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1 de 5
Intro
• LE Edema
• Life threatening
• Take-away 2 things
• 5 part approach to LEedema
• Ins-Outs Approach to building a DDx
• 6 cards for etio
• Use 2 cases to put it together
• Won’t Talk about Dx or MGMT, as it varies
•Localize
•Onset
•Rx
•Dependent
•Evaluate Ely, et al. Approach to leg edema of unclear
etiology. J Am Board Fam Med 2006
Lymphatic Drainage
Venous
Drainage
Protein Gradient
Hydrostatic
Pressure
• CHF
• Pulm. HTN (OSA)
• Rx: Diuretics, CCB
Permeability
• Cellulitis
• Allergic Reaction
• Elephantiasis
• Pelvic/Abdominal Obstruction
• Chronic
Venous
Insufficiency
• DVT
• Compartment
Synd.
↑ Loss
• Nephrotic Synd.
• Protein-Loss Enteropathy
↓ Gain
• Malnutrition
• Liver Disease
LORDE 68 yo obese “royal”
who sits on the throne
all day comes in annual
appt
24 yo smoker flying to
one of those “perfect
places” comes in for
leg pain
46 yo w/ fatigued
obese comes in bc he
recently fell asleep at a
“Green Light”
Lateralize BiL Uni Bilat
Onset Chronic Acute Chronic
Rx None None Diuretics
Dependent Improves with leg
elevation
Elevating can relieve
pain
No change with
elevation
Evaluate Pitting
Mild aching
Brown discoloration
over ankles and lower
legs
Pitting
PainFUL
Warm
Erythematous
Mild pitting
Painless
CVI affects 30% pop PHTN (OSA) – often
Lymphatic Drainage
Venous
Drainage
Protein
Gradient
PermeabilityHydrostatic
Pressure

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Edema Pathophysiology

  • 1. Intro • LE Edema • Life threatening • Take-away 2 things • 5 part approach to LEedema • Ins-Outs Approach to building a DDx • 6 cards for etio • Use 2 cases to put it together • Won’t Talk about Dx or MGMT, as it varies
  • 2. •Localize •Onset •Rx •Dependent •Evaluate Ely, et al. Approach to leg edema of unclear etiology. J Am Board Fam Med 2006
  • 3. Lymphatic Drainage Venous Drainage Protein Gradient Hydrostatic Pressure • CHF • Pulm. HTN (OSA) • Rx: Diuretics, CCB Permeability • Cellulitis • Allergic Reaction • Elephantiasis • Pelvic/Abdominal Obstruction • Chronic Venous Insufficiency • DVT • Compartment Synd. ↑ Loss • Nephrotic Synd. • Protein-Loss Enteropathy ↓ Gain • Malnutrition • Liver Disease
  • 4. LORDE 68 yo obese “royal” who sits on the throne all day comes in annual appt 24 yo smoker flying to one of those “perfect places” comes in for leg pain 46 yo w/ fatigued obese comes in bc he recently fell asleep at a “Green Light” Lateralize BiL Uni Bilat Onset Chronic Acute Chronic Rx None None Diuretics Dependent Improves with leg elevation Elevating can relieve pain No change with elevation Evaluate Pitting Mild aching Brown discoloration over ankles and lower legs Pitting PainFUL Warm Erythematous Mild pitting Painless CVI affects 30% pop PHTN (OSA) – often

Notas del editor

  1. Get a good H&P 5 Musts Localize – UL, BL Onset – days, months, years Rx – several Rx cause edema Dep – does it improve with elevation Eval – pitting? Nonpitt? Temperature? Skin findings?