direct vasodilators (hydralazine, minoxidil)
            • Beta-blockers

          • Hormones
            • Estrogens/progesterones
            • Testosterone
            • Corticosteroids

          • Nonsteroidal anti-inflammatory drugs (NSAIDs)
          • Thiazolidinediones

        • Endocrine: myxedema

      • Due to a venous or lymphatic cause
        • Venous obstruction
          • Bilateral deep venous thrombosis (DVT)
          • Bilateral pelvic or retroperitoneal lymphadenopathy or mass

        • Venous insufficiency
        • Lymphatic obstruction (lymphedema)
          • Primary (idiopathic, often bilateral)
            • Congenital
            • Lymphedema praecox (onset in puberty) or tarda (onset after age 20)

          • Secondary (more common; generally unilateral)

    • Unilateral limb edema
      • Venous obstruction
        • Unilateral DVT
        • Unilateral lymphadenopathy or mass

      • Venous insufficiency (more often bilateral)
      • Lymphedema (secondary)
        • Neoplasm
        • Surgery (especially following mastectomy)
        • Radiation therapy
        • Miscellaneous (tuberculosis, recurrent lymphangitis, filariasis)

      • Cellulitis/erysipelas (can also be localized)
      • Baker cyst (leg only)

    • Localized edema
      • Burns
      • Angioedema, hives
      • Trauma
      • Cellulitis, erysipelas
    Last edited by admin; Tue 23rd May '17 at 8:21pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

  7. #7
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    Default The Differential Diagnosis of Lower Extremity Edema

    The Differential Diagnosis of Lower Extremity Edema

    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease. Chengdu, Sichuan, China.

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