Edema-水肿英语.ppt

Edema,Definition,The excessive accumulation of intestitial fluid A pathologic process caused by diseases Not accompanied with cellular edema,Classification,According to the range that edema fluid spreads to: Generalized edema Localized edema According to the cause of edema: Renal edema Hepatic edema Cardiac edema Malnutritional edema lymphedema,Classification,Generalized edema: Puffiness of the face Indentation of the skin “pitting edema” Ascites & Hydrothorax Localized edeme,Edema,Pitting edema,Ascites,Differential diagnosis,Heart failure Renal diseases Cirrhosis Nutritional origin Idiopathic Others,Differential diagnosis Heart Failure,Occurs at lower part of the body (lower extremities) Symmetric location The presence of heart diseases Cardiac enlargement Gallop rhythm Dyspnea Basilar rales Venous distention Hepatomegaly,Differential diagnosis Renal diseases,Hypoalbuminemia & Retention of sodium and water Associated : Hematuria Proteinuria Hypertention Impaired renal functional test Characteristic of edema Puffiness of the face,Differential diagnosis Cardiac/Renal disease,Renal Cardiac Location onset from the face, onset from the lower periobital areas part of the body Progression progress quickly progress slowly Identity soft and mobile relatively solid, less mobile Other signs proteinuria signs of heart failure: hypertension cardiac enlargement impaired renal venous distention functional test hepatomegaly,Differential diagnosis Liver diseases (cirrhosis),Clinical evidence of hepatic disease Jaundice Spider angiomas Ascites Ascites refractory to the treatment,cirrhosis,Differential diagnosis Idiopathic edema,Exclusive in women Periodic episodes Accompanied by abdominal distention,Differential diagnosis Other Causes of Edema,Hypothyroidism Pregnancy Estrogens Angioneurotic,Approach to the patient,Generalized,Localized,or,Heart Liver Kidney,Venous obstruction Lymphatic obstruction,A 50-year-old man has a history of diffuse edema for 5 years. He presents to the hospital with worsening edema for a month. The edema began from the lower limbs and spreaded up to he chest and back, accompanied with dyspnea and difficulties in lying down. The symptoms responded to diuretics therapy. Past history: mitral valve replacement and aortic valve replacement for rheumatc heart disease 30 years ago. Bp: 130/80mmhg. Physical examination reveals jugular venus distention. Dullness to percussion and decreased breath sounds in lower parts of both lungs The liver edge is palpated 4cm inferior to the rib with tenderness and shifting dullness is positive.pitting edema in both lower limbs and the abdominal wall,1. Which of the following is the most likely diagnosis for this patient? A Edema of the nephrotic syndrom B Cardiogenic edema C Hepatogenic edema D. Venous thrombosis E Idiopathic edema,2. Which of the following is the diagnostic test of choice for this patient? A Doppler ultrasonography for the kidneys BDoppler ultrasonography for lower extremity deep veins C Abdomen CT D. Echocardiographhy E EStrogen test,3. Which of the