tailieunhanh - Chapter 036. Edema (Part 6)
Edema of Heart Failure (See also Chap. 227) The presence of heart disease, as manifested by cardiac enlargement and a gallop rhythm, together with evidence of cardiac failure, such as dyspnea, basilar rales, venous distention, and hepatomegaly, usually indicate that edema results from heart failure. Noninvasive tests, such as echocardiography, may be helpful in establishing the diagnosis of heart disease. The edema of heart failure typically occurs in the dependent portions of the body. | Chapter 036. Edema Part 6 Edema of Heart Failure See also Chap. 227 The presence of heart disease as manifested by cardiac enlargement and a gallop rhythm together with evidence of cardiac failure such as dyspnea basilar rales venous distention and hepatomegaly usually indicate that edema results from heart failure. Noninvasive tests such as echocardiography may be helpful in establishing the diagnosis of heart disease. The edema of heart failure typically occurs in the dependent portions of the body. Edema of the Nephrotic Syndrome See also Chap. 277 Marked proteinuria g d hypoalbuminemia 35 g L and in some instances hypercholesterolemia are present. This syndrome may occur during the course of a variety of kidney diseases which include glomerulonephritis diabetic glomerulosclerosis and hypersensitivity reactions. A history of previous renal disease may or may not be elicited. Edema of Acute Glomerulonephritis and Other Forms of Renal Failure See also Chap. 277 The edema occurring during the acute phases of glomerulonephritis is characteristically associated with hematuria proteinuria and hypertension. Although some evidence supports the view that the fluid retention is due to increased capillary permeability in most instances the edema results from primary retention of NaCl and H2O by the kidneys owing to renal insufficiency. This state differs from congestive heart failure in that it is characterized by a normal or sometimes even increased cardiac output and a normal arterial-mixed venous oxygen difference. Patients with edema due to renal failure commonly have evidence of arterial hypertension as well as pulmonary congestion on chest roentgenograms even without cardiac enlargement but they may not develop orthopnea. Patients with chronic renal failure may also develop edema due to primary renal retention of NaCl and H2O. Edema of Cirrhosis See also Chap. 302 Ascites and biochemical and clinical evidence of hepatic disease collateral venous channels jaundice
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