Anasarca: Difference between revisions
| Line 59: | Line 59: | ||
*[[Hypothyroidism]] (advanced untreated hypothyroidism) | *[[Hypothyroidism]] (advanced untreated hypothyroidism) | ||
*Idiopathic [[edema]] | *Idiopathic [[edema]] | ||
*Increased capillary permeability | *[[Increased capillary permeability]] | ||
*Increased interstitial oncotic pressure | *Increased interstitial oncotic pressure | ||
*[[Interleukin-2]] therapy | *[[Interleukin-2]] therapy | ||
*[[Kwashiorkor]] | *[[Kwashiorkor]] | ||
*Lymphatic obstruction usually cause localized limb edema unless very proximal | *Lymphatic obstruction usually cause localized limb [[edema]] unless very proximal | ||
*[[Malnutrition]] | *[[Malnutrition]] | ||
*[[Malignant ascites]] is usually associated with lower extremities edema | *[[Malignant ascites]] is usually associated with lower extremities edema | ||
| Line 86: | Line 86: | ||
*[[Tropical sprue]] | *[[Tropical sprue]] | ||
*Venous obstruction usually causes localized edema in the limb | *Venous obstruction usually causes localized edema in the limb | ||
*Water overload | *[[Water overload]] | ||
*[[Yellow nail syndrome]] | *[[Yellow nail syndrome]] | ||
Revision as of 16:28, 25 January 2009
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| ICD-10 | R60.1 |
| ICD-9 | 782.3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Synonyms and keywords: Generalized edema, leucophlegmatia
Overview
Anasarca is a medical symptom characterized by widespread swelling of the skin due to effusion of fluid into the extracellular space. Anasarca is often due to either congestive cardiac failure, liver failure (cirrhosis of the liver), renal failure/disease, or the other diseases listed below. Plant-derived anticancer chemotherapeutic agents, such as docetaxel, cause anasarca through a poorly understood capillary leak syndrome.
Complete Differential Diagnosis of the Causes of Anasarca:
(In alphabetical order)
- Acute renal failure, especially oliguric renal failure with fluid retention
- Allergic reactions, only systemic severe allergic reactions with associated capillary leak
- Angioedema, rarely, when it is severe and generalized
- Burns (generalized severe burns can result in Hypoalbuminemia and capillary leak)
- Calcium channel blockers usually cause localized edma and not anasarca
- Capillary leak syndrome
- Cardiac tamponade resulting in heart failure and generalized edema
- Chronic kidney disease (advanced stages with fluid retention)
- Constrictive pericarditis with associated heart failure
- Cor pulmonale resulting in right heart failure
- Diazoxide usually cause localized edma and not anasarca
- Corticosteriods
- Dilated cardiomyopathy
- Docetaxel usually cause localized edma and not anasarca
- Eclampsia (severe eclampsia)
- Effusive-constrictive pericarditis with associated heart failure
- Estrogens
- Fludrocortisone
- Glomerulonephritis
- Haemolytic disease of the newborn
- Heart failure
- Hepatic cirrhosis
- Hereditary angioedema in severe cases
- Hypertrophic cardiomyopathy
- Hypoalbuminemia
- Hypoproteinemia
- Hypothyroidism (advanced untreated hypothyroidism)
- Idiopathic edema
- Increased capillary permeability
- Increased interstitial oncotic pressure
- Interleukin-2 therapy
- Kwashiorkor
- Lymphatic obstruction usually cause localized limb edema unless very proximal
- Malnutrition
- Malignant ascites is usually associated with lower extremities edema
- Minoxidil usually causes localized edema to the lower extremities
- Nephrotic syndrome
- Nonsteroidal antiinflammatory drug causes localized edma
- Ovarian hyperstimulation syndrome
- POEMS syndrome
- Portal thrombosis causes lower extremities edema
- Pramipexole
- Pregnancy
- Protein loss
- Protein-losing enteropathy
- Reduced albumin synthesis
- Refeeding edema
- Restrictive cardiomyopathy
- Severe inflammation or sepsis
- Sodium overload
- Thiazolidinediones
- Trauma (severe trauma)
- Tricuspid stenosis
- Tropical sprue
- Venous obstruction usually causes localized edema in the limb
- Water overload
- Yellow nail syndrome
Complete Differential Diagnosis of the Causes of Anasarca:
(By organ system)
| Cardiovascular | Cardiac tamponade ,
Constrictive pericarditis, Cor pulmonale, Dilated cardiomyopathy, Effusive-constrictive pericarditis, Heart failure, Hypertrophic cardiomyopathy, Restrictive cardiomyopathy, Tricuspid stenosis |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Calcium channel blockers, Diazoxide, Docetaxel, Estrogens
Fludrocortisone, Interleukin-2 therapy, Minoxidil, Nonsteroidal antiinflammatory drugs, Corticosteriods |
| Ear Nose Throat | No underlying causes |
| Endocrine | Corticosteriods |
| Environmental | No underlying causes |
| Gastroenterologic | Alcoholic liver disease , Autoimmune hepatitis, Chronic hepatitis B, Chronic hepatitis C, Hepatic cirrhosis, Hepatic venous obstruction, Hereditary hemochromatosis, Portal thrombosis, Primary biliary cirrhosis, Primary sclerosing cholangitis, Wilson's disease |
| Genetic | Angioedema, Alpha-1-antitrypsin deficiency, Hereditary angioedema
Hereditary hemochromatosis, Hypertrophic cardiomyopathy, Wilson's disease, Yellow nail syndrome |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Tropical sprue |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | Hypoalbuminemia, Hypoproteinaemia, Kwashiorkor, Malnutrition
Protein loss, Protein-losing enteropathy, Reduced albumin synthesis, Refeeding edema, Sodium overload, Tropical sprue, Water overload |
| Obstetric/Gynecologic | Eclampsia, Estrogens, Haemolytic disease of the newborn, Ovarian hyperstimulation syndrome, Pregnancy |
| Oncologic | Malignant ascites |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | Haemolytic disease of the newborn, Autoimmune hepatitis |
| Sexual | No underlying causes |
| Trauma | Trauma |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Treatment
The treatment of anasraca depends on the underlying cause. It involves the use of diuretics in cases related to heart failure or kidney disease. The latter may require hemodialysis especially if there are signs or symptoms of uremia. In cases of severe burns resulting in hypoalbuminemia and capillary leak, admission to a burn unit, volume and electrolyte replacement, and adequate nutrition is of paramount. Withdrawal of the offending drug is critical in drug-induced anasarca. The use of diuretics, paracentesis, and adequate nutritional supplementation is needed in anasarca secondary to hepatic cirrhosis. Profound hypothyroidism requires thyroid hormone replacement. Protein malabsorption syndromes require the identification of the underlying disease process and adequate protein supplementation.