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'.)
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- 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
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS