APPROACH TO A CASE OF ANASARCA

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APPROACH TO A CASE OF ANASARCA

• Presented By
• Prof. Arvind Mishra
• Department of Medicine

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Anasarca

• Defined as gross generalised edema
• Edema is defined as a clinically apparent
  increase in the interstitial fluid volume, which
  may expand by several liters before the
  abnormality is evident

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Causes of anasarca

• Cardiac
• -cardiac failure,
• -pericardial effusion,
• -constrictive pericarditis
• Renal
• -chronic renal failure
• -nephrotic syndrome
• Hepatic- cirrhosis

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• Malnutrition/malabsorption(i.e. celiac
  disease,crohns disease etc)
• Drug-induced
• Thyroid disorder

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Clinical feature

• Puffiness of face
• Pedal edema(pitting/non-pitting)
• Abdominal wall edema(by pressing with palm)
• Sacral edema

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• STARLING FORCES IN SHIFTING THE FLUID IN
  DIFFERENT COMPARTMENTS
• The hydrostatic pressure within the vascular
  system and the colloid oncotic pressure in the
  interstitial fluid tend to promote movement of
  fluid from the vascular to the extravascular
  space.
• By contrast, the colloid oncotic pressure
  contributed by plasma proteins and the
  hydrostatic pressure within the interstitial
  fluid promote the movement of fluid into the
  vascular compartment.

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Mechanism of anasarca

• Decreased plasma oncotic pressure
• Lymphatic obstruction
• Increased capillary permeability
• Increased hydrostatic pressure

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Drugs causing edema
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HYPOTHYROIDISM
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INVESTIGATIONS

• Serum protein albumin
• Urine analysis
• -protein, sugar
• -cast
• Kidney function test
• -s.urea
• -s.creatinine

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• Liver function test
• -SGOT/SGPT
• -ALP
• -S.bilirubin
• Fecal fat estimation
• -to rule out malabsorption
• Thyroid function test
• ECG and echocardiography
• -LVEF
• -Valvular lesion
• -Regional wall motion abnormality

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Treatment

• Treatment of the underlying cause(cardiac, renal,
  hepatic, thyroid abnormality)
• Stop and replace the drug causing edema
• Diuretics
• Restricting salt and fluid intake and monitoring
  input-output
• Protein rich diet (in hypoalbuminemic state)

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• MCQs

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• 1)Causes of non pitting edema are all except
• a)Myxoedema
• b)Filariasis
• c)Angioneurotic edema
• d)Nephrotic syndrome

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• 2)Pattern of edema(Legs -gtface -gtascitis)
• in the given manner occurs in
• a)Cirrhosis
• b)Cardiac failure
• c)Nephrotic syndrome
• e)Nutritional edema

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• 3)Drugs causing edema are all except
• a)Cilnidipine
• b)Hydralazine
• c)Amlodipine
• d)Clonidine

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• 4)Milroys disease refers to
• a)Absence of thymus
• b)Congenital hypoplasia of lymphatics
• c)Post mastectomy lymphedema of upper limb
• d)Chylous pleural effusion

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• 5)Angioneurotic edema is due to deficiency of
• a)C1 esterase inhibitor deficiency
• b) C5 convertase (C3bBbC3b)
• c)C1 esterase deficiency
• d) Factor Hrelated protein 1 (CFHR1)