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DIURETICS

DIURETICS. How do they work? What do they do? WHEN DO I USE THEM? How do I use them?. DEFINITION OF EDEMA. The Accumulation of Abnormal Amounts of Extravascular, Extracellular Fluid. ANASARCA: Severe, widely distributed pitting edema. TYPES OF EDEMA. GENERALIZED. LOCALIZED. CARDIAC

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DIURETICS

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  1. DIURETICS How do they work? What do they do? WHEN DO I USE THEM? How do I use them?

  2. DEFINITION OF EDEMA The Accumulation of Abnormal Amounts of Extravascular, Extracellular Fluid. ANASARCA: Severe, widely distributed pitting edema.

  3. TYPES OF EDEMA GENERALIZED LOCALIZED • CARDIAC • HEPATIC • RENAL • NEPHROTIC SYNDROME • ACUTE GN • CRF • IDIOPATHIC • Other • Cyclic • Myxedema • Vasodilator-induced • Pregnancy-induced • Capillary leak syndrome • Inflammation • Lymphatic Obstruction • Venous Obstruction • Thrombophlebitis

  4. odema Filtration < or = Lymphatic Drainage DEMA Filtration > Lymphatic Drainage MECHANISMS OF EDEMA FORMATION PIS alance of Starling Forces cap Pcap IS (Capillary Permeability) nterstitial Space

  5. CARDIAC EDEMA Diagnosis • History of Heart Disease • Evidence of Pulmonary Edema • Orthopnea • SOB • Exertional Dyspnea • Evidence of Volume Expansion • Hepatic Congestion • Hepatojugular Reflux • Ventricular Gallop Rhythm

  6. CARDIAC EDEMA Pathophysiology HEART DISEASE Left Ventricular Dysfunction Right Ventricular Dysfunction Hypotension Increased Pulmonary Venous Pressure Renal Na Retention Pulmonary Edema Systemic Edema

  7. HEPATIC EDEMA Diagnosis • History of Liver Disease • Diminished CrCl (Normal Serum Cr) • Evidence of Chronic Liver Disease • Spider Angiomata • Palmar Erythema • Jaundice • Hypoalbuminemia • Evidence of Portal Hypertension • Venous Pattern on Abdominal Wall • Esophogeal Varices • Ascites

  8. LIVER DISEASE HEPATIC EDEMA Pathophysiology Liver Cirrhosis Increased Pressure in Hepatic Sinusoids Neurohumoral Activation (Increased “Volume Hormones”) Exudation of Fluid Into Peritoneal Cavity Functional Renal Insufficiency (Hepatorenal Syndrome) Ascites Renal Na Retention Systemic Edema

  9. RENAL EDEMA Diagnosis History of Renal Disease • Evidence of Albumin Loss • Narrow, pale transverse bands in nail beds • Proteinuria (3+ to 4+) • Hypoalbuminuria • Renal Imaging • Enlarged Kidneys Nephrotic Syndrome or AGN • Shrunken Kidneys CRF

  10. RENAL EDEMA Diagnosis • Nephrotic Syndrome • Hyaline Casts • Oval Fat Bodies • Lipid Droplets/Casts • Acute Glomerulonephritis • Hematuria • Erythrocyte Casts • Leukocyte Casts • Pyuria • Chronic Renal Failure • Broad Waxy Casts Urinalysis

  11. RENAL EDEMA Pathophysiology RENAL DISEASE NEPHRITIC PATHWAY NEPHROTIC PATHWAY Reduced GFR Urinary Loss of Albumin Hypoalbuminemia Renal Na Retention Altered Starling Forces Systemic Edema

  12. CARDIAC HEPATIC RENAL Dependent Edema Severe Moderate Mild Absent Absent Severe/Moderate Facial Edema Absent/Mild Severe Absent/Mild Ascites Absent Moderate/Mild Severe Hypoalbuminemia Absent/Trace Severe Proteinuria Absent/Trace

  13. IDIOPATHIC EDEMA Diagnosis • Women of Childbearing Age • Associated with Eating Disorders • Dependent Edema • Facial Edema • Abdominal Bloating

  14. DEMA Filtration > Lymphatic Drainage IDIOPATHIC EDEMA Pathophysiology PIS alance of Starling Forces  cap Pcap  IS  (Capillary Permeability) nterstitial Space

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