WRITTEN REPORT IN EDEMA

PHYSIO I

Submitted by:
EBORA, Paula Coleen F.
BSPT 3-1

Submitted to:
Prof. Prime Rose Fabul
I) MEDICAL BACKGROUND

DEFINITION
- Refers to the presence of excess fluid in the body tissues
- An abnormal acccumulation of watery fluid in the interstitial or intracellular spaces
- It is frequently a symptom of a disease rather than a disease itself

TYPES
A) According to Fluid Composition:
- Transudate (low protein content)
Accumulation of fluid due to a hydrostatic imbalance between the intravascular and extravascular
compartments despite normal vascular permeability
Results from increased fluid pressures or diminished colloid oncotic pressures in plasma
Has low protein content and a low specific gravity
- Exudate (high protein content)
In situations of increased vascular permeability, protein and blood cells escape from the vessel wall and are
present in the extravascular edema fluid
Has higher protein content and specific gravity

B) According to Location:
- Localized
Means that edema is localized to a specific region of the body
- Generalized
In this case, edema involves more than one part of the body simultaneously

C) According to Clinical Finding:

- Pitting
Respond to pressure, usually from a hand or finger and would leave an indentation
- Non-pitting
Applying pressure doesn't cause any lasting indentation

II) EPIDEMIOLOGY AND DEMOGRAPHICS

A) INCIDENCE
The swelling can occur in one particular part of the body or may be more general, depending on the cause.
Edema is often a symptom of an underlying health condition. It can occur as a result of the following conditions or
treatment:
- pregnancy
- kidney disease 
- heart failure 
- chronic lung disease 
- liver disease  
- medication, such as corticosteroids or medicine for high blood pressure (hypertension)
- etc.

B) POPULATION
The condition could actually be equal for both sexes.

C) AGE
Edema is usually identified in patients age 40 and 60 years.

D) FACTORS
1. Increased hypostatic pressure
2. Osmotic Pressure
3. Obstruction of lymphatic system
4. Increased permeability of vasculature
5. Water retention
 E) PRECAUTIONS
- Reduce daily sodium intake.
- Avoid tight clothing and jewelry that could constrict the affected area
- Avoid extreme temperatures.
- Keep the affected limb above your heart when possible.
- Massaging the affected area firmly (but not painfully) towards the heart can help reduce excess fluid. Consider
finding a qualified physical therapist to properly perform this procedure.
- During activity, monitor the affected limb for any change in size, shape, tissue, texture, soreness, heaviness, or
firmness.
- Pay particular attention to the limb during air travel, as the decrease in pressure and extended time seated can
exacerbate existing symptoms of edema. Consider wearing a compression garment for such travel, except if you have
open wounds or poor circulation in the affected limb.

III) ETIOLOGY
a) Anascara (or Extreme Generalized Edema) is a medical condition characterized by widespread swelling of
the skin due to effusion of fluid into the extracellular space

Etiology:
liver failure (cirrhosis of the liver)
renal failure/disease
right-sided heart failure
severe malnutrition/protein deficiency
some plant-derived anticancer chemotherapeutic agents, such as docetaxel

b) Hydrothorax s a type of pleural effusion in which transudate accumulates in the pleural cavity

Etiology:
Congestive heart failure
Cirrhosis or Ascites
Accumulation of other fluids
if the fluid is blood it is known as hemothorax (as in major chest injuries)
if the fluid is pus it is known as pyothorax (resulting from chest infections)
if the fluid is lymph it is known as chylothorax (resulting from rupture of the thoracic duct)

c) Hydropericardium is a non-inflammatory condition of the pericardium, attended by an accumulation of sero-

albuminous fluid.

Etiology:
Obstructed circulation of coronary vessels
Occurs with ascites or general dropsy
Last stages of chronic nephritis
Follows scarlatina, tuberculosis, cancer, diabetes, degenerative changes in spleen and liver
Addison’s disease
All conditions leading to marasmus
Mediastinal tumor
Aneurism
Thrombosis in cardiac veins

d) Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity that exceeds 25 mL.

Etiology:
Right-sided heart disease
Cirrhosis
Severe liver disease or metastatic cancer
 e) Cerebral Edema is excess accumulation of fluid in the intracellular or extracellular spaces of the brain.

Etiology:
Head trauma
Low blood sodium (hyponatremia)
High altitude
Brain tumor
Block in fluid drainage (hydrocephalus)

f) Peripheral Edema is edema in tissues perfused by the peripheral vascular system, usually in the lower limbs. In the
most dependent parts of the body (those hanging distally), it may be called dependent edema.

Etiology:
Aging
Congestive heart failure
Trauma
Alcoholism
Altitude sickness
Pregnancy
Hypertension
Sickle cell anemia
Compromised lymphatic system
Long periods of time sitting or standing without moving

g) Pitting-dependent Edema

Etiology:
Immobility
Varicose veins
Obesity
Cardiac
Drugs
Hepatic:
Decreased oncotic pressure due to hypoalbuminaemia. Also increased capillary permeability from systemic
venous hypertension.
Renal:
Decreased oncotic pressure from protein loss, and increased fluid pressure from sodium and water retention:
acute nephritic syndrome, nephrotic syndrome.
Gastrointestinal:
Decreased oncotic pressure: starvation, malnutrition, malabsorption, protein-losing enteropathy (eg, Crohn's
disease, ulcerative colitis, tumours of stomach and colon, coeliac disease and other intestinal allergies).
Obstructive sleep apnea
Pregnancy
High-altitude illness
Idiopathic edema
Post-thrombotic syndrome

h) Pitting Localized Limb Edema

Etiology:
DVT
Compression of large veins by tumour or lymph nodes
Following hip replacement or knee replacement
Chronic venous insufficiency.
Local infection, trauma (including burns, which may also cause generalised oedema because of protein loss), animal
bites or stings
 i) Non-pitting Lower Limb Edema

Etiology:
Hypothyroidism (mucopolysaccharide deposition)
Lymphedema
Lipoedema
Allergy

IV) PATHOPHYSIOLOGY
General Edema Pathophysiology
Edema results from increased movement of fluid from the intravascular to the interstitial space or decreased
movement of water from the interstitium into the capillaries or lymphatic vessels. The mechanism involves one or more of
the following:

Increased capillary hydrostatic pressure

Decreased plasma oncotic pressure
Increased capillary permeability
Obstruction of the lymphatic system

As fluid shifts into the interstitial space, intravascular volume is depleted. Intravascular volume depletion activates
renin-angitensin-aldosterone-vasopressin (ADH) system, resulting in renal sodium retention. By increasing osmolality,
renal sodium retention triggers water retention by the kidneys and helps maintain plasma volume. Increased renal sodium
retention also may be a primary cause of fluid overload and hence edema. Excessive exogenous sodium intake may also
contribute.
Less often, edema results from decreased movement of fluid out of the interstitial space into the capillaries due to
lack of adequate plasma oncotic pressure as in nephrotic syndrome, protein-losing enteropathy, liver failure or starvation.
Increased capillary permeability occurs in infections or as the result of toxin or inflammatory damage to the capillary
walls.
The lymphatic system is responsible for removing protein and WBCs (along with some water) from the interstitium.
Lymphatic obstruction allows these substances to accumulate in the interstitium.

V) CLINICAL MANIFESTATIONS
Signs:
Swelling or puffiness of the tissue directly under the skin
Stretched or shiny skin
Skin that retains a dimple after being pressed for several seconds
Increased abdominal size

Symptoms:
Your symptoms will depend on the amount of edema you have and where you have it. But there are general
symptoms:
Swelling or puffiness of the tissue directly under your skin
Stretched or shiny skin
Skin that retains a dimple after being pressed for several seconds
Increased abdominal size
The skin near the edema feels warm
Your clothing or jewelry starts to feel tight and uncomfortable
Tautness and pain in the surrounding area

VI) DIFFERENTIAL DIAGNOSIS

The diagnosis can be narrowed by categorizing the edema according to its duration (acute or chronic), distribution
(unilateral or bilateral) if extremities, and accompanying symptoms (such as dyspnea, pain, thickening of skin and
pigmentation).
The differential diagnosis includes systemic illnesses such as heart failure, liver disease, malnutrition and thyroid
disorder; local conditions such as tumors, infection, trauma and venous thrombosis; and various medications known to
increase the risk of edema.