Anasarca

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 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 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.

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

Common Causes

Common causes of anasarca may include:

• Congestive cardiac failure
• Anaphylaxis
• Urticaria
• Hepatic cirrhosis
• Renal failure
• Kwashiorkor disease
• Obstructive sleep apnea
• Pregnancy
• Nephrotic syndrome
• Use of certain medications (Beta blockers, calcium channel blockers, clonidine, methyldopa, hydralazine, androgen, corticosteroid)

Differential Diagnosis

Diseases		Clinical manifestation									Lab findings									Imaging studies	Gold standard diagnosis
		Onset		Abdominal distention due to ascities			Associated symptoms
								Blood pressure		Tachycardia												Physical examination finding
		Congestive cardiac failure		Chronic	+	Dysnea,Orthopnea, Proxysmal nocturnal dyspnea		↓ / ↑	+	Tachypnea, jugular venous distention, elevated CVP, S3, decreased breath sounds in lower lung fields, hepatojugular reflex	Increase BNP	Chest X-ray: Cardiomegaly, pleural effusion, Berkley lines Cardiac ECHO: Reduced Ejection fraction	LVEF on echocardiography	+	+	–	Nl	–	↑				↓	↑	Anti saccharomyces cerevisiae antibodies (ASCA) Vitamin B12 deficiency Elevated ESR Elevated CRP	Uveitis Arthritis Erythema nodosum Pyoderma gangrenosum Amyloidosis Venous and arterial thromboembolism Renal stones Bronchiectasis	Abnormal immune response to self antigens	Colonoscopy with biopsy
				Ulcerative colitis		–	+	+	+	+	±	+	+	Abdominal tenderness Blood on rectal examination	+	+	–	Nl	–			↑	↓	↑	Anti–neutrophil cytoplasmic antibody (P–ANCA) Hypoalbuminemia Hypokalemia Hypomagnesemia Elevated ESR Elevated CRP	Skin rash Iritis Uveitis Seronegative arthritis Clubbing Erythema nodosum	Abnormal immune response to self antigens	Colonoscopy with biopsy
Celiac disease				–	+	±	–	±	–	+	+	Abdominal distention Increased bowel sounds Oral mucosal lesions Hepatosplenomegaly Ascites	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	IgA endomysial antibody Anti–tissue transglutaminase antibody Anti–gliadin antibody Fat soluble vitamins deficiency	Malabsorption Dementia Dermatitis herpetiformis	HLA–DQ2 HLA–DQ8 Innate responses to wheat proteins	IgA endomysial antibody Anti–tissue transglutaminase antibody
Cause				Duration		Diarrhea			Fever	Abdominal pain	Weight loss	GI signs	Stool exam					CBC			Other lab findings	Extra intestinal findings	Cause/Pathogenesis	Gold standard diagnosis
				Acute	Chronic	Watery	Bloody	Fatty					WBC	RBC	Ova/Parasite	Osmotic gap	Other	WBC	Hgb	Plt
Cystic fibrosis				–	+	–	–	+	±	+	+	Abdominal distention Hepatosplenomegaly Rectal prolapse	–	–	–	Nl	Fat droplets on sudan stain	Nl	↓	Nl	Positive DNA analysis for cystic fibrosis transmembrane conductance regulator (CFTR) Nasal transepithelial potential difference Fat soluble vitamins deficiency	Malabsorption Recurrent respiratory tract infection Bronchiectasis Diabetes mellitus Scoliosis Infertility	Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) protein	Positive genetic testing Elevated sweat chloride ≥60 mmol/L References