Anasarca
| Anasarca | |
 | |
|---|---|
| CT scan showing generalized edema of skin | |
| ICD-10 | R60.1 |
| ICD-9 | 782.3 |
|
Anasarca Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]
Synonyms and keywords: Generalized edema, generalized swelling, leucophlegmatia
Overview
Edema is characterized by the collection of excess fluid in the interstitial space. Anasarca is severe edema characterized by generalized swelling throughout the body. The main underlying cause of edema is an imbalance in the hemodynamic status of the capillaries resulting in excess filtration of fluid in the intercellular space due to increased hydrostatic pressure, increased permeability of the capillaries and decreased oncotic pressure. It exceeds the absorptive capacity of lymph vessels. It exceeds the absorptive capacity of lymph vessels. It can be caused by systemic diseases including chronic heart failure, liver cirrhosis, hypersensitivity reaction, and chronic renal failure.
Classification
The edema is classified in different types depending upon the severity of fluid accumulation assessed clinically[1].
| Grade | Visibility of edema | Pitting over tibia | Level of edema |
|---|---|---|---|
| 0+ | No | Absent | Cannot assess |
| 1+ | Yes | Slight | Cannot assess |
| 2+ | Yes | Moderate | Below knee |
| 3+ | Yes | Moderate | Above knee |
| 4+ | Yes | Severe (cannot reach tibia) | Above knee |
Causes
Common Causes
Common causes of anasarca may include:[2][3][4][5]
- Congestive cardiac failure
- Anaphylaxis
- Urticaria
- Hepatic cirrhosis
- Renal failure
- Kwashiorkor disease
- Obstructive sleep apnea
- Pregnancy
- Nephrotic syndrome
- Use of certain medications (Beta blockers, calcium channel blockers, clonidine, methyldopa, hydralazine, androgen, corticosteroid)
Differential Diagnosis
| Diseases | Clinical manifestation | Para-clinical findings | Gold Standard | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Onset | Abdominal distention due to ascities | Associated symptoms | Blood pressure | Tachycardia | Physical examination findings | Lab findings | Imaging | ||
| Congestive Cardiac Failure | Chronic | + | Dysnea,Orthopnea, Proxysmal nocturnal dyspnea | ↓ ↑ | + | Tachypnea, jugular venous distention, elevated CVP, S3, decreased breath sounds in lower lung fields, hepatojugular reflex | Elevated BNP |
|
LVEF on echocardiography |
| Liver cirrhosis | Chronic | + | Nausea,vomitting, jaundice, telangiactesia, palmar erythema, hematemsis, anorectal varicies | ↓ | - | Jaundice, pallor, caput meducae, spleenomegaly, inintially hepatomegaly, clubbing, Dupuytren's contracture | Elevated ALP, AST, ALT, GGT, bilrubin, hypoalbuminemia, prolonged prothrombin time | USG liver will show cirrhotic, irregular nodular liver with increased echogenicity. | Liver biopsy |
| Chronic kidney disease | Chronic | + | Anorexia, Nausea, bleeding, fatigue, weakness | ↑ | + | Pallor, tachypnea, pericardial friction rub, crackles on chest ascultation, uremic fetor | Elevated BUN,creatine, decrease hemoglobin, acidosis, hyperkalemia, elevated TAG | USG kidney will show atrophied kidney with cortical thinning and increased echogenecity. | GFR |
| Protein losing nephropathy | Chronic | + | Dyspnea, headache, irratibility, bacterial or viral infections, recent H/O of URTI | ↑ /N | - | Hematuria in some patients, Facial malar rash in SLE patients. | Hypoalbuminemia, 24 hour urine protein excretion.3.5g, Elevated TAG and cholesterol. | USG kidney may show increased echogenecity. | Renal biopsy |
| Protein Calorie malnutrition | Chronic | + | Muscle wasting, stunted growth, swolen face, dry skin, brittle hair | ↓ /N | + | Hepatomegaly, Scaling, hyperpigmentaion anh hypopigmentation of skin | Hypoalbuminemia | NA | NA |
| Allergic reactions | Acute | - | Dyspnea, difficulty breathing, raised eythematous skin rashes, abdominal cramping | ↓ | + | Bronchial wheezing on chest ascultation | Elevated tryptase and plasma histamine levels | NA | NA |
| Pregnancy | Chronic | - | Amenorrhea, morning sickness, fatigue, breast tenderness, constipation, back pain | ↓ | + | Fundal height of the fetus, pallor, melasma | Urine pregnancy test positive, increased serum beta hcG | USG Abdomen will show an intrauterine pregnancy. | Blood levels of beta hcG |
| Medication-induced | Chronic | - | Temporal relation between medicine intake and appearance of symptoms | N/ ↓ | - | Specific to the medicine | Resolution of symptoms after discontinuing medicine | NA | NA |
| Obstructive sleep apnea | Chronic | Due to obesity | Snoring, Frequent night-time awakening, daytime drowsiness | ↑ | - | High BMI, increase neck size and waist circumference, enlarged tongue, hypertrophy of tonsils, enlarged uvula, nasal polyps and high arched palate | Polysomnography | NA | Polysomnography |
References
- ↑ "Correction to Lancet Infectious Diseases 2020; published online April 29. https://doi.org/10.1016/ S1473-3099(20)30064-5". Lancet Infect Dis. 20 (7): e148. 2020. doi:10.1016/S1473-3099(20)30370-4. PMID 32595044 Check
|pmid=value (help). External link in|title=(help) - ↑ Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.
- ↑ O'Brien JG, Chennubhotla SA, Chennubhotla RV (2005). "Treatment of edema". Am Fam Physician. 71 (11): 2111–7. PMID 15952439.
- ↑ Cho S, Atwood JE (2002). "Peripheral edema". Am J Med. 113 (7): 580–6. doi:10.1016/s0002-9343(02)01322-0. PMID 12459405.
- ↑ Yale SH, Mazza JJ (2001). "Approach to diagnosing lower extremity edema". Compr Ther. 27 (3): 242–52. doi:10.1007/s12019-001-0021-5. PMID 11569326.