Clinical manifestations and diagnosis of edema in adults
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor of Medicine
- University of Rochester School of Medicine and Dentistry
Edema is defined as a palpable swelling produced by expansion of the interstitial fluid volume; when massive and generalized, the excess fluid accumulation is called anasarca. A variety of clinical conditions are associated with the development of edema, including heart failure, cirrhosis, and the nephrotic syndrome, as well as local conditions such as venous and lymphatic disease (table 1). (See "Pathophysiology and etiology of edema in adults".)
The clinical features and diagnosis of generalized edematous states in adults are reviewed here. The general principles of the treatment of edema in adults, including the use of diuretics to remove the excess fluid, the treatment of refractory edema, and the approach to edema in children, are discussed separately. (See "General principles of the treatment of edema in adults" and "Treatment of refractory edema in adults" and "Evaluation and management of edema in children".)
OVERVIEW OF PATHOPHYSIOLOGY
The pathophysiology and etiology of edema formation are discussed in detail elsewhere, but the pathophysiology is briefly reviewed here. (See "Pathophysiology and etiology of edema in adults".)
An increase in interstitial fluid volume that could lead to edema does not occur in normal subjects because of the tight balance of hemodynamic forces along the capillary wall and the function of the lymphatic vessels. For generalized edema to occur, two factors must be present:
●An alteration in capillary hemodynamics that favors the movement of fluid from the vascular space into the interstitium. Such movement requires a change in one or more components of Starling's law: increased capillary hydrostatic pressure, decreased capillary oncotic pressure (ie, hypoalbuminemia), and/or increased capillary permeability. (See "Pathophysiology and etiology of edema in adults", section on 'Capillary hemodynamics'.)
- McHugh TJ, Forrester JS, Adler L, et al. Pulmonary vascular congestion in acute myocardial infarction: hemodynamic and radiologic correlations. Ann Intern Med 1972; 76:29.
- Rinaldo JE, Rogers RM. Adult respiratory-distress syndrome: changing concepts of lung injury and repair. N Engl J Med 1982; 306:900.
- Guazzi M, Polese A, Magrini F, et al. Negative influences of ascites on the cardiac function of cirrhotic patients. Am J Med 1975; 59:165.
- Henriksen JH, Bendtsen F, Gerbes AL, et al. Estimated central blood volume in cirrhosis: relationship to sympathetic nervous activity, beta-adrenergic blockade and atrial natriuretic factor. Hepatology 1992; 16:1163.
- Crandall ED, Staub NC, Goldberg HS, Effros RM. Recent developments in pulmonary edema. Ann Intern Med 1983; 99:808.
- Taylor AE, Parker JC. Pulmonary interstitial spaces and lymphatics. In: Handbook of Physiology. Section 3: The Respiratory System, Fishman AP, Fisher AB. (Eds), American Physiological Society, Madison, WI 1985. Vol I, p.167.
- Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin 2009; 59:8.
- Carrie BJ, Hilberman M, Schroeder JS, Myers BD. Albuminuria and the permselective properties of the glomerulus in cardiac failure. Kidney Int 1980; 17:507.
- Humphreys MH. Mechanisms and management of nephrotic edema. Kidney Int 1994; 45:266.
- Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Curr Cardiol Rep 2002; 4:479.
- The diagnosis and treatment of peripheral lymphedema: 2003 consensus of the International Society of Lymphology Executive Committee www.u.arizona.edu/%7Ewitte/ISL.htm (Accessed on April 19, 2011).
- OVERVIEW OF PATHOPHYSIOLOGY
- CLINICAL MANIFESTATIONS AND DIAGNOSIS
- Pulmonary edema
- Peripheral edema
- - Pitting edema
- Distribution of edema and central venous pressure
- - Heart failure and pericardial disease
- - Cirrhosis
- - Renal sodium retention
- - Nephrotic syndrome
- - Idiopathic edema
- Drug-induced edema
- Unilateral edema
- - Venous insufficiency or thrombosis
- - Lymphedema
- Periorbital and scrotal edema
- Nonpitting edema
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