Anasarca - Definition, Pathophysiology, Pictures, Causes, Treatment [PDF]

Anasarca Definition By definition, Anasarca is the gross and generalized edema of the body tissues with profound subcuta

2 downloads 18 Views 99KB Size

Recommend Stories


PDF Pathophysiology
Keep your face always toward the sunshine - and shadows will fall behind you. Walt Whitman

PdF Pathophysiology
Why complain about yesterday, when you can make a better tomorrow by making the most of today? Anon

PDF Download Applied Pathophysiology
This being human is a guest house. Every morning is a new arrival. A joy, a depression, a meanness,

(PDF) Pathophysiology Flash Cards
I want to sing like the birds sing, not worrying about who hears or what they think. Rumi

[PDF] Essentials of Pathophysiology
Love only grows by sharing. You can only have more for yourself by giving it away to others. Brian

[PDF] Essentials of Pathophysiology
In every community, there is work to be done. In every nation, there are wounds to heal. In every heart,

PdF Essentials of Pathophysiology
Where there is ruin, there is hope for a treasure. Rumi

PDF Essentials of Pathophysiology
Respond to every call that excites your spirit. Rumi

Causes and Treatment of Hypoalbuminemia
If your life's work can be accomplished in your lifetime, you're not thinking big enough. Wes Jacks

Ascites: Causes, Diagnosis, and Treatment
Before you speak, let your words pass through three gates: Is it true? Is it necessary? Is it kind?

Idea Transcript


Anasarca

Anasarca

Page Contents 1 Anasarca Definition 2 Pathophysiology of Anasarca 2.1 Increased hydrostatic pressure 2.2 Reduced colloid osmotic pressure 2.3 Sodium Retention 3 Causes of Anasarca 3.1 Increased hydrostatic pressure 3.2 Reduced osmotic pressure 3.3 Reduced protein intake 3.4 Sodium retention 3.5 Some drugs 4 Anasarca in heart failure 5 Anasarca in Nephrotic syndrome 6 Anasarca in Liver diseases 7 Anasarca in Children 8 Differential Diagnosis of Anasarca 9 Treatment of Anasarca

Anasarca Definition By definition, Anasarca is the gross and generalized edema of the body tissues with profound subcutaneous swelling. [1] So, what is edema? Edema is the bloating up of any body part due to accumulation of excess fluid in the body tissue.

When this edema is confined to a particular part, say in a twisted ankle, it’s called localized edema. When this bloating involves the whole body and appears like an inflated balloon , it is known as Anasarca which is derived from the Greek phrase ‘ anà ‘ meaning ‘through’ and ‘sarx’ meaning ‘flesh ‘.[2]

Pathophysiology of Anasarca As Anasarca is the gradual progression of the swelling, the pathophysiology of Anasarca is the same as that of edema, only for a longer duration and with more severity. To understand the mechanism, one should know a few relevant facts. About 60% of our lean body weight is made up of water of which two third lies within the cells (40%) and one third lies outside the cells (20%). The extracellular fluid can be divided into Interstitial fluid, the fluid that lies in between the cells (IF -15% – about 10.5 l) and plasma fluid which lies within the blood vessels (5% – about 5 l) [3]. Accumulation of excess fluid in the interstitial space between the tissues causes edema.

This can occur due to Abnormal leak of plasma fluid to interstitial space

Increased hydrostatic pressure Reduced plasma osmotic pressure Sodium Retention Failure of lymphatic vessels to return excess fluid from interstitium to plasma. Lymphatic obstruction Major surgery Some cancers

Of the factors above, Lymphatic obstruction usually causes localized edema of the part which is drained by the obstructed lymphatic vessel and the factors severe enough to cause Anasarca are :

Increased hydrostatic pressure The blood lies in blood vessel which is like a pipe which allows fluid and some substances to pass through its walls and reach the tissue nearby. Hydrostatic pressure is the effort of the fluid in the blood vessel to escape into the surrounding tissue. Hence, when there is more fluid in the vessel, it exerts more pressure to leak into the surrounding. This happens mostly due to venous stasis, in which the blood flow slows down and pools in a region. Thus all conditions causing venous stasis will cause edema which when not relieved will lead to Anasarca.

Reduced colloid osmotic pressure Similar to the force exerted by magnets on iron dust, the plasma proteins exert the colloid osmotic pressure that is responsible for retention of fluid within the blood vessel. Albumin is the major contributor of colloid osmotic pressure. When there is a gross decrease in plasma proteins either due to reduced synthesis or increased loss, it leads to profound fluid leak into the interstitial space.

Sodium Retention Kidney is the major organ for regulating the concentration of various salts in our body of which, the most important are sodium and potassium. When there are more electrolytes, the kidney removes them in urine and when there is low electrolyte level, it retains the salts to balance them to normal. When there is a kidney disease, this function is affected. Excess of Sodium or Salt is retained which in turn causes water retention. This leads to more fluid in the blood causing intravascular volume expansion which in turn increases the hydrostatic pressure. Also, the increased intravascular fluid volume leads to dilution of the plasma proteins causing reduction in the colloid osmotic pressure. Thus sodium retention involves both the mechanisms. [1]

Causes of Anasarca Increased hydrostatic pressure Impaired venous outflow Congestive heart failure Constrictive pericarditis Liver cirrhosis Venous obstruction due to large tumors Arteriolar dilatation Neurohumoral dysregulation

Reduced osmotic pressure Reduced protein intake Protein malnutrition – Kwashiorkor Starvation Reduced protein synthesis Liver cirrhosis Increased excretion of protein Protein losing glomerulopathies – Nephrotic syndrome Protein losing enteropathy

Sodium retention Increased salt intake with renal insufficiency Increased reabsorption of sodium Increased rennin- angiotensin – aldosterone mechanism Mineralocorticoid excess

Some drugs like anabolic steroids, steroids like prednisolone [1] [4][5]

Anasarca in heart failure Congestive heart failure or right heart failure is the most common and most serious cause of Anasarca. [4]As correctly said, Heart is a pump that pushes the blood throughout the body. The circulated blood again reaches the heart and the cycle continues. When the heart fails to pump, the circulated blood (venous blood) is slowed down from pumped again leading to venous stasis. As said above, it leads to increased hydrostatic pressure and edema. The edema begins in the most dependent part initially – feet and ankle- and then becomes a full blown Anasarca when the heart’s function has deteriorated to great extent.

Anasarca in Nephrotic syndrome Nephrotic syndrome is a kidney disease of children in which the sieve like glomerular membrane become leaky to the plasma proteins like albumin. So a large amount of albumin is lost in urine which lowers the colloid osmotic pressure. Initially the edema begins in loose tissues around the eyes giving a puffy eye appearance which then gradually progress to Anasarca when the plasma protein level falls below 2.5 gm/100ml which is less than one third of normal level. [6] Other kidney diseases affect the excretion of sodium and water which leads to excessive intravascular fluid volume leading to edema.

Anasarca in Liver diseases The most common liver disease causing Anasarca is Liver cirrhosis. Liver is the factory manufacturing the plasma proteins. When the functional parenchymal cells, the workers of liver get replaced by useless fibrous tissue, it leads to low protein production. This leads to low osmotic pressure and fluid leak to the interstitium. Another mechanism is that, fibrous scar in the liver compress the portal vessels which pass through the liver, leading to increased hydrostatic pressure in the veins of abdominal organs. This leads to accumulation of fluid in peritoneal cavities which is known as hydroperitonium or Ascites.

Anasarca

Picture 1: Anasarca (abdomen) Image Source: expression.psmalik.com

Anasarca in Children The major cause of Anasarca in children is protein energy malnutrition – Kwashiorkor in which the protein deficiency is more severe than energy malnutrition. It is most commonly seen in children of 1-4yrs of the impoverished Southeast Asian countries and African children are who are weaned early. [7] Rarely, premature infants develop hypoprotenemic edema due to immature liver which doesn’t produce the sufficient plasma proteins.

Picture 2: Anasarca in a Child Image source: en.wikipedia.org

Differential Diagnosis of Anasarca Congestive heart failure Heart failure due to cardiac cirrhosis Heart failure due to thiamine deficiency Alcoholic liver cirrhosis Nephrotic syndrome Malnutrition / starvation Kwashiorkor Kwashiorkor like syndrome in severe trauma and burns Hypoalbuminemia/ hypoprotenemia Protein losing enteropathy Eclampsia in pregnancy Hypothyroidism

Treatment of Anasarca Anasarca is not a disease but a symptom indicating a serious underlying derangement. So treatment of the underlying cause will resolve Anasarca. When Anasarca is caused by fluid overload, diuretics are the choice. When it is due to protein deficiency, albumin infusion can be tried. And every cause of Anasarca has its own treatment protocol. [8] References 1. Robbins and Kotran 7/e pg 120- 121 2. www.merriam-webster.com/dictionary/anasarca 3. Ganong 22/e pg 1 4. Guyton 11/e pg 303 5. Wikipedia 6. O.P.Ghai 7/e pg 450 7. O.P.Ghai 7/e pg 67 8. http://www.webmd.com/heart-disease/heart-failure/edema-overview

She Had No Idea Why The Crew Was Staring

Macaulay Culkin Opens Up About What Happened

Here's Why You Should Never Squash A Centipede

Couple Who Accepts A Tiny Shelter Puppy

Final Photos Taken Seconds Before Tragedy Struck

Michelle's IQ Vs Melania's IQ Is Pretty Unnerving

Female Cop Hid Her Double Life For A Few Years

If You Come Across This Snake, Your Life Is All But Over

Last Photos Taken Seconds Before Tragedy Struck

(Visited 11,122 times, 6 visits today) +1

31

Tweet

61

Share

338

Stumble 116

Pin

300

846

SHARES

Smile Life

When life gives you a hundred reasons to cry, show life that you have a thousand reasons to smile

Get in touch

© Copyright 2015 - 2024 PDFFOX.COM - All rights reserved.