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| {{SK}} Generalized edema, generalized swelling, leucophlegmatia | | {{SK}} Generalized edema, generalized swelling, leucophlegmatia |
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| ==Overview== | | == [[Anasarca overview|Overview]] == |
| '''Anasarca''' is a [[list of medical symptoms|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 [[chemotherapy|chemotherapeutic]] agents, such as [[docetaxel]], cause anasarca through a poorly understood [[capillary leak syndrome]].
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| ==Complete Differential Diagnosis of the Underlying Causes of Anasarca == | | == [[Anasarca pathophysiology|Pathophysiology]] == |
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| (In alphabetical order)
| | == [[Anasarca causes|Causes]] == |
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| *[[Acute renal failure]], especially oliguric renal failure with fluid retention
| | == Diagnosis == |
| *[[Allergic reactions]], only systemic severe allergic reactions with associated capillary leak
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| *[[Angioedema]], rarely, when it is severe and generalized
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| *[[Burns]] (generalized severe burns can result in [[Hypoalbuminemia]] and capillary leak)
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| *[[Calcium channel blockers]] usually cause localized edma and not anasarca
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| *[[Capillary leak syndrome]]
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| *[[Cardiac tamponade ]] resulting in heart failure and generalized edema
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| *[[Chronic kidney disease]] (advanced stages with fluid retention)
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| *[[Constrictive pericarditis]] with associated heart failure
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| *[[Cor pulmonale]] resulting in right heart failure
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| *[[Diazoxide]] usually cause localized edma and not anasarca
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| *Corticosteriods
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| *[[Dilated cardiomyopathy]]
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| *[[Docetaxel]] usually cause localized edma and not anasarca
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| *[[Eclampsia]] (severe eclampsia)
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| *[[Effusive-constrictive pericarditis]] with associated heart failure
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| *[[Estrogens]]
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| *[[Fludrocortisone]]
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| *[[Glomerulonephritis]]
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| *[[Haemolytic disease of the newborn]]
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| *[[Heart failure]]
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| *Hepatic [[cirrhosis]]
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| **[[Alcoholic liver disease]]
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| **[[Alpha-1-antitrypsin deficiency]]
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| **[[Autoimmune hepatitis]]
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| **Chronic [[hepatitis B]]
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| **Chronic [[hepatitis C]]
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| **Hepatic venous obstruction
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| **[[Hereditary hemochromatosis]]
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| **[[Primary biliary cirrhosis]]
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| **[[Primary sclerosing cholangitis]]
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| **[[Non-alcoholic fatty liver disease|Nonalcoholic fatty liver disease]]
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| **[[Wilson's disease]]
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| *[[Hereditary angioedema]] in severe cases
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| *[[Hypertrophic cardiomyopathy]]
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| *[[Hypoalbuminemia]]
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| *[[Hypoproteinemia]]
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| *[[Hypothyroidism]] (advanced untreated hypothyroidism)
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| *Idiopathic [[edema]]
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| *[[Increased capillary permeability]]
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| *Increased interstitial oncotic pressure
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| *[[Interleukin-2]] therapy
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| *[[Kwashiorkor]]
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| *Lymphatic obstruction usually cause localized limb [[edema]] unless very proximal
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| *[[Malnutrition]]
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| *[[Malignant ascites]] is usually associated with lower extremities edema
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| *[[Minoxidil]] usually causes localized edema to the lower extremities
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| *[[Nephrotic syndrome]]
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| *[[Nonsteroidal antiinflammatory drug]] causes localized edma
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| *[[Ovarian hyperstimulation syndrome]]
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| *[[POEMS syndrome]]
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| *[[Portal thrombosis]] causes lower extremities edema
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| *[[Pramipexole]]
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| *[[Pregnancy]]
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| *Protein loss
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| *[[Protein-losing enteropathy]]
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| *Reduced [[albumin]] synthesis
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| *[[Refeeding]] edema
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| *[[Restrictive cardiomyopathy]]
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| *Severe inflammation or [[sepsis]]
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| *Sodium overload
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| *[[Thiazolidinediones]]
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| *[[Trauma]] (severe trauma)
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| *[[Tricuspid stenosis]]
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| *[[Tropical sprue]]
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| *Venous obstruction usually causes localized edema in the limb
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| *[[Water overload]]
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| *[[Yellow nail syndrome]]
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| == '''Complete Differential Diagnosis of the Causes of Anasarca''': ==
| | [[Anasarca history and symptoms|History and Symptoms]] | [[Anasarca physical examination|Physical Examination]] |[[Anasarcalaboratory tests|Laboratory Findings]] | [[Anasarca electrocardiogram|ECG]] | [[Anasarca electroencephalogram|EEG]] | [[Anasarca CT|CT]] | [[Anasarca echocardiography or ultrasound|Echocardiography or Ultrasound]] |[[Anasarca other imaging findings|Other Imaging Findings]] | [[Anasarca other diagnostic studies|Other Diagnostic Studies]] |
| (By organ system)
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| {|style="width:75%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cardiac tamponade ]], [[Constrictive pericarditis]], [[Cor pulmonale]], [[Dilated cardiomyopathy]], [[Effusive-constrictive pericarditis]], [[Heart failure]], [[Hypertrophic cardiomyopathy]], [[Restrictive cardiomyopathy]], [[Tricuspid stenosis]]
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| |-
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| |-bgcolor="LightSteelBlue" | |
| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Calcium channel blockers]], [[Diazoxide]], [[Docetaxel]], [[Estrogens]]
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| [[Fludrocortisone]], Interleukin-2 therapy, [[Minoxidil]], Nonsteroidal antiinflammatory drugs, Corticosteriods
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| Corticosteriods
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| [[Water intoxication]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[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]]
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| | == Treatment == |
| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[Angioedema]], [[Alpha-1-antitrypsin deficiency]], [[Hereditary angioedema]]
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| [[Hereditary hemochromatosis]], [[Hypertrophic cardiomyopathy]], [[Wilson's disease]], [[Yellow nail syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| [[Water intoxication]], excess intravenous fluids
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Tropical sprue]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Hypoalbuminemia]], Hypoproteinaemia, [[Kwashiorkor]], [[Malnutrition]]
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| Protein loss, [[Protein-losing enteropathy]], Reduced albumin synthesis, Refeeding edema, Sodium overload, [[Tropical sprue]], Water overload
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"|[[Eclampsia]], [[Estrogens]], [[Haemolytic disease of the newborn]], [[Ovarian hyperstimulation syndrome]], [[Pregnancy ]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Malignant ascites]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| [[Water intoxication]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| [[Nephrotic syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Haemolytic disease of the newborn]], [[Autoimmune hepatitis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| [[Trauma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |}
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| <br>
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| <br>
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| ==Diagnosis==
| | [[Anasarca medical therapy|Medical therapy]] | [[Anasarca surgery|Surgery]] | [[Anasarcaprevention|Prevention]] | [[Anasarca future or investigational therapies|Future or Investigational Therapies]] |
| '''CT images demonstrate diffuse anasarca'''
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| <gallery>
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| Image:
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| Anasarca-001.jpg
| | ==References== |
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| Image:
| | {{reflist|2}} |
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| Anasarca 002.jpg
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| Image:
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| Anasarca-003.jpg
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| </gallery>
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| =='''Treatment'''==
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| The treatment of anasraca depends on the underlying cause. It involves the use of [[diuretic]]s 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.
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| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
