Signs and symptoms he signs and symptoms of fluid retention include ankle edema, shoe discomfort, nocturia, oliguria, abdominal pain and tension, nausea, anorexia, flatulence, sensation of a full stomach, constipation, increased body weight, and thirst with a correspondingly excessive fluid intake. As the disease progresses, the edema involves the legs, thighs, genitals, and abdominal wall. In more severe cases it may reach as high as the trunk.
The contributory factors include reduced renal flow and perfusion due to increased renovascular resistance, itself resulting from the increase in systemic resistance designed to maintain blood pressure. Intrarenal flow is redistributed to increase sodium retention. Activation of the renin-angiotensin-aldosterone system increases peripheral resistance and causes sodium accumulation and increased circulating vasopressin. Aldosterone clearance is reduced due to hepatic dysfunction. Capillary permeability to fluid and small proteins increases. Reduced physical activity contributes to edema.
What differentiates cardiac edema from other types of edema?
History and physical examination are essential to the differential diagnosis (Table), complemented by blood pressure, urinalysis, urea, creatinine, electrolytes, and albumin. Hepatic dysfunction and alcohol abuse point to liver disease. Because the most frequent cause of peripheral edema is venous insufficiency, a history of forced immobility or varicose veins may indicate venous Doppler studies. Unilateral edema suggests venous thrombosis or pelvic malignancy. Calcium channel blockers may cause edema confined to the feet and ankles. Edema associated with raised jugular venous pressure, orthopnea, paroxysmal nocturnal dyspnea, or dyspnea with exertion is probably cardiac.
What distinguishes cardiac from noncardiac peripheral edema? Photo Gallery
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