Anasarca patient information: Difference between revisions
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{{CMG}} | |||
{{AE}} {{MSJ}} | |||
==Overview== | ==Overview== | ||
Anasarca is the presence of excess fluid in the interstitial space throughout the body. | [[Anasarca]] is the presence of excess fluid in the interstitial space throughout the body. | ||
==What are the symptoms of [[Anasarca]]== | ==What are the symptoms of [[Anasarca]]== | ||
The following questions should be asked to the patient regarding edema. | The following questions should be asked to the [[patient]] regarding [[edema]].<ref name="pmid11569326">{{cite journal| author=Yale SH, Mazza JJ| title=Approach to diagnosing lower extremity edema. | journal=Compr Ther | year= 2001 | volume= 27 | issue= 3 | pages= 242-52 | pmid=11569326 | doi=10.1007/s12019-001-0021-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11569326 }} </ref><ref name="pmid16513903">{{cite journal| author=Ely JW, Osheroff JA, Chambliss ML, Ebell MH| title=Approach to leg edema of unclear etiology. | journal=J Am Board Fam Med | year= 2006 | volume= 19 | issue= 2 | pages= 148-60 | pmid=16513903 | doi=10.3122/jabfm.19.2.148 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16513903 }} </ref><ref name="pmid11871635">{{cite journal| author=Topham EJ, Mortimer PS| title=Chronic lower limb oedema. | journal=Clin Med (Lond) | year= 2002 | volume= 2 | issue= 1 | pages= 28-31 | pmid=11871635 | doi=10.7861/clinmedicine.2-1-28 | pmc=4953165 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11871635 }} </ref> | ||
* Onset of the swelling: acute or chronic | |||
* Timing of the day when the swelling is worst. | *Onset of the [[swelling]]: acute or chronic | ||
* Location of swelling. Whether it is unilateral or bilateral. | *Characteristic: pitting and non-pitting edema | ||
* Tenderness in the swelling. | *Timing of the day when the [[swelling]] is worst. | ||
* Change in color or blisters at the site of the swelling. | *Location of [[swelling]]. Whether it is unilateral or bilateral. | ||
* The exacerbation of edema with changes in the position of the patient. | *Tenderness in the swelling. | ||
* Dependent edema occurs in venous insufficiency. It improves with the elevation of legs. The edema with reduced plasma oncotic pressure as underlying etiology is not improved by elevating the | *Change in color or blisters at the site of the [[swelling]]. | ||
* Medication history. | *The exacerbation of edema with changes in the position of the patient. | ||
* Medical history. Any coexisting heart, renal, or liver disease. | *Dependent [[edema]] occurs in [[venous insufficiency]]. It improves with the elevation of [[Leg|legs]]. The edema with reduced [[Plasma (blood)|plasma]] [[oncotic pressure]] as underlying etiology is not improved by elevating the [[leg]]<nowiki/>s. | ||
*Medication history. | |||
*Medical history. Any coexisting [[heart]], [[Kidney|renal]], or [[liver]] disease. | |||
==What causes [[Anasarca]]== | ==What causes [[Anasarca]]== | ||
* Exacerbation of congestive heart failure | The common causes are: <ref name="pmid23939641">{{cite journal| author=Trayes KP, Studdiford JS, Pickle S, Tully AS| title=Edema: diagnosis and management. | journal=Am Fam Physician | year= 2013 | volume= 88 | issue= 2 | pages= 102-10 | pmid=23939641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23939641 }} </ref><ref name="pmid15952439">{{cite journal| author=O'Brien JG, Chennubhotla SA, Chennubhotla RV| title=Treatment of edema. | journal=Am Fam Physician | year= 2005 | volume= 71 | issue= 11 | pages= 2111-7 | pmid=15952439 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15952439 }} </ref><ref name="pmid12459405">{{cite journal| author=Cho S, Atwood JE| title=Peripheral edema. | journal=Am J Med | year= 2002 | volume= 113 | issue= 7 | pages= 580-6 | pmid=12459405 | doi=10.1016/s0002-9343(02)01322-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12459405 }} </ref><ref name="pmid11569326">{{cite journal| author=Yale SH, Mazza JJ| title=Approach to diagnosing lower extremity edema. | journal=Compr Ther | year= 2001 | volume= 27 | issue= 3 | pages= 242-52 | pmid=11569326 | doi=10.1007/s12019-001-0021-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11569326 }} </ref> | ||
* Exacerbation of chronic renal disease | *Exacerbation of [[congestive heart failure]] | ||
* Hepatic cirrhosis | *Exacerbation of [[Chronic renal failure|chronic renal disease]] | ||
* Kwashiorkor | *Hepatic [[cirrhosis]] | ||
* Nephrotic syndrome | *Kwashiorkor disease | ||
* Pregnancy | *[[Nephrotic syndrome]] | ||
* Allergic reactions (anaphylaxis or urticaria) | *[[Pregnancy]] | ||
* Adverse effects of medications (beta-blockers, calcium channel | *Allergic reactions ([[anaphylaxis]] or [[urticaria]]) | ||
*Adverse effects of medications ([[Beta blockers|beta-blockers]], [[calcium channel blocker]]<nowiki/>s, [[Methyl dopa|alpha-methyl dopa]], [[Corticosteroid|corticosteroids]], [[Testosterone|testosterone,]] [[estrogen]], [[cyclophosphamide]], [[cyclosporine]]) | |||
==Who is at the Highest Risk== | |||
*Poorly controlled underlying systematic diseases. | |||
*Severe [[malnutrion]] | |||
*Exposure to allergens | |||
==When to Seek Urgent Medical Care== | |||
* The [[pulmonary edema]] is a life-threatening medical condition and its emergence requires urgent medical care. The clinical symptoms of pulmonary edema are [[tachypnea]], [[dyspnea]], [[cough]] with straw-colored [[sputum]]. On [[chest]] auscultation crackles and decreased breath sounds are heard. It is managed aggressively by intravenous [[diuretic|diuretics]], [[vasodilator|vasodilators]], and [[oxygen]] therapy.<ref name="pmid19324966">{{cite journal| author=Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG | display-authors=etal| title=2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. | journal=Circulation | year= 2009 | volume= 119 | issue= 14 | pages= e391-479 | pmid=19324966 | doi=10.1161/CIRCULATIONAHA.109.192065 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19324966 }} </ref> | |||
==Diagnosis== | |||
The diagnostic study of choice depends upon the underlying etiology. The following tests should be carried out: | |||
*Serum [[Brain natriuretic peptide|BNP]], [[Chest X-ray]] and Cardiac [[Echocardiography]]: To assess [[heart failure]] in [[cardiac failure patients]]. | |||
*Serum [[creatinine]], [[blood urea nitrogen]], complete metabolic profile and [[Kidney|renal]] [[ultrasound]]: To assess [[Kidney|renal]] functions in [[Chronic renal failure|chronic kidney disease]] [[patient]]<nowiki/>s. | |||
*[[Liver function tests]] and [[coagulation]] profile test: In patients with [[liver]] [[cirrhosis]]. | |||
*Serum [[albumin]] level: In [[protein]] losing [[nephropathy]], decrease [[protein]] intake, and deranged [[liver]] functions. | |||
*Nocturnal [[sleep]] studies in [[obstructive sleep apnea]] patients. | |||
==Treatment Options== | |||
Medical therapies should be specifically directed towards underlying etiology. | |||
* Diuretics, [[oxygen]], inotropic drugs, and vasodilators in cardiac patients. | |||
* Albumin administration is helpful in improving symptoms, survival and reducing ascities in cirrhotic patients.<ref name="pmid28634518">{{cite journal| author=Walayat S, Martin D, Patel J, Ahmed U, N Asghar M, Pai AU | display-authors=etal| title=Role of albumin in cirrhosis: from a hospitalist's perspective. | journal=J Community Hosp Intern Med Perspect | year= 2017 | volume= 7 | issue= 1 | pages= 8-14 | pmid=28634518 | doi=10.1080/20009666.2017.1302704 | pmc=5463675 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28634518 }} </ref> | |||
* [[Hemodialysis]], [[vitamin D]], and [[erythropoietin]] for end-stage renal disease patients. | |||
* [[Lactulose]], diuretics, and antibiotics in hepatic [[cirrhosis]] patients. | |||
* I/V [[adrenaline]], intravenous fluids, and inhaled bronchodilators are administered in patients with allergic reactions. | |||
==Prevention== | |||
* Leg elevation and pneumatic compression stocking to promote venous and lymphatic drainage from lower limbs.<ref name="pmid9192256">{{cite journal| author=Alguire PC, Mathes BM| title=Chronic venous insufficiency and venous ulceration. | journal=J Gen Intern Med | year= 1997 | volume= 12 | issue= 6 | pages= 374-83 | pmid=9192256 | doi=10.1046/j.1525-1497.1997.00063.x | pmc=1497122 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9192256 }} </ref><ref name="pmid12618689">{{cite journal| author=Berliner E, Ozbilgin B, Zarin DA| title=A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers. | journal=J Vasc Surg | year= 2003 | volume= 37 | issue= 3 | pages= 539-44 | pmid=12618689 | doi=10.1067/mva.2003.103 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12618689 }} </ref> | |||
* Edema in lower limbs increases the risk for [[skin]] breakouts and, venous ulcers. Topical [[corticosteroid]] creams and emollients are applied to hydrate the [[skin]] and prevent cutaneous infection.<ref name="pmid23939641">{{cite journal| author=Trayes KP, Studdiford JS, Pickle S, Tully AS| title=Edema: diagnosis and management. | journal=Am Fam Physician | year= 2013 | volume= 88 | issue= 2 | pages= 102-10 | pmid=23939641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23939641 }} </ref> | |||
==Sources== | |||
Latest revision as of 16:42, 3 September 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]
Overview
Anasarca is the presence of excess fluid in the interstitial space throughout the body.
What are the symptoms of Anasarca
The following questions should be asked to the patient regarding edema.[1][2][3]
- Onset of the swelling: acute or chronic
- Characteristic: pitting and non-pitting edema
- Timing of the day when the swelling is worst.
- Location of swelling. Whether it is unilateral or bilateral.
- Tenderness in the swelling.
- Change in color or blisters at the site of the swelling.
- The exacerbation of edema with changes in the position of the patient.
- Dependent edema occurs in venous insufficiency. It improves with the elevation of legs. The edema with reduced plasma oncotic pressure as underlying etiology is not improved by elevating the legs.
- Medication history.
- Medical history. Any coexisting heart, renal, or liver disease.
What causes Anasarca
The common causes are: [4][5][6][1]
- Exacerbation of congestive heart failure
- Exacerbation of chronic renal disease
- Hepatic cirrhosis
- Kwashiorkor disease
- Nephrotic syndrome
- Pregnancy
- Allergic reactions (anaphylaxis or urticaria)
- Adverse effects of medications (beta-blockers, calcium channel blockers, alpha-methyl dopa, corticosteroids, testosterone, estrogen, cyclophosphamide, cyclosporine)
Who is at the Highest Risk
- Poorly controlled underlying systematic diseases.
- Severe malnutrion
- Exposure to allergens
When to Seek Urgent Medical Care
- The pulmonary edema is a life-threatening medical condition and its emergence requires urgent medical care. The clinical symptoms of pulmonary edema are tachypnea, dyspnea, cough with straw-colored sputum. On chest auscultation crackles and decreased breath sounds are heard. It is managed aggressively by intravenous diuretics, vasodilators, and oxygen therapy.[7]
Diagnosis
The diagnostic study of choice depends upon the underlying etiology. The following tests should be carried out:
- Serum BNP, Chest X-ray and Cardiac Echocardiography: To assess heart failure in cardiac failure patients.
- Serum creatinine, blood urea nitrogen, complete metabolic profile and renal ultrasound: To assess renal functions in chronic kidney disease patients.
- Liver function tests and coagulation profile test: In patients with liver cirrhosis.
- Serum albumin level: In protein losing nephropathy, decrease protein intake, and deranged liver functions.
- Nocturnal sleep studies in obstructive sleep apnea patients.
Treatment Options
Medical therapies should be specifically directed towards underlying etiology.
- Diuretics, oxygen, inotropic drugs, and vasodilators in cardiac patients.
- Albumin administration is helpful in improving symptoms, survival and reducing ascities in cirrhotic patients.[8]
- Hemodialysis, vitamin D, and erythropoietin for end-stage renal disease patients.
- Lactulose, diuretics, and antibiotics in hepatic cirrhosis patients.
- I/V adrenaline, intravenous fluids, and inhaled bronchodilators are administered in patients with allergic reactions.
Prevention
- Leg elevation and pneumatic compression stocking to promote venous and lymphatic drainage from lower limbs.[9][10]
- Edema in lower limbs increases the risk for skin breakouts and, venous ulcers. Topical corticosteroid creams and emollients are applied to hydrate the skin and prevent cutaneous infection.[4]
Sources
- ↑ 1.0 1.1 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.
- ↑ Ely JW, Osheroff JA, Chambliss ML, Ebell MH (2006). "Approach to leg edema of unclear etiology". J Am Board Fam Med. 19 (2): 148–60. doi:10.3122/jabfm.19.2.148. PMID 16513903.
- ↑ Topham EJ, Mortimer PS (2002). "Chronic lower limb oedema". Clin Med (Lond). 2 (1): 28–31. doi:10.7861/clinmedicine.2-1-28. PMC 4953165. PMID 11871635.
- ↑ 4.0 4.1 Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.
- ↑ O'Brien JG, Chennubhotla SA, Chennubhotla RV (2005). "Treatment of edema". Am Fam Physician. 71 (11): 2111–7. PMID 15952439.
- ↑ Cho S, Atwood JE (2002). "Peripheral edema". Am J Med. 113 (7): 580–6. doi:10.1016/s0002-9343(02)01322-0. PMID 12459405.
- ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG; et al. (2009). "2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation". Circulation. 119 (14): e391–479. doi:10.1161/CIRCULATIONAHA.109.192065. PMID 19324966.
- ↑ Walayat S, Martin D, Patel J, Ahmed U, N Asghar M, Pai AU; et al. (2017). "Role of albumin in cirrhosis: from a hospitalist's perspective". J Community Hosp Intern Med Perspect. 7 (1): 8–14. doi:10.1080/20009666.2017.1302704. PMC 5463675. PMID 28634518.
- ↑ Alguire PC, Mathes BM (1997). "Chronic venous insufficiency and venous ulceration". J Gen Intern Med. 12 (6): 374–83. doi:10.1046/j.1525-1497.1997.00063.x. PMC 1497122. PMID 9192256.
- ↑ Berliner E, Ozbilgin B, Zarin DA (2003). "A systematic review of pneumatic compression for treatment of chronic venous insufficiency and venous ulcers". J Vasc Surg. 37 (3): 539–44. doi:10.1067/mva.2003.103. PMID 12618689.