subcutaneous tissue edema
Introduction
Introduction Subcutaneous tissue edema refers to excessive accumulation of body fluids in the extravascular tissue space, which is one of the common clinical symptoms. Unlike obesity, edema is characterized by a significant depression when the finger presses a small area of the subcutaneous tissue (such as the anterior side of the calf). The motherland medicine called it "water vapor", also known as "edema." Edema is a common pathological process in which the accumulated body fluid comes from plasma, and its ratio of sodium to water is approximately the same as that of plasma. Habitually, the accumulation of excessive body fluids in the body cavity is called hydrops or effusions, such as pleural effusion, ascites, and pericardial effusion.
Cause
Cause
Systemic edema
(1) Cardiogenic edema: congestive heart failure (right heart failure) in various heart diseases, such as pulmonary heart disease, rheumatic heart disease, hypertensive heart disease, coronary atherosclerotic heart disease, anemia Heart disease and cardiomyopathy, myocarditis, pericarditis (especially constrictive pericarditis), etc., can occur in varying degrees of edema.
(2) nephrotic edema: acute and chronic glomerulonephritis and nephrotic syndrome, renal arteriosclerosis and congenital tubular disease can cause edema.
(3) Liver edema: edema may occur in diseases such as liver cirrhosis, liver cancer, and diffuse liver necrosis.
(4) Nutritional edema: due to chronic obsessive-compulsive diseases, lack of nutrition, low protein and other factors, edema may occur when hypoproteinemia or vitamin deficiency occurs.
(5) Pregnancy edema: edema can occur in late pregnancy and pregnancy poisoning.
(6) endocrine edema: seen in hypothyroidism, hypopituitarism, etc., mostly non-invasive edema. Adrenal hyperfunction, long-term use of corticosteroids and primary aldosteronism can produce edema.
(7) Idiopathic edema: edema occurs without any obvious, known causes, mainly found in women.
2. Local edema: more common in the veins, lymphatic tissue reflux obstruction and inflammation, increased capillary permeability.
(1) Infectious edema: seen in sputum, sputum, erysipelas, cellulitis and insects, snake poisoning, such edema is often accompanied by local congestion.
(2) blocked lymphatic drainage: such as chronic lymphangitis, erysipelas, filariasis and so on.
(3) Upper and lower vena cava reflux obstruction: It is caused by mediastinal tumor, intrathoracic aneurysm or lymph node enlargement, which is caused by head, face, neck and upper extremity edema. The inferior vena cava is blocked by thrombosis, such as thrombophlebitis, which may have lower extremity edema and skin dystrophy. Abdominal mass, ovarian cysts, ascites and other pressure caused by the two lower extremity edema, abdominal wall edema.
(4) Physical damage: local burns or frostbite.
(5) Allergic reactions: urticaria, angioedema, serum disease, contact dermatitis and allergic reactions such as food and drugs.
(6) Contusion: Contusion of local deep tissue (including subcutaneous tissue or muscle), causing subcutaneous hemorrhage or increased leakage of plasma to tissues.
(7) Neurotrophic disorders: local edema caused by limb paralysis.
3. The location of edema: the initial manifestation of eyelid edema, mostly early stage of nephritis. Systemic edema with low plasma protein, heart, liver, kidney and other organ diseases are more common. Drooping edema is more common in heart failure; upper extremity and upper chest edema, more common in blood vessels or lymphatic vessels (such as vena cava obstruction syndrome).
4. The onset of illness is slow: the acute onset of the disease is more common with local infectious diseases and allergic diseases. Sudden onset of facial, lip, tongue and oral mucosal edema can be angioedema, related to allergic substances in drugs, food, and the environment; slow onset, increasing edema, mostly renal, hepatic, and cardiac And dystrophic edema.
5. Accompanying symptoms: accompanied by palpitations, shortness of breath, difficulty breathing, unable to supine, consider cardiogenic edema caused by cardiac insufficiency; accompanied by nausea, anorexia, jaundice should pay attention to skin with or without spider mites, ascites, Large liver conditions, the possibility of liver disease is high; accompanied by hypertension, decreased urine output, found in edema caused by kidney disease; accompanied by chills, slow response, lazy words, less movement, should consider thyroid function Hypothyroidism; accompanied by numbness of the hands and feet, dyskinesia of the limbs, suggesting vitamin B1 deficiency; accompanied by central obesity, muscle consumption, fatigue, seen in hypercortisolism.
6. History: Pay special attention to the history of heart disease, liver disease, kidney disease, diet and nutritional status, and allergies. Menstrual history, such as 7 to 10 days before menstruation, there are headaches, irritability, insomnia, mostly premenstrual tension syndrome, related to menstruation. Pay attention to what drugs have been taken in the near future. If there is a rash and edema after taking the medicine, the possibility of drug allergy is high.
Examine
an examination
Related inspection
Urine routine blood test
1. Localized edema: Most of the localized edema is due to edema caused by inflammation.
(1) The onset is faster, accompanied by local skin redness, swelling, heat and tenderness, and elevated body temperature, considering sputum, sputum, erysipelas, and cellulitis. These lesions are mostly on the surface, easy to find, and can be seen in general surgery.
(2) accompanied by local shallow tissue pain, tenderness, generally no fever, considering limb venous thrombosis. On the basis of the above, there is fever at the same time, considering thrombophlebitis.
(3) With lower limbs, most of the calf's veins are dilated, curved, and bulged. It is more obvious when standing. The skin can be seen with pigmentation and chronic ulcer formation, considering the varicose veins of the lower extremities.
(4) accompanied by abdominal distension, abdominal varicose veins, lower extremities and scrotum (male), labia (female) edema, liver splenomegaly, lower extremity venous pressure, considering chronic inferior vena cava obstruction syndrome, there are two causes: one It is because of malignant tumor compression or tumor tissue invading the vein causing obstruction; second, benign thrombosis. Causes blockage. (The above 2 to 4 cases can be seen in the vascular surgery number).
(5) slow onset, accompanied by cyanosis, shortness of breath, cough and hoarseness, edema of face, neck, upper limbs and upper chest, superficial veins of jugular vein and anterior chest, pleural effusion when heavy, considering chronic superior vena cava obstruction syndrome . Mostly caused by malignant tumors (lung cancer, malignant lymphoma, etc.), a small number of benign, caused by chronic tuberculous mediastinal inflammation, primary superior vena cava thrombosis. The number of thoracic surgery can be seen.
(6) accompanied by sudden, painless, hard and elastic localized edema, edema of the skin is pale or waxy luster, edema in the center of the micro concave, no obvious boundaries, there are drugs, food or around A history of environmental allergies, considering angioedema caused by an allergic reaction. If it is caused by drugs, you can go to the original clinic for follow-up. If you are allergic to food or the surrounding environment, you should get rid of allergies.
2. Systemic edema: caused by heart, liver, kidney and dystrophic diseases, followed by endocrine disorders, connective tissue diseases.
(1) edema gradually formed, mostly from the lower extremity or sagging site and throughout the body, edema is indentation, relatively hard, less mobility, history of heart disease, and signs of heart failure, such as rapid heart rate, jugular vein engorgement , liver, severely accompanied by chest, abdominal cavity, pericardial effusion, considered for heart disease edema, such as rheumatic heart disease, dilated cardiomyopathy, congenital heart disease, hypertensive heart disease, ischemic heart disease Wait. You can visit the Department of Internal Medicine.
(2) Onset is rapid, edema appears in the morning, develops from the eyelids and face to systemic, edema is easier to move, accompanied by elevated blood pressure, decreased urine output, considered nephrotic edema, such as acute nephritis, chronic nephritis, Nephrotic syndrome and even kidney failure. The number of the Department of Nephrology can be hanged.
(3) Systemic edema from the beginning of mild edema of the lower extremity, accompanied by anorexia, nausea, jaundice, ascites, hepatosplenomegaly, abnormal liver function, plus a history of liver disease or alcoholism, considering hepatic edema, such as cirrhosis, liver cancer Wait. Can be linked to the number of digestive medicine or liver surgery. For systemic edema of kidney disease, heart disease, and liver disease, it often means the failure of the function of the organ. It is very important to promptly check and diagnose and perform necessary treatment.
(4) With long-term nutritional deficiency or physical depletion, when given a high-calorie, high-protein diet (that is, increase nutrition), edema can be resolved, considering nutritional edema. Can be linked to the number of digestive medicine.
(5) With rash, erythema, joint pain and multiple system damage, consider systemic lupus erythematosus. The number of the immune rheumatology should be hanged.
(6) accompanied by cold, dry skin, scaly, hair loss, sparse, slow response, sluggish expression, edema is mucinous edema (skin compression without concave), mostly appear after postpartum hemorrhage, consider anterior pituitary dysfunction Or hypothyroidism. The number of endocrinology can be hung.
(7) With the manifestation of central obesity, muscle consumption, osteoporosis, increased blood pressure, and impaired glucose tolerance, consider hypercortisolism. The number of endocrinology can be hung.
(8) with neurosis, manifested as excitement, irritability, irritability, insomnia, laziness, lack of concentration, symptoms disappear after menstruation, consider premenstrual tension syndrome. Hang the number of neurology or gynecology.
(9) Edema that occurs after taking the drug, can gradually disappear after stopping the drug, considering the edema caused by the drug. Go to the original clinic for a follow-up visit.
Diagnosis
Differential diagnosis
Differential diagnosis of subcutaneous tissue edema:
1, cardiogenic edema: left heart failure caused by cardiogenic pulmonary edema; right heart failure caused by systemic edema, used to be called cardiac edema.
Performance: Subcutaneous edema in the sagging area
Pathogenesis:
1 sodium water retention: glomerular filtration rate decreased; renal tubular reabsorption of sodium water increased.
2 capillary hydrostatic pressure and increased venous pressure.
3 Other factors: Partial right heart failure patients with low plasma protein concentration may be one of the factors of cardiac edema.
Prevention and treatment principles: etiological treatment, improve heart function and increase cardiac output. Diuretic, reduce the burden on the heart, while properly limiting the intake of sodium water, reducing sodium retention.
2, renal edema: systemic edema caused by primary kidney disease, known as renal edema. Divided into nephrotic edema and nephritis edema.
1) Nephrotic edema: one of the four characteristics of nephrotic syndrome.
Pathogenesis:
1 The decrease of plasma colloid osmotic pressure caused by hypoproteinemia is the central link of its pathogenesis. 2 Sodium water retention secondary to effective circulating blood loss will also play an important role in the development of nephrotic edema.
2) Nephritic edema: mainly seen in acute glomerulonephritis.
Pathogenesis: At the same time, the glomerular filtration rate decreased significantly, but the renal tubular reabsorption did not decrease correspondingly, and some increased, resulting in serious ball-tube imbalance, resulting in sodium retention.
3, hepatic edema: the abnormal accumulation of body fluids in the liver disease is called hepatic edema.
Performance: ascites
Mechanism: 1 blocked hepatic venous return; 2 portal hypertension caused by increased intestinal lymph production; 3 sodium water retention; 4 effective colloid osmotic pressure.
4, pulmonary edema: pulmonary interstitial (extravascular tissue space) in the accumulation of excess fluid and / or spillage into the alveolar cavity pathological phenomenon, known as pulmonary edema. From pulmonary interstitial edema to alveolar edema.
Pathogenesis:
1 pulmonary capillary hydrostatic pressure increased;
2 increased permeability of capillaries and / or alveolar epithelium;
3 plasma colloid osmotic pressure decreased;
4 pulmonary lymphatic drainage disorder.
Prevention and treatment principles: Active treatment of primary disease. On the basis of improving general treatments such as ventilation, oxygen delivery, and diuresis, specific treatment measures are adopted according to the pathogenesis.
5, cerebral edema: increased brain volume and weight caused by increased brain fluid, known as cerebral edema.
Classification and reasons:
1 vasogenic cerebral edema: mainly the permeability of capillaries in the brain increases, and the protein-containing fluid enters the intercellular barrier.
2 cell toxic brain edema: common causes are acute cerebral hypoxia, acute and chronic renal failure caused by water intoxication and certain metabolic inhibitors.
3 interstitial cerebral edema: mainly obstructive ventricular hydrocephalus.
Clinical features:
1 obvious symptoms and signs;
2 heavy can cause a series of dysfunction: syndrome caused by increased intracranial pressure; focal brain signs; secondary signs caused by cerebral palsy.
The mechanism:
1 vasogenic cerebral edema: increased permeability of microvessels.
2 cytotoxic cerebral edema: the role of acute hypoxia or metabolic inhibitors, ATP production is reduced, cells transport sodium barriers outward, water enters the cells leading to cerebral edema; oxygen free radicals damage the structure and function of the membrane; acute In hyponatremia, the extracellular fluid is hypotonic and the water is transferred into the cells.
3 interstitial cerebral edema: the aqueduct is blocked by tumor or inflammatory hyperplasia, oppression, cerebrospinal fluid production and reflux pathway blocked, indoor pressure rises, cerebrospinal fluid to the surrounding white matter, causing interstitial edema.
Principles of treatment: First, the cause of the disease, on the basis of the application of cell membrane stabilizers, dehydrating agents or surgical decompression therapy.
6, nutritional edema: systemic edema caused by nutritional deficiencies called nutritional edema, also known as dystrophic edema.
Performance: From the loose tissue to the whole body, the lower part is prominent, and the lower extremity edema is obvious.
The mechanism:
1 hypoproteinemia.
2 Because the tissue decomposition consumes voids to make the tissue gap have a greater negative pressure, it is replaced by liquid.
3 Due to the increase in the volume of extracellular fluid, the effective circulating blood volume decreases the aldosterone and ADH in the second place.
Principles of treatment: relieve the cause and supplement nutrition.
7, idiopathic edema: a systemic edema that occurs in a middle-aged woman whose cause has not yet been finally identified.
Performance: Irregular intermittent episodes, swelling of the eyelids in the morning, thickening of the bridge of the nose, tightening of the fingers, and subsequent swelling of the breasts and abdomen.
Pathogenesis:
1 position factor.
2 microvascular bed abnormalities.
3 Possible effects of body fluid factors.
Principles of treatment: relieve the patient's mental stress, properly limit sodium, reduce standing, use appropriate diuretic methods, and pay attention to bed rest.
