L 11 12 .Approach to edema & clubbing

Approach to edema & clubbing

1. APPROACH TO CLUBBING & EDEMA DR.Bilal Natiq Nuaman,MD C.A.B.M. , F .I.B.M.S. , D.I.M. , M.B.Ch.B. Lecturer in Al-Iraqia Medical College 2018-2019

2. CLUBBING

3. Edema involving the legs but sparing the feet is lipedema, Because there is no fat on the top of the feet, they are spared. Decreasing intravascular volume with diuretics will not mobilize the fluid of lipedema.

4. Classifications of edema

5. Peripheral edema is graded on a 1 to 4 scale based on the pit recovery time (PRT). To assess the PRT, apply pressure with one finger over the area of edema for 5 seconds. Release the pressure and assess the time required for the pit to return to normal. Each 1 point on the scale corresponds to 30 seconds of PRT (1+ edema = < 30 seconds PRT; 2+ edema = 30–60 seconds PRT, etc.). The higher the PRT, the greater the likelihood that the edema is due to increased hydrostatic pressure ( ie , congestive heart failure).

6. <30 seconds 30-60 seconds 60-90 seconds >90 seconds

7. Mild to moderate heart failure results in edema involving the legs, feet, and toes. Severe heart failure leads to edema involving the legs and feet but sparing the toes. The inadequate cardiac output causes peripheral vascular constriction to maintain core mean arterial pressure, which decreases blood flow to the toes, thus diminishing edema in the toes.

8. Angioedema Angioedema is an episodic, localized, non-pitting swelling of submucous or subcutaneous tissues.

9. characterized by soft-tissue swelling that most frequently affects the face. Involvement of the larynx or tongue may cause life-threatening respiratory tract obstruction, and edema of the intestinal mucosa may cause abdominal pain and distension.