Anasarca

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Anasarca
CT scan showing generalized edema of skin
ICD-10 R60.1
ICD-9 782.3

Anasarca Microchapters

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Patient Information

Overview

Classification

Causes

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]

Synonyms and keywords: Generalized edema, generalized swelling, leucophlegmatia

Overview

Edema is characterized by the collection of excess fluid in the interstitial space. Anasarca is severe edema characterized by generalized swelling throughout the body. The main underlying cause of edema is an imbalance in the hemodynamic status of the capillaries resulting in excess filtration of fluid in the intercellular space due to increased hydrostatic pressure, increased permeability of the capillaries and decreased oncotic pressure. It exceeds the absorptive capacity of lymph vessels. It can be caused by systemic diseases including chronic heart failure, liver cirrhosis, hypersensitivity reaction, and chronic renal failure.

Classification

The edema is classified in different types depending upon the severity of fluid accumulation assessed clinically:[1]

Grade Visibility of edema Pitting over tibia Level of edema
0+ No Absent Cannot assess
1+ Yes Slight Cannot assess
2+ Yes Moderate Below knee
3+ Yes Moderate Above knee
4+ Yes Severe (cannot reach tibia) Above knee

Causes

Life-threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Common causes of anasarca may include the following:[2][3][4][5]

Differential Diagnosis

On the basis of onset of symptoms, ascities, and hypertension, anasarca must be differentiated from congestive heart failure, chronic kidney disease, liver cirrhosis, anaphylaxis, nephrotic syndrome, and protein-calorie malnutrition.[6][7][8][9][10][11][12][13][14][15][16][17]

Diseases Clinical manifestation Para-clinical findings Gold Standard
Onset Abdominal distention due to ascities Associated symptoms Blood pressure Tachycardia Physical examination findings Lab findings Imaging
Congestive Cardiac Failure Chronic + Dyspnea,Orthopnea, Proxysmal nocturnal dyspnea ↓ /↑ + Tachypnea, jugular venous distention, elevated CVP, S3, decreased breath sounds in lower lung fields, hepatojugular reflex Elevated BNP LVEF on echocardiography
Liver cirrhosis Chronic + Nausea,vomitting, jaundice, telangiactesia, palmar erythema, hematemsis, anorectal varicies ↓ - Jaundice, pallor, caput meducae, splenomegaly, inintially hepatomegaly, clubbing, Dupuytren's contracture Elevated ALP, AST, ALT, GGT, bilirubin, hypoalbuminemia, prolonged prothrombin time USG liver will show cirrhotic, irregular nodular liver with increased echogenicity. Liver biopsy
Chronic kidney disease Chronic + Anorexia, Nausea, bleeding, fatigue, weakness ↑ + Pallor, tachypnea, pericardial friction rub, crackles on chest ascultation, uremic fetor Elevated BUN,creatinine, decrease hemoglobin, acidosis, hyperkalemia, elevated TAG USG kidney will show atrophied kidney with cortical thinning and increased echogenecity. GFR
Protein losing nephropathy Chronic + Dyspnea, headache, irratibility, bacterial or viral infections, recent H/O of URTI ↑ /N +/- Hematuria in some patients, Facial malar rash in SLE patients. Hypoalbuminemia, 24 hour urine protein excretion>3.5g, Elevated TAG and cholesterol. USG kidney may show increased echogenecity. Renal biopsy
Protein Calorie malnutrition Chronic + Muscle wasting, stunted growth, swollen face, dry skin, brittle hair ↓ /N + Hepatomegaly, Scaling, hyperpigmentation and hypopigmentation of skin Hypoalbuminemia NA NA
Allergic reactions Acute - Dyspnea, difficulty breathing, raised erythematous skin rashes, abdominal cramping ↓ + Bronchial wheezing on chest ascultation Elevated tryptase and plasma histamine levels NA NA
Pregnancy Chronic - Amenorrhea, morning sickness, fatigue, breast tenderness, constipation, back pain ↓ + Fundal height of the fetus, pallor, melasma Urine pregnancy test positive, increased serum beta hcG USG Abdomen will show an intrauterine pregnancy. Blood levels of beta hcG
Medication-induced Chronic - Temporal relation between medicine intake and appearance of symptoms N/ ↓ - Specific to the medication Resolution of symptoms after discontinuing medication NA NA
Obstructive sleep apnea Chronic Due to obesity Snoring, Frequent night-time awakening, daytime drowsiness ↑ - High BMI, increase neck size and waist circumference, enlarged tongue, hypertrophy of tonsils, enlarged uvula, nasal polyps and high arched palate. Polysomnography NA Polysomnography

Abbreviations: CVP: Central venous pressure, BNP: Brain natriuretic peptide, LVEF: Left ventricular ejection fraction, ALP: Alkaline phosphatase, AST: Aspartate transferase, ALT: Alanine transferase, GGT: Gamma Glutamyl transferase, BUN: Blood urea nitrogen, N: Normal, TAG: Triglycerides, URTI: Upper respiratory tract infection, USG: Ultrasound, hcG: human chorionic gonadotropin, BMI: Body mass index, N/A: Not applicable.

Treatment

References

  1. ↑ Stoltz JF, Nicolas A (1978). "Study of amino groups of the human platelet membrane". Acta Haematol. 60 (5): 304–9. doi:10.1159/000207727. PMID 101016/j.cardfail.2013.06.276 Check |pmid= value (help).
  2. ↑ Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.
  3. ↑ O'Brien JG, Chennubhotla SA, Chennubhotla RV (2005). "Treatment of edema". Am Fam Physician. 71 (11): 2111–7. PMID 15952439.
  4. ↑ Cho S, Atwood JE (2002). "Peripheral edema". Am J Med. 113 (7): 580–6. doi:10.1016/s0002-9343(02)01322-0. PMID 12459405.
  5. ↑ Yale SH, Mazza JJ (2001). "Approach to diagnosing lower extremity edema". Compr Ther. 27 (3): 242–52. doi:10.1007/s12019-001-0021-5. PMID 11569326.
  6. ↑ "StatPearls". 2020. PMID 29939653.
  7. ↑ Yap FY, Skalski MR, Patel DB, Schein AJ, White EA, Tomasian A; et al. (2017). "Hypertrophic Osteoarthropathy: Clinical and Imaging Features". Radiographics. 37 (1): 157–195. doi:10.1148/rg.2017160052. PMID 27935768.
  8. ↑ Auld T, Werntz JR (2017). "Dupuytren's disease: How to recognize its early signs". J Fam Pract. 66 (3): E5–E10. PMID 28505213.
  9. ↑ Carmelli D, Swan GE, Bliwise DL (2000). "Relationship of 30-year changes in obesity to sleep-disordered breathing in the Western Collaborative Group Study". Obes Res. 8 (9): 632–7. doi:10.1038/oby.2000.81. PMID 11225711.
  10. ↑ Inamdar AA, Inamdar AC (2016). "Heart Failure: Diagnosis, Management and Utilization". J Clin Med. 5 (7). doi:10.3390/jcm5070062. PMC 4961993. PMID 27367736.
  11. ↑ Levey AS, Inker LA (2016). "GFR as the "Gold Standard": Estimated, Measured, and True". Am J Kidney Dis. 67 (1): 9–12. doi:10.1053/j.ajkd.2015.09.014. PMID 26708193.
  12. ↑ Hansen KL, Nielsen MB, Ewertsen C (2015). "Ultrasonography of the Kidney: A Pictorial Review". Diagnostics (Basel). 6 (1). doi:10.3390/diagnostics6010002. PMC 4808817. PMID 26838799.
  13. ↑ Vadas P, Perelman B, Liss G (2013). "Platelet-activating factor, histamine, and tryptase levels in human anaphylaxis". J Allergy Clin Immunol. 131 (1): 144–9. doi:10.1016/j.jaci.2012.08.016. PMID 23040367.
  14. ↑ Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP; et al. (2009). "Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults". J Clin Sleep Med. 5 (3): 263–76. PMC 2699173. PMID 19960649.
  15. ↑ Sheth SG, Flamm SL, Gordon FD, Chopra S (1998). "AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection". Am J Gastroenterol. 93 (1): 44–8. doi:10.1111/j.1572-0241.1998.044_c.x. PMID 9448172.
  16. ↑ Krzeski P, Zych W, Kraszewska E, Milewski B, Butruk E, Habior A (1999). "Is serum bilirubin concentration the only valid prognostic marker in primary biliary cirrhosis?". Hepatology. 30 (4): 865–9. doi:10.1002/hep.510300415. PMID 10498635.
  17. ↑ Schwartz LB (2006). "Diagnostic value of tryptase in anaphylaxis and mastocytosis". Immunol Allergy Clin North Am. 26 (3): 451–63. doi:10.1016/j.iac.2006.05.010. PMID 16931288.
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