Edema - Sign, Symptoms and Causes
Definition of Edema
Edema is observable swelling from fluid accumulation in body tissues. Edema most commonly occurs in the feet (legs) and legs (the legs), in which he referred to as peripheral edema. The swelling is the result of excessive accumulation of fluid under the skin in the spaces within the tissues. All tissues of the body is formed from the cells and connective tissues (connective tissue) that keep the unity of the cells. Connective tissue around the cells and blood vessels known as the interstitium. Most of the body fluids that are found outside the cells are normally stored in two spaces; blood vessels (as part of a liquid or serum from your blood) and interstitial spaces (not in the cells). In various diseases, excess fluid can accumulate in one or two of the parts of the room (compartment) of this.
Organs have interstitial spaces where fluid can accumulate. The accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in a disease called pulmonary edema. In addition, excess fluid sometimes collects in what is called the third space, which includes cavity in the abdomen (abdominal or peritoneal cavity - called "ascites") or in the chest (lung or pleural cavity - called a "pleural effusion"). Anasarca refers to the accumulation of fluid is severe, widespread in all tissues and cavities of the body at the same time.
Definition Pitting Edema And Differences Of Non-Pitting Edema
Pitting edema can be demonstrated by using pressure on the swollen area by tapping the skin with your fingers. If the pressure causes the indentation persist for some time after the release of pressure, the edema is referred to as pitting edema. All forms of pressure, such as rubber socks, can induce pitting (indentation) with this type of edema.
In non-pitting edema, which usually affects the limbs (legs) or the arms, the pressure used on the skin does not result in a persistent indentation. Non-pitting edema can occur in certain diseases of the lymphatic system such as lymphedema, where disruption of the lymphatic circulation that may occur after mastectomy surgery, lymph node, or congenitally. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the bone dry in some patients with hyperthyroidism. Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally ineffective, although raising the legs periodically throughout the day and the means of pressure may reduce the swelling.
Causes Pitting Edema
Edema is caused by systemic diseases, namely, the diseases that affect various organ systems of the body, or by local conditions involving only members of the body are affected. Systemic diseases most commonly associated with edema involve the heart, liver, and kidneys. In these diseases, edema occurs primarily because the arrest body of salt (sodium chloride) that is too much. Excessive salt causes the body to retain water. This water is leaking into the interstitial tissue spaces, where he appears as edema.
Local conditions of the most common cause of edema are varicose veins and thrombophlebitis (inflammation of the veins) of the veins in the legs (legs). These conditions can cause inadequate pumping of blood by the veins (venous insufficiency). Increased back pressure resulting in the veins forces fluid stay on the feet and hands (especially the ankles and the legs). Excessive fluid then leaks into the interstitial tissue spaces, causing edema.
Entered Salt Affects Edema
Salt balance of the body is usually well regulated. A normal person can consume quantities of small or large salt in the diet without concern for developing salt depletion or detention. Entered salt is determined by the patterns of spending on food and salt from the body by the kidneys. The kidneys have a great capacity to control the amount of salt in the body by changing the amount of salt eliminated (removed) in the urine. The amount of salt is removed by the kidneys regulated by hormonal factors and physical which signals whether the detention or removal of salt by the kidneys is necessary.
If blood flow to the kidneys is reduced by an underlying condition such as heart failure, the kidneys react by withholding salt. Detention salt occurs because the kidneys feel that the body needs more fluids to compensate for reduced blood flow. If the patient has a kidney disease that interferes with the function of the kidneys, the ability to excrete salt in the urine is limited. In both conditions, the amount of salt in the body increases, which causes the patient to retain water and develop edema.
Patients who experience disruptions in its ability to normally excrete salt may need to be placed on a restricted salt diet and / or given diuretic medications (water pills). Previously, patients with diseases associated with edema placed on diets with a very restricted salt intake. With the development of diuretic agents are new and very powerful, who noted this restriction on dietary salt intake is generally no longer necessary. These diuretics work by blocking the reabsorption and retention of salt by the kidneys, thereby increasing the amount of salt and water are eliminated in the urine.
Why Prevent Heart Disease Patients With Fluid?
Heart failure is the result of poor cardiac function and is represented by the reduced volume of blood pumped out by the heart, called cardiac output. Heart failure can be caused by weakness of the heart muscle, which pumps blood out through the arteries to all body, or by dysfunction of the heart valves, which regulate blood flow between the rooms (chambers) of the heart. Reduced volume of blood pumped out by the heart (cardiac output is reduced) is responsible for reduced blood flow to the kidneys. As a result, the kidneys sense that there is a reduction of blood volume in the body. To fight seemed lost fluids, the kidneys retain salt and water. In this event, the kidneys deceived into thinking that the body needs to retain more fluid volume when, in fact, the body has been holding too much fluid.
Increase in this fluid eventually resulted in the accumulation of fluid in the lungs, causing shortness of breath. Because of the reduced volume of blood pumped out by the heart (cardiac output is reduced), the volume of blood in the arteries is also reduced, although there is a noticeable increase in total body fluid volume. Related increase in the amount of fluid in blood vessels of the lungs causing shortness of breath due to excess fluid from the blood vessels leak into the lung air spaces (alveoli) and the interstitium of the lung. The accumulation of fluid in the lungs is called pulmonary edema. At the same time, accumulation of fluid in the legs (legs) cause pitting edema. This edema occurs due to a buildup of blood in the veins of the legs (legs) causing leakage of fluid from capillaries foot (small blood vessels) into the interstitial spaces.
Understanding of how the heart and lungs interact will help you understand better how working fluid retention in heart failure. The heart has four chambers; auricle and ventricle on the left side of the heart and the auricle and ventricle on the right side. Left Auricle receiving oxygenated blood from the lungs and sends it to the left ventricle, which then pumps it through the arteries throughout the body. The blood is then transported back to the heart by the veins into the right auricle and sent to the right ventricle, which then pumps it to the lungs for oxygen given back.
Left side heart failure, caused mainly by a weak left ventricle, usually caused by coronary heart disease, hypertension, or disease heart valves. Typically, when these patients come to their doctors initially troubled by shortness of breath with exertion and at night when lying down (orthopnea). These symptoms are caused by pulmonary edema caused by the gathering of blood in vessels of the lungs.
In contrast, right-sided heart failure, which is often caused by chronic lung diseases like emphysema, initially caused the arrest of salt and edema. Detention salts are persistent in these patients, however, may lead to the enlarged volume of blood in blood vessels, thereby causing an accumulation of fluid in the lungs (pulmonary congestion) and shortness of breath.
In patients with heart failure caused by a weak heart muscle (cardiomyopathy), both ventricle-left ventricle and right heart is usually unaffected. These patients, therefore, may initially suffer from swelling in both lungs (pulmonary edema) and on the legs and feet (peripheral edema). The doctor who examined patients with congestive heart failure with fluid retention seek certain signs. These include:
* Pitting edema of the legs (the legs) and feet (legs),
* Rales in the lungs (sounds of splashing the excess moisture from the liquid which can be heard with a stethoscope),
* Gallops rhythm (cardiac three voices instead of the normal two caused by muscle weakness), and
* Neck veins are distended. Neck veins are distended reflects the accumulation of blood in the veins that return blood to the heart.
Why Patients Develop Heart Disease Patients With Ascites and Edema?
In patients with chronic liver disease, fibrosis (scarring) of the liver often occurs. When scarring (scarring) continues, the condition is called cirrhosis of the liver. Ascites is excess fluid that accumulates in the abdominal cavity (peritoneal). He is a complication of cirrhosis and appears as a bump. The peritoneum is the inner lining of the abdominal cavity, which also wrap covers the organs within the abdomen such as liver, gallbladder, spleen, pancreas, and intestines. Ascites develops because of a combination of two factors:
1. increasing pressure on the venous system that transports blood from the stomach, intestines and spleen to the liver (portal hypertension); and
2. low level of protein albumin in the blood (hypoalbuminemia). Albumin, which is the main protein in the blood and helps maintain blood volume, reduced in cirrhosis primarily because of a damaged liver can not produce enough.
Other consequences of portal hypertension include enlarged veins in the esophagus (varices), prominent veins in the stomach, and spleen are enlarged. Each of these conditions are caused mainly by increased pressure and accumulation of blood and excess fluid in the abdominal blood vessels. From ascites fluid can be removed from the abdominal cavity using a syringe and long needle, a procedure called paracentesis. Analysis of fluid can help differentiate ascites caused by cirrhosis of other causes of ascites, such as cancer, tuberculosis, congestive heart failure, and nephrosis. Occasionally, when ascites does not respond to treatment with diuretics, paracentesis may be used to remove large amounts of ascitic fluid.
Peripheral edema, which is usually seen as pitting edema of the legs and feet, also occurs in cirrhosis. Edema is the consequence of hypoalbuminemia and kidneys retain salt and water.
The presence or absence of edema in patients with cirrhosis and ascites is an important consideration in the treatment of ascites. In patients with ascites without edema, diuretics must be given the extra attention. Diuresis (urine volume induces an increase in the use of diuretics) that is too aggressive or fast in these patients can lead to low blood volume (hypovolemia), which can cause kidney and liver failure. In contrast, when patients who have both edema and ascites undergo diuresis, edema fluid in the interstitial space more or less serve as a buffer against the development of low blood volume. Excess fluid moves into the interstitial spaces of the blood vessels to quickly replace depleted blood volume.
Why Edema Occurred In Patients With Kidney Disease Patients?
Edema formed in patients with kidney disease for two reasons:
1. severe loss of protein in the urine, or
2. kidney function (renal) are disrupted.
Losing weight proteins in urine
In this situation, the patient has normal kidney function or normal enough. Losing weight protein in the urine (over 3.0 grams per day) with accompanying edema is termed nephrotic syndrome. Nephrotic syndrome result in a reduction in the concentration of albumin in the blood (hypoalbuminemia). Since albumin helps maintain blood volume in blood vessels, reduction of fluid in blood vessels occurs. The kidneys then noted that there is depletion or reduction of blood volume and, therefore, try to retain salt. By consequence, the fluid moves into interstitial spaces, thus causing pitting edema.
Treatment of fluid retention in these patients is to reduce the loss of protein into the urine and limit salt in your diet. Loss of protein in the urine may be reduced by the use of ACE inhibitors and angiotensin receptor blockers (ARB's). Both categories of drugs, which are typically used to lower blood pressure, encouraging the kidneys to reduce the loss of protein into the urine.
These medications include ACE inhibitor enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), benazepril (Lotensin), trandolapril (Mavik), lisinopril (Zestril or Prinivil) and ramipril (Altace).
Angiotensin receptor blockers, including losartan (Cozaar), valsartan (Diovan), candesartan (Atacand) and irbesartan (Avapro).
Certain kidney diseases may contribute to loss of protein in the urine and edema development. Biopsy of the kidney may be required ubntuk make the diagnosis of kidney disease type, so that treatment may be given.
Kidney function (renal) affected
In this situation, patients who have kidney diseases that interfere with renal function develop edema due to the limited ability of the kidneys to remove sodium into the urine. Thus, patients with renal failure of any disease will develop edema if their sodium intake exceeds the ability of their kidneys to remove sodium. Furthermore, kidney failure, a greater problem than the possibility of detention of salt. The most severe situation is the patient degann end-stage renal failure requiring dialysis therapy. Salt balance of this patient is totally governed by dialysis, which can excrete salt during treatment. Dialysis is a method of cleansing the body of impurities that accumulate when the kidneys fail. Dialysis performed with the patient's blood circulates through the membrane (membrane) artificial (hemodialysis) or by using the patient's own abdominal membrane cavity (peritoneal membrane) as a surface pembersi. Individuals decreased kidney function in less than 5% to 10% of normal may require dialysis.
Definition of Idiopathic Edema
Idiopathic edema is pitting edema of unknown cause that occurs primarily in women with pre-menopausal women who do not have evidence of heart disease, liver, or kidneys. In this condition, the first fluid retention may be seen especially pre-menstrually (just before menstruation), which is why he is sometimes called "cyclical" edema. However, it is a problem that is more permanent and severe.
Patients with idiopathic edema often take diuretics to reduce edema in order to reduce the discomfort of bloating and swelling. Paradoxically, however, the edema in this condition may be more problems after the use of diuretics. Patients can develop fluid retention as a phenomenon that bounces back every time they stop the diuretics. It is important to talk to your doctor before using any diuretics.
Patients with idiopathic edema appears to have leaks in the capillaries (blood vessels that connect the small peripheral arteries with the veins) so that fluid passing from the blood vessels into the surrounding interstitial space. Thus, patients with idiopathic edema has reduced blood volume, which leads to the typical reaction from the detention of salt by the kidneys.
* Edema leg (foot) in these patients is exaggerated in the standing position, because the edema tends to accumulate in the body parts close to the ground at the time.
* Paien, these patients often have edema around the eyes (periorbital edema) in the morning because accumulation edema fluid during the night around their eyes when they sleep lying flat.
In contrast, edema around the eyes, the eyes do not tend to develop in patients who sustain cardiac their heads up at night because of shortness of breath when they lie flat. These patients characteristically experience varying amounts of edema in different parts of the body at different times of day.
Patients with idiopathic edema often become dependent on diuretics, and this dependence seirngkali difficult to cut. Along the three-week period off diuretics may be needed to break the cycle of dependency. Withdrawal of diuretics may lead to fluid retention and swelling that result in major inconvenience. Furthermore, there are certain risks associated with prolonged use of diuretics in these individuals, which is compounded by the tendency to increase doses of diuretics.
As a result of the use and chronic diuretic abuse, patients may develop:
* Lack of potassium,
* Reduction of blood volume in blood vessels, and
* Deficiency or kidney failure.
Other side effects of diuretics include:
* High blood sugar (diabetes),
* High uric acid (gout),
* Muscle cramps, sensitive breasts enlarged dn (gynecomastia), and
* Pancreatitis (inflammation of the pancreas).
Despite the withdrawal of diuretics are the most important factor in treating patients, other drugs have been used to try to minimize fluid retention. These medications include ACE inhibitors, low doses of amphetamines, ephedrine, bromocriptine (Parlodel), or levodopa-carbidopa (Sinemet) in combination. However, the effectiveness-their effectiveness is uncertain and side effects of these medications may occur. For example, hypotension (low blood pressure) may be seen with the use of ACE inhibitors, especially if patients also taking diuretics.
Lack Veins Causing Edema
The veins in the legs (legs) is responsible for transporting blood up into the veins of the torso, where he later reversed to the heart. The veins of the legs have valves that prevent backflow of blood in them. Venous insufficiency is the inability of the veins that occur due to dilation or enlargement of the veins and dysfunction of their valves. This happens, for example, in patients with varicose veins. Venous insufficiency leads to backup of blood and increased pressure on the veins, thus resulting in edema of the legs (legs) and feet (legs). Edema of the legs may also occur with episodes of deep vein thrombophlebitis, which is a clot or blood clots in the veins that are inflamed. In this situation, the clot or deep vein clot blocking blood return, and the consequences lead to increased back pressure on the leg veins (leg).
Venous insufficiency is matter localized to legs, ankles (ankles), and feet. One foot (leg) may be more affected than the other (asymmetrical edema). In contrast, systemic diseases associated with fluid retention generally cause the same amount of edema in both legs (legs), and can also cause edema and swelling elsewhere in the body. Response to therapy with diuretic drugs in patients with venous insufficiency tends to be unsatisfactory. This is because the gathering of the continuous fluid in the lower extremities makes it difficult diuretics to mobilize edema fluid. Appointment of limbs (legs) are periodic throughout the day and the use of compression stockings may relieve edema. Some patients require surgical treatment to eliminate chronic edema caused by venous insufficiency.
Diuretics Used For Treating Edema
Edema can be a problem in systemic diseases of the heart, liver or kidneys. Diuretic therapy can be initiated, often reducing the edema. The most powerful diuretics are loop diuretics, so called because they work on the part of the kidney tubules which are referred to as the loop of Henle. Renal tubules are small ducts that regulate salt and water balance, while transporting urine is formed. Clinical loop diuretics available are:
* Furosemide (Lasix),
* Torsemide (Demadex), and
* Butethamine (Bumex).
Doses of these diuretics vary depending on clinical circumstances. Although patients seriously ill in hospital may receive them intravenously for a more immediate response or effective. If one of loop diuretics is not effective alone, it may be combined with an agent that works further down (more distally) in the tubule. These agents including thiazide-type diuretics, like hydrochlorothiazide (HydroDIURIL), or type of diuretic that similar but more powerful, called metolazone (Zaroxolyn). When diuretics that work at different places in the kidney are used together, the response is often greater than the combined responses to the individual diuretics (synergistic response).
Some diuretics seringjali cause excessive loss of potassium in the urine, leading to reduction of body potassium. These medications include loop diuretics, thiazide diuretics, and metolazone. Patients on diuretics are generally advised to take potassium supplements and / or to eat foods high potassium. High-potassium foods include certain fruits such as:
* Bananas,
* Orange juice,
* The tomatoes, and
* The potatoes.
Patients with poor kidney function often do not require potassium supplements with diuretics because their kidneys are weak tend to retain potassium. In certain events, urine volume induced by diuretics could be improved by adding a potassium sparing diuretic, one that does not cause reduction of potassium. These diuretics include spironolactone (Aldactone), triamterene (Dyrenium, the components of Dyazide), and amiloride (Midamor). Adding one of these diuretics in diuretic regimen patients may avoid the need for potassium supplements. Another diuretic that can be used is acetazolamide (Diamox), which counteract the development of an increased concentration of bicarbonate (too much alkali) in the blood. Increased bicarbonate sometimes occurs in patients receiving other diuretics.
Used For Other Goals
Diuretics have several other uses in addition to treating edema.
* Diuretics may be used as part of the treatment program for patients with hypertension. (Hypertension or high blood pressure may be caused by the detention of salt, or caused by some antihypertensive drugs). In fact, most drugs that dilate blood vessels and reduce blood pressure, except for ACE inhibitors and angiotensin receptor blockers, leading to the arrest secondary salt by the kidneys.
* Thiazide diuretics have also been used to prevent formation of kidney stones. These medications reduce the expenditure of urinary calcium, which is a component of kidney stones.
* Acetazolamide (Diamox) taken before going to high altitudes, appears to reduce the tendency for people developing altitude sickness.
0 comments:
Post a Comment