edema
Introduction
Introduction Edema refers to excessive accumulation of body fluids in the extravascular tissue space, which is one of the common clinical symptoms. About 5% of the body fluid remains in the interstitial space of the human body, and it shuttles between the various cell nucleus vessels of the body. Edema is characterized by a significant depression when the finger presses a small area of the subcutaneous tissue (such as the front side of the calf). Chinese medicine calls 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
Edema can be divided into systemic edema (ana-sarca) and local edema (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.
First, systemic edema
1, heart: rheumatism, hypertension, syphilis and other causes and various diseases such as valves, myocardium, congestive heart failure, constrictive pericarditis.
2, kidney: acute glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome, pyelonephritis, renal failure, renal arteriosclerosis, renal tubular disease.
3, liver: liver cirrhosis, liver necrosis, liver cancer, acute hepatitis and so on.
4, nutritional: 1 primary food intake is insufficient, seen in war or other reasons (such as severe famine) caused by hunger; 2 secondary dystrophic edema found in a variety of pathological conditions, such as secondary feeding inadequate ( Sexual anorexia, loss of appetite in severe diseases, gastrointestinal disorders, vomiting in pregnancy, mental disorders, oral disorders, etc.), digestive dysfunction (insufficient digestive juice, hyperactivity of intestinal tract, decreased absorption area, etc.), excretion or loss Many (large area burns and exudation, acute or chronic blood loss, proteinuria, etc.) and impaired protein synthesis, severe diffuse liver disease.
5, pregnancy: the second half of pregnancy, pregnancy poisoning and so on.
6, endocrine: Syndrom of inappropriate secretion of ADH (SI-ADH), adrenal hyperfunction (Cushing's syndrome, increased aldosterone secretion), hypothyroidism (hypophyseal anterior pituitary dysfunction Symptoms, hypothalamic thyrotropin-releasing hormone secretion is insufficient, hyperthyroidism and so on.
7. Idiopathic: This type of edema is a syndrome whose cause is unknown or whose cause has not been determined (may be more than one). It is more common in women and is often associated with the periodicity of menstruation.
Second, local edema
1, lymphatic: primary lymphedema (congenital lymphedema, early onset lymphedema), secondary lymphedema (tumor, infection, surgery, radiation, etc.).
2, venous obstruction: tumor compression or tumor metastasis, local inflammation, venous thrombosis, thrombophlebitis, scar contraction and trauma. Can be divided into chronic venous insufficiency, superior vena cava obstruction syndrome, inferior vena cava obstruction syndrome and other venous obstruction.
3, inflammatory: the most common local edema. Seen in erysipelas, bloated, Ludovici angina, snake poisoning.
4, allergic: urticaria, serum disease and allergic reactions such as food, drugs, irritant external medicine.
5, vascular neurological: may be allergic or neurogenic, can be induced by insects, mechanical stimulation, warm stimulation or emotional arousal. Some cases are related to heredity.
Examine
an examination
Related inspection
Serous effusion cell count serum bile acid determination (TBA) estradiol (E2) urine concentration test intrapulmonary fractionation (Qsp, Qs/Qt)
Depending on the cause of the edema, the laboratory tests that need to be performed are not the same. Clinically common edema is often caused by diseases of some important systems or organs, so in addition to the general laboratory examination of edema, it is necessary to check the primary disease to determine the treatment of edema and estimate the prognosis of edema. For patients with systemic edema, the following laboratory tests should generally be considered.
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
According to the cause, clinical manifestations and laboratory tests confirmed.
