Differential diagnosis and treatment edema. Tactics gp

Other types of edema:

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  traumaticendocrineMyxedema.
  
• 
  neurogenic edema
  
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  Hypothalamic edema.
  
• 
  Trofedema Meza.
  
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  Complex regional pain syndrome (reflex sympathetic dystrophy).
  

Swelling caused by medication:

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  Hormones (corticosteroids, female sex hormones, estrogen, progesterone, testosterone).
  
• 
  Antihypertensive drugs (Rauwolfia alkaloids, β-blockers, angiotensin kaltsevyh tubules, etc.)
  
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  Nonsteroidal anti-inflammatory drugs (phenylbutazone, naproxen, ibuprofen, indomethacin).
  
• 
  Other drugs (MAO inhibitors, antidepressants, midantana).
  

Pseudoedema

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  myxedema
  
• 
  Systemic scleroderma.
  
• 
  Pseudotrichiniasis
  

Mechanisms of edema
Pathophysiologic mechanisms of edema are reduced oncotic pressure (ie pressure, formed as a result of osmotic activity of albumin) and the osmotic pressure of blood plasma (pressure due to plasma osmolality, one component of it is the oncotic pressure). As edema with increasing hydrostatic pressure of the blood in the capillary. Opposing forces P are P ONC Guide, P OSM and P t Tissue pressure consists of osmotic pressure of interstitial space and the interstitial tissue in the wall of the capillary. An important factor in the appearance of edema is increased permeability of the capillary wall, developing during hypoxia, hypercapnia, acidosis, inflammation, elevated P guide.In connection with the above mentioned pathological processes run different pathophysiological mechanisms for the development of edema. This is reflected in the nature of differential diagnosis and treatment. Diagnostic challenge in the form of edema is formed on the basis of these basic causes of edema, the pathophysiological mechanisms and clinical classification. In order to determine whether the selected pathophysiological mechanism, it is necessary to bear in mind the diagnostic algorithm. Of course, each of the pathological conditions leading to the formation of edema, has a clinical picture, which reflect in the algorithm is to make it cumbersome and non-functional.Factors contributing to the development of edema, are:- Reduction of tissue pressure in the connective tissue collagen depletion with increasing its looseness, for example, with the release of hyaluronidase, which is observed Ave inflammatory and toxic edema- Low pressure in the pleural cavity facilitates the development of hydrothorax for general edema in patients with heart failure.Positive water balance is based on the excess of sodium retention by the kidneys. The resulting hyperospheresia extracellular space is increased secretion of vasopressin, which increases water reabsorption in the renal tubules, leading to excessive delays in its body. Less often at the heart of edema is the primary hypersecretion of vasopressin. The main cause of the accumulation of sodium edema aldosterone hypersecretion is due to hypovolemia or decreased cardiac output. The associated reduction in renal blood flow increases renin secretion by the kidneys, increases the formation of angiotensin II, which excites the secretion of aldosterone. As a result of sodium reabsorption in the distal nephron increases, increased osmotic pressure of the extracellular fluid, the second increase secretion of vasopressin and excessively absorbed water.Thus, the main factors leading to disruption of local water balance can be:

1. 
   Increase in hydrostatic pressure in the capillaries.
   
2. 
   Decrease oncotic pressure of plasma.
   
3. 
   Increased interstitial fluid oncotic pressure.
   
4. 
   Reduction of tissue mechanical pressure.
   
5. 
   Increased capillary permeability.
   
6. 
   Violation of lymph drainage.