Edematous syndrome

Description:

Edematous syndrome - the excess accumulation of liquid in body tissues and serous cavities which is shown increase in volume of fabrics and change of capacity of a serous cavity, change of physical properties and disturbance of functions of edematous bodies and fabrics.

Symptoms of the Edematous syndrome:

Distinguish the hypostasis local (localized), connected with a liquid delay in the limited site of tissues of body or body, and the general (generalized) - manifestation of a positive water balance of an organism in general. Carry cardiac dropsies to generalized hypostases, liver cirrhoses, nephrotic and nephritic, a hydrops gravidarum, kakheksichesky and idiopathic, and also as a result of chronic losses by a potassium organism at abuse of reception of purgatives. To promote emergence of hypostases or can accelerate their development: phenylbutazone, derivatives of pyrazyl ketone, mineralokortikoida, androgens, estrogen, glycyrrhiza root drugs.

Carry to the localized hypostases: wet brain, fluid lungs, hypostasis of extremities. Local hypostasis develops in the absence of the general disturbances water элеетролитного exchange and is connected with existence of local frustration haemo - and limfodinamik, capillary permeability and metabolism.

If after pressing the pole does not remain a finger on edematous skin, then hypostasis can be carried to false. Such hypostases meet at a myxedema, a scleroderma, obesity.

For differential diagnosis of hypostases lower the extremity at venous insufficiency with the hypostases caused by heart failure should measure venous pressure in an elbow vein. Hypostasis at damage of veins soft or moderate density, edematous skin warm. At a lymphostasis quite often there are irreversible hypodermic consolidations. Additional methods of inspection can be necessary for recognition of a hydrothorax and ascites as the main, and (radiological, laboratories the analysis of intracavitary liquid, etc.).

At objective inspection at a hydrothorax note restriction of mobility of a thorax at breath, weakening of voice trembling, a stupid percussion sound over liquid, and over its upper bound - prituplenno-tympanic. Breath over area of obtusion is weakened or is absent, over the upper bound of obtusion bronchial breath owing to a lung prelum can be listened. Radiological at a hydrothorax homogeneous characteristic blackout in a lower part of the pulmonary field is defined. At a trial pleurocentesis we receive transudate which is characterized with a low specific weight (less than 1015), protein content less than 3%, by scanty cellular structure.

In the presence of liquid in an abdominal cavity the stomach convex, droops in position of the patient standing a little and extends in side departments in position of the patient lying (a frog stomach). The area of a navel vypyachatsya, skin of an abdominal wall smooth, brilliant, sometimes with pink strips. At stomach percussion in position of the patient on spin the stupid sound in side departments of a stomach is defined. At a body postural change localization of dullness changes: if the patient on the right side - dullness only on the right if the patient costs - dullness in the bottom of a stomach, etc. Perketorny definition of ascites is possible at accumulation not less than 1,5 - 2 l of liquid. At small amount of liquid sometimes it is possible to receive a stupid sound in a navel if to percuss from below on a front abdominal wall in genucubital position of the patient. At ascites of an inflammatory origin characteristic distribution of a percussion sound also as well as its change, at a body postural change, can not be observed owing to an union of loops kishy among themselves and with a mesentery and liquid encystments. Diagnosis of ascites is promoted by emergence of fluctuation: when applying a hand to one side of a stomach and percussion on an abdominal wall with an arch of the party fluctuations (liquid fluctuation) are felt. For an exception of vibration of an abdominal wall помощнк puts a palm elbow edge on the average line of a stomach.

The gradual beginning is characteristic of nephrotic hypostasis. Hypostases are localized not only on a face, especially in the field of a century (puffiness of the person is more expressed in the mornings), but also standing, a waist, generative organs, a front abdominal wall. Hypostases are quickly enough displaced at change of provisions of a body. Edematous skin dryish, soft, pale, sometimes brilliant. Often there is ascites, is more rare - a hydrothorax. An asthma, as a rule, does not arise.

At nephritic hypostasis quick (early) start. Edematous skin pale, plotnovaty, usual temperature. Hypostases are localized preferential on a face, and also on upper and lower extremities. Sometimes hydrothorax, hydrocardia.

Hypostases at cirrhosis - usually arise in a late stage of a disease. Are shown preferential by ascites which is more expressed, than hypostases standing. Sometimes the hydrothorax comes to light (usually right-hand). Edematous skin plotnovaty, warm. At inspection - clinical and laboratory signs of a basic disease.

Cachectic hypostasis - arises at the general starvation or a sharp lack of protein food, and also at the diseases which are followed by loss of protein through intestines (exudative forms of a gastroenteritis, ulcer colitis, lymphangiectasias at intestines tumors). Heavy avitaminosis, alcoholism. Hypostases usually small, are localized on shins and feet, often are followed by puffiness of the person. If hypostasis of all body, then it is very mobile. Edematous skin of a pasty consistence, dry. The general exhaustion, a hypoglycemia, a hypochilesterinemia, a sharp hypoproteinemia, a hypoalbuminemia is characteristic.

Hypostasis at pregnant women can be caused by heart failure, an aggravation of a chronic glomerulonephritis, late toxicosis of the pregnant woman. The hydrops gravidarum is found after the 30th week, seldom after the 25th week of pregnancy. Edematous skin soft, vlazhnovaty. Hypostasis at first develops standing, then on external genitals, a front abdominal wall, a front wall of a thorax, a waist, a back, a face. Ascites and a hemothorax are found seldom.

Idiopathic hypostasis. It is observed mainly at women of childbearing age, inclined to obesity and vegetative disturbances. At men arises seldom. Sometimes after mental injuries and neuroinfections. Hypostasis is soft, localized mainly on shins, accrues during the day and in hot season. Hypostases quite often are found on centuries and fingers of hands. Skin standing quite often cyanochroic. The skin hyperesthesia is sometimes noted.

The nephrotic syndrome is characterized by low blood serum protein content, priteinuriy, increase in abstention of lipids in blood, hypostases. Dystrophic, degenerative processes in kidneys are the cornerstone of pathological process. The nephrotic syndrome develops for the second time, being a component of many diseases of the kidneys proceeding with defeat of balls. Carry to them chronic a glomerulonephritis, a glomerulonephritis at general diseases of connecting fabric, an amyloidosis, a diabetes mellitus, damage of a kidney owing to a sensitization allergens. Patients handle a nephrotic syndrome in connection with emergence at them of hypostases, in the absence of hypostases the nephrotic syndrome can be found on a considerable proteinuria. Hypostasis gradually increase, take hypodermic cellulose of all body (anasarca). Liquid can accumulate in a pleura, a pericardium, an abdominal cavity. Wet small quantity, sometimes to 300 ml/days, sometimes dark, muddy, specific weight - 1030 - 1040, a squirrel of 3-5 g/days. In an urocheras - cells of a renal epithelium, hyaline, granular, wax-like cylinders, leukocytes. In blood of squirrels it is reduced, the amount of cholesterol is increased, SOE is accelerated.

Reasons of the Edematous syndrome:

Hypostasis can be kakheksichesky, connected with a heart disease, kidneys, vessels, allergic, connected with liver diseases, idiopathic, etc. Identification of species of hypostasis is important for differential and diagnostic search of the reasons of this symptom. It is necessary to pay attention to many factors which will help to otdifferentsirovat a type of hypostasis. At peripheral hypostases increase in volume of an extremity or a part of a body, swelling of skin and hypodermic cellulose, reduction of their elasticity is noticed. At a palpation the pasty consistence of integuments is felt, after pressing the pole remains a finger on skin. In the absence of inflammatory complications skin color in the field of hypostasis pale or cyanochroic. At sharply expressed hypostases on the stretched brilliant skin there can be cracks from which edematous liquid exudes.

The factors promoting development of hypostases are:

- decrease in fabric pressure at depletion of connecting fabric collagen with increase in its friability, for example, at hyaluronidase release that the ave. inflammatory and toxic hypostases is observed

- low pressure in a pleural cavity facilitates development of a hydrothorax at the general hypostases at patients with a circulatory unefficiency.

- positive the water balance of an organism has in the basis an excess delay sodium kidneys. The arising hyperosmia of extracellular space causes increase in secretion of vasopressin which strengthens a water reabsorption in renal tubules and conducts to an excess delay it in an organism. Less often primary hypersecretion of vasopressin is the cornerstone of hypostases. The main reason of accumulation of sodium at an edematous syndrome Aldosteronum hypersecretion caused by a hypovolemia or decrease in cordial emission is considered. The reduction of a renal blood-groove connected with it strengthens secretion of a renin kidneys, increases formation of angiotensin II which excites secretion of Aldosteronum. As a result of a sodium reabsorption increases in distal department of nephron, the osmotic pressure of extracellular liquid increases, secretion of vasopressin for the second time amplifies and it is excessive water is absorbed.

Thus, the major factors leading to disturbance of local balance of water can be the following:

1. Increase in hydrostatic pressure in capillaries.

2. Decrease in oncotic pressure of a blood plasma.

3. Increase in oncotic pressure of intersticial liquid.

4. Decrease in fabric mechanical pressure.

5. Increase in permeability of capillaries.

6. Disturbance of outflow of a lymph.

Treatment of the Edematous syndrome:

Treatment of all hypostases is begun with a diet in which limit salt to 1,5-3 g a day, and happens, as it is less. But absolutely it is impossible to refuse salt.

The question of restriction of proteins, fats, carbohydrates in a diet is solved the doctor. Proteins have to arrive with lactic products, with low-fat young meat, fish, a bird which are better for giving in a boiled look.

You remember: black bread, sausage, ham, sausages, canned food, cheeses contains a lot of salt. It is not enough in pasta, potatoes, starch, an egg yolk, but not in protein. In rice, flour, tea, coffee of salt is not present.

If the doctor did not set other drinking mode, then it is possible to use liquids to one and a half liters a day, including broths, soups, drinks and waters.

Fennel, parsley, garlic, green onions, bay leaf, caraway seeds, tarragon, naturally, taking into account tastes and portability are relevant to improvement of perception of unsalted food.

Enough and vitamins, especially groups B, vitamins A is necessary, for PP, C and P. There is a lot of them in a citrus, carrots, a sea-buckthorn, cowberry, blackcurrant, a dogrose, apples, etc. fruit and vegetables.

The patient with hypostases has to eat fractionally, small portions, 5-6 times a day. The last acceptance of food has to be in 3-4 hours prior to a dream.

Among necessary drugs which are appointed by the doctor in treatment of a basic disease by all means there will be a place and diuretic. In their use there are several essential principles:

1. The accounting of contraindications to them.
2. Began with small doses, gradually raising, depending on effect.
3. The principle of a maintenance dose for prolonged use.
4. A combination of diuretic different groups, with accession of a veroshpiron to them.
5. Control of electrolytes and other biochemical indicators of blood is obligatory.
6. In mild cases it is reasonable to use herbs and other natural means.
7. At advanced age of a dose have to be lower than usual.

Among diuretic herbs and roots stood the test of time: the leaf of a bearberry, a grass of a horsetail field, a leaf of an orthosiphon, it is renal tea, a leaf of cowberry, flowers of a centaurea blue, juniper fruits, birch kidneys, a St. John's Wort, a celery, mint, roots of an inula, parsley, a water-lily. It is possible to use also pharmaceutical diuretic collecting No. 1 or No. 2.

Diuretic action milk, cottage cheese, honey, juice of a guelder-rose, a mountain ash, a lemon, green grades of apples, tea, especially green, possess coffee.

It is necessary to take in diuretic cocktail on a glass of juice of a guelder-rose, a mountain ash, a half of a glass of juice of a lemon, 100 g of honey and three spoons of Phytolysinum. Everything carefully to mix and accept on one tablespoon of 4-5 times a day. It is necessary to refuse night reception.