Diffuse drumming
Introduction
Introduction The edema and swelling are in a diffuse state, the skin is tight, the depression is pressed and then recovered, and the drum is sounded by hand. Excessive body fluids accumulate in the interstitial space or body cavity called edema. There is only a small amount of liquid in the normal body cavity. If the body fluid accumulates in the body cavity, it is called stagnant water, such as ascites (ascites), pleural effusion (thoracic water), hydronephrosis, hydrocephalus, scrotal water. The edema fluid is generally interstitial fluid. According to the amount of protein contained in the edema fluid, the edema fluid can be divided into exudate, the relative density is >1.018, and the leakage liquid has a relative density of <1.015.
Cause
Cause
Edema can be divided into systemic edema and local edema according to the distribution range. Edema is often named for its causes, such as cardiogenic edema, hepatic edema, nephrogenic edema, nutritional edema, lymphedema, venous obstructive edema, inflammatory edema, and so on. Edema is divided into systemic and localized.
Examine
an examination
Related inspection
Serum protein electrophoresis, urine routine renal function test, red blood cell count (RBC)
1. Determination of plasma protein and albumin
If the plasma protein is lower than 55 g / liter or the albumin is lower than 23 g / liter, it means that the plasma colloid osmotic pressure is lowered. Among them, the reduction of albumin is particularly important. Plasma protein and albumin reduction are common in cirrhosis, nephrotic syndrome, and malnutrition.
2. Urine test and renal function test
When there is systemic edema, check the urine for protein, red blood cells and casts. If there is no proteinuria, it is likely that edema is not caused by heart or kidney disease. Patients with heart failure often have mild or moderate proteinuria, while persistent severe proteinuria is characteristic of nephrotic syndrome. Persistent proteinuria, increased red blood cells and casts in the urine, accompanied by a significant decrease in renal function often suggest edema caused by kidney disease; heart failure patients may have the above performance, but urine test and renal function changes to a degree Generally lighter. Renal function tests related to edema, often using phenol sulfonate, also known as phenol red test, urine concentration and dilution test, urea clarification test, etc., in order to determine the renal excretory function.
3. Determination of red blood cell count and hemoglobin content
If the red blood cell count and hemoglobin content are significantly reduced, it should be considered that this edema may be related to anemia.
4. Calculate the daily intake and discharge of water and sodium salts
Calculate the daily intake and discharge of water and sodium salt, and determine the plasma sodium chloride content if necessary, which helps to understand the retention of water and salt in the body.
Diagnosis
Differential diagnosis
(1) Cardiogenic edema: common in congestive heart failure, acute or chronic pericarditis.
(2) Nephrogenic edema: common in glomerulonephritis, pyelonephritis and nephrotic syndrome.
(3) Hepatogenic edema: common in viral hepatitis, cirrhosis and so on.
(4) dystrophic edema: common in hypoproteinemia, vitamin B1 deficiency and so on.
(5) Edema caused by connective tissue disease: common in lupus erythematosus, scleroderma and dermatomyositis.
(6) allergic edema: such as serum disease.
(7) Endocrine edema: common in Xi Han disease, hypothyroidism and Cushing's syndrome.
(8) idiopathic edema: such as functional edema.
(9) Others: anemia edema, toxic edema in pregnancy.
