EDEMA

DEFINITION
Edema is defined as a clinically apparent

increase in the interstitial fluid volume.

Anasarca refers to gross, generalized edema.
Ascites and hydrothorax refer to accumulation
of excess fluid in the peritoneal and pleural
cavities, respectively, and are considered to
be special forms of edema.

SIGNS OF EDEMA
a weight gain of several kilograms
puffiness of the face, which is most readily

apparent in the periorbital

persistence of an indentation of the skin
following pressure; pitting edema
ring on a finger fits more snugly than in the
past
a patient complains of difficulty in putting on
shoes, particularly in the evening

PATHOGENESIS
Increased hydrostatic pressure
Decreased colloid oncotic pressure
Increased capillary permeability
Retension of water and salt

CAUSES OF EDEMA
Obstruction of Venous (and Lymphatic)

Drainage of a Limb
Congestive Heart Failure
Nephrotic Syndrome
Severe nutritional deficiency states
Severe, chronic liver disease

DIFFERENTIAL
DIAGNOSIS
LOCALIZED EDEMA
Inflammation
Venous obstruction
Lymphatic obstruction
GENERALIZED EDEMA
Cardiac
Hepatic
Renal
Nutritional

CARDIAC EDEMA
Dyspnea with exertion prominent, often

associated with orthopnea, or paroxysmal

nocturnal dyspnea.
Elevated jugular venous pressure, ventricular
(S3) gallop, basilar rales.
Distribution:
More extensive in the legs and to be accentuated

in the evening.
When patients with heart failure have been
confined to bed, edema may be most prominent in
the presacral region.

HEPATIC EDEMA
Dyspnea infrequent
Frequently associated with ascites; jugular

venous pressure normal or low; blood pressure

lower than in renal or cardiac disease; one or
more additional signs of chronic liver disease
(jaundice, palmar erythema, spider
angiomata, male gynecomastia)
Distribution:
Ascites

RENAL EDEMA
Usually chronic: may be associated with

uremic signs and symptoms, including

decreased appetite, altered (metallic or fishy)
taste, altered sleep pattern, difficulty
concentrating.
Blood pressure elevated
Distribution
periorbital edema predominate

NUTRITIONAL EDEMA
Hipoproteinemia (hipoalbuminemia)
Edema resulting from hypoproteinemia

characteristically is generalized, but it is

especially evident in the very soft tissues of
the eyelids and face and tends to be most
pronounced in the morning because of the
recumbent posture assumed during the night.

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