Anasarca: Difference between revisions
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| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |[[Dyspnea]],Orthopnea, Proxysmal nocturnal dyspnea | | align="left" style="background:#F5F5F5;" |[[Dyspnea]],[[Orthopnea]], [[Proxysmal nocturnal dyspnea]] | ||
| align="center" style="background:#F5F5F5;" |↓ ↑ | | align="center" style="background:#F5F5F5;" |↓ ↑ | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Tachypnea, jugular venous distention, elevated CVP, S3, decreased breath sounds in lower lung fields, hepatojugular reflex | | align="left" style="background:#F5F5F5;" |[[Tachypnea]], [[Jugular venous pressure|jugular venous distention]], elevated [[Central venous pressure|CVP]], S3, decreased [[Breathing|breath]] sounds in lower [[lung]] fields, [[hepatojugular reflex]] | ||
| align="center" style="background:#F5F5F5;" |Elevated BNP | | align="center" style="background:#F5F5F5;" |Elevated [[Brain natriuretic peptide|BNP]] | ||
| align="left" style="background:#F5F5F5;" | | | align="left" style="background:#F5F5F5;" | | ||
*Chest X-ray: Cardiomegaly, pleural effusion, Berkley lines | *[[Chest X-ray]]: [[Cardiomegaly]], [[pleural effusion]], Berkley lines | ||
*Cardiac ECHO: Reduced Ejection fraction | *Cardiac ECHO: Reduced [[Ejection fraction]] | ||
| align="left" style="background:#F5F5F5;" |LVEF on echocardiography | | align="left" style="background:#F5F5F5;" |[[Ejection fraction|LVEF]] on echocardiography | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Liver]] [[cirrhosis]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Liver]] [[cirrhosis]] | ||
| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Nausea,vomitting, jaundice, telangiactesia, palmar erythema, hematemsis, anorectal varicies | | align="left" style="background:#F5F5F5;" |[[Nausea and vomiting|Nausea]],[[Nausea and vomiting|vomitting]], [[jaundice]], [[Telangiactesia|telangiactesia,]] [[palmar erythema]], [[hematemsis]], anorectal varicies | ||
| align="center" style="background:#F5F5F5;" |↓ | | align="center" style="background:#F5F5F5;" |↓ | ||
| align="center" style="background:#F5F5F5;" | - | | align="center" style="background:#F5F5F5;" | - | ||
| align="left" style="background:#F5F5F5;" |Jaundice, pallor, caput meducae, | | align="left" style="background:#F5F5F5;" |[[Jaundice]], [[pallor]], [[caput meducae]], [[splenomegaly]], inintially [[hepatomegaly]], [[clubbing]], [[Dupuytrens contracture|Dupuytren's contracture]] | ||
| align="left" style="background:#F5F5F5;" |Elevated ALP, AST, ALT, GGT, | | align="left" style="background:#F5F5F5;" |Elevated [[ALP]], [[AST]], [[Alanine transaminase|ALT]], [[Gamma-glutamyl transpeptidase|GGT]], [[bilirubin]], hypoalbuminemia, prolonged [[prothrombin time]] | ||
| align="left" style="background:#F5F5F5;" |USG liver will show cirrhotic, irregular nodular liver with increased echogenicity. | | align="left" style="background:#F5F5F5;" |USG [[liver]] will show [[Cirrhosis|cirrhotic]], irregular nodular [[liver]] with increased echogenicity. | ||
| align="left" style="background:#F5F5F5;" |Liver biopsy | | align="left" style="background:#F5F5F5;" |[[Liver]] [[biopsy]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Chronic kidney disease]] | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Chronic kidney disease]] | ||
| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Anorexia, Nausea, bleeding, fatigue, weakness | | align="left" style="background:#F5F5F5;" |[[Anorexia]], [[Nausea and vomiting|Nausea]], [[bleeding]], [[Fatigue|fatigue,]] [[weakness]] | ||
| align="center" style="background:#F5F5F5;" |↑ | | align="center" style="background:#F5F5F5;" |↑ | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Pallor, tachypnea, pericardial friction rub, crackles on chest ascultation, uremic fetor | | align="left" style="background:#F5F5F5;" |[[Pallor]], [[tachypnea]], [[pericardial friction rub]], crackles on chest ascultation, uremic fetor | ||
| align="left" style="background:#F5F5F5;" |Elevated BUN, | | align="left" style="background:#F5F5F5;" |Elevated [[Blood urea nitrogen|BUN]],[[creatinine]], decrease [[hemoglobin]], [[acidosis]], [[hyperkalemia]], elevated [[Triglyceride|TAG]] | ||
| align="left" style="background:#F5F5F5;" |USG kidney will show atrophied kidney with cortical thinning and increased echogenecity. | | align="left" style="background:#F5F5F5;" |[[Ultrasound|USG]] [[kidney]] will show atrophied [[kidney]] with cortical thinning and increased echogenecity. | ||
| align="left" style="background:#F5F5F5;" |GFR | | align="left" style="background:#F5F5F5;" |[[Glomerular filtration rate|GFR]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Protein losing nephropathy | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Protein losing [[nephropathy]] | ||
| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Dyspnea, headache, irratibility, | | align="left" style="background:#F5F5F5;" |[[Dyspnea]], [[headache]], irratibility, [[bacteria]]<nowiki/>l or [[Virus|viral]] infections, recent H/O of [[Upper respiratory tract infection|URTI]] | ||
| align="center" style="background:#F5F5F5;" |↑ /N | | align="center" style="background:#F5F5F5;" |↑ /N | ||
| align="center" style="background:#F5F5F5;" | - | | align="center" style="background:#F5F5F5;" | - | ||
| align="left" style="background:#F5F5F5;" |Hematuria in some patients, Facial malar rash in SLE | | align="left" style="background:#F5F5F5;" |[[Hematuria]] in some patients, Facial [[malar rash]] in [[SLE]] [[patient]]<nowiki/>s. | ||
| align="left" style="background:#F5F5F5;" |Hypoalbuminemia, 24 hour urine protein excretion | | align="left" style="background:#F5F5F5;" |[[Hypoalbuminemia]], 24 hour [[urine]] [[protein]] excretion>3.5g, Elevated [[Triglyceride|TAG]] and [[cholesterol]]. | ||
| align="left" style="background:#F5F5F5;" |USG kidney may show increased echogenecity. | | align="left" style="background:#F5F5F5;" |[[Ultrasound|USG]] [[kidney]] may show increased echogenecity. | ||
| align="left" style="background:#F5F5F5;" |Renal biopsy | | align="left" style="background:#F5F5F5;" |[[Kidney|Renal]] [[biopsy]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Protein Calorie malnutrition | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Protein Calorie [[malnutrition]] | ||
| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Muscle wasting, stunted growth, | | align="left" style="background:#F5F5F5;" |[[Muscle wasting]], stunted [[growth]], swollen [[face]], dry [[skin]], brittle [[hair]] | ||
| align="center" style="background:#F5F5F5;" |↓ /N | | align="center" style="background:#F5F5F5;" |↓ /N | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Hepatomegaly, Scaling, | | align="left" style="background:#F5F5F5;" |[[Hepatomegaly]], [[Scaling skin|Scaling]], [[hyperpigmentation]] and [[hypopigmentation]] of [[skin]] | ||
| align="left" style="background:#F5F5F5;" |Hypoalbuminemia | | align="left" style="background:#F5F5F5;" |[[Hypoalbuminemia]] | ||
| align="left" style="background:#F5F5F5;" |NA | | align="left" style="background:#F5F5F5;" |NA | ||
| align="left" style="background:#F5F5F5;" |NA | | align="left" style="background:#F5F5F5;" |NA | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Allergic reactions | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Allergic Reaction|Allergic reactions]] | ||
| align="center" style="background:#F5F5F5;" |Acute | | align="center" style="background:#F5F5F5;" |Acute | ||
| align="center" style="background:#F5F5F5;" | - | | align="center" style="background:#F5F5F5;" | - | ||
| align="left" style="background:#F5F5F5;" |Dyspnea, difficulty breathing, raised | | align="left" style="background:#F5F5F5;" |[[Dyspnea]], difficulty [[breathing]], raised erythematous [[skin]] [[rash]]<nowiki/>es, [[abdominal cramping]] | ||
| align="center" style="background:#F5F5F5;" |↓ | | align="center" style="background:#F5F5F5;" |↓ | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Bronchial wheezing on chest ascultation | | align="left" style="background:#F5F5F5;" |[[Wheeze|Bronchial wheezing]] on [[chest]] ascultation | ||
| align="left" style="background:#F5F5F5;" |Elevated tryptase and plasma histamine levels | | align="left" style="background:#F5F5F5;" |Elevated [[tryptase]] and plasma [[histamine]] levels | ||
| align="left" style="background:#F5F5F5;" |NA | | align="left" style="background:#F5F5F5;" |NA | ||
| align="left" style="background:#F5F5F5;" |NA | | align="left" style="background:#F5F5F5;" |NA | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Pregnancy | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pregnancy]] | ||
| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="left" style="background:#F5F5F5;" | - | | align="left" style="background:#F5F5F5;" | - | ||
| align="left" style="background:#F5F5F5;" |Amenorrhea, morning sickness, fatigue, breast tenderness, constipation, back pain | | align="left" style="background:#F5F5F5;" |[[Amenorrhea]], morning sickness, [[Fatigue (physical)|fatigue]], [[Breast|breast tenderness]], [[constipation]], [[back pain]] | ||
| align="center" style="background:#F5F5F5;" |↓ | | align="center" style="background:#F5F5F5;" |↓ | ||
| align="center" style="background:#F5F5F5;" | + | | align="center" style="background:#F5F5F5;" | + | ||
| align="left" style="background:#F5F5F5;" |Fundal height of the fetus, pallor, melasma | | align="left" style="background:#F5F5F5;" |Fundal height of the [[fetus]], [[pallor]], [[melasma]] | ||
| align="left" style="background:#F5F5F5;" |Urine | | align="left" style="background:#F5F5F5;" |[[Urine]] [[Pregnancy|pregnanc]]<nowiki/>y test positive, increased serum beta [[Human chorionic gonadotropin|hcG]] | ||
| align="left" style="background:#F5F5F5;" |USG Abdomen will show an intrauterine pregnancy. | | align="left" style="background:#F5F5F5;" |[[Medical ultrasonography|USG]] [[Abdomen]] will show an intrauterine [[pregnancy]]. | ||
| align="left" style="background:#F5F5F5;" |Blood levels of beta hcG | | align="left" style="background:#F5F5F5;" |Blood levels of [[Human chorionic gonadotropin|beta hcG]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Medication-induced | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |Medication-induced | ||
| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="left" style="background:#F5F5F5;" | - | | align="left" style="background:#F5F5F5;" | - | ||
| align="left" style="background:#F5F5F5;" |Temporal relation between medicine intake and appearance of symptoms | | align="left" style="background:#F5F5F5;" |Temporal relation between [[medicine]] intake and appearance of symptoms | ||
| align="center" style="background:#F5F5F5;" |N/ ↓ | | align="center" style="background:#F5F5F5;" |N/ ↓ | ||
| align="center" style="background:#F5F5F5;" | - | | align="center" style="background:#F5F5F5;" | - | ||
| align="left" style="background:#F5F5F5;" |Specific to the | | align="left" style="background:#F5F5F5;" |Specific to the medication | ||
| align="left" style="background:#F5F5F5;" |Resolution of symptoms after discontinuing | | align="left" style="background:#F5F5F5;" |Resolution of symptoms after discontinuing medication | ||
| align="left" style="background:#F5F5F5;" |NA | | align="left" style="background:#F5F5F5;" |NA | ||
| align="left" style="background:#F5F5F5;" |NA | | align="left" style="background:#F5F5F5;" |NA | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: center;" |Obstructive sleep apnea | ! style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Obstructive sleep apnea]] | ||
| align="center" style="background:#F5F5F5;" |Chronic | | align="center" style="background:#F5F5F5;" |Chronic | ||
| align="left" style="background:#F5F5F5;" |Due to obesity | | align="left" style="background:#F5F5F5;" |Due to obesity | ||
| align="left" style="background:#F5F5F5;" |Snoring, Frequent night-time awakening, daytime drowsiness | | align="left" style="background:#F5F5F5;" |[[Snoring]], Frequent night-time awakening, daytime [[Somnolence|drowsiness]] | ||
| align="center" style="background:#F5F5F5;" |↑ | | align="center" style="background:#F5F5F5;" |↑ | ||
| align="center" style="background:#F5F5F5;" | - | | align="center" style="background:#F5F5F5;" | - | ||
| align="left" style="background:#F5F5F5;" |High BMI, increase neck size and waist circumference, enlarged tongue, hypertrophy of | | align="left" style="background:#F5F5F5;" |High [[Body mass index|BMI]], increase [[neck]] size and waist circumference, enlarged [[tongue]], [[Hypertrophy (medical)|hypertrophy]] of [[tonsil]]<nowiki/>s, enlarged [[Palatine uvula|uvula]], [[Nasal polyp|nasal polyps]] and high arched [[palate]]. | ||
| align="left" style="background:#F5F5F5;" |Polysomnography | | align="left" style="background:#F5F5F5;" |[[Polysomnography]] | ||
| align="left" style="background:#F5F5F5;" |NA | | align="left" style="background:#F5F5F5;" |NA | ||
| align="left" style="background:#F5F5F5;" |Polysomnography | | align="left" style="background:#F5F5F5;" |Polysomnography |
Revision as of 15:44, 1 September 2020
Anasarca | |
CT scan showing generalized edema of skin | |
ICD-10 | R60.1 |
ICD-9 | 782.3 |
Anasarca Microchapters |
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 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 | 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 |