EDEME, CIRCULATIE COLATERALA
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Transcript of EDEME, CIRCULATIE COLATERALA
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EDEME, EDEME,
CIRCULATIE COLATERALACIRCULATIE COLATERALA
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EDEMEEDEME
EDEMEDEM (gr. (gr. OidemaOidema - umflatura) = - umflatura) = acumulare de lichid in interstitiu, localizata acumulare de lichid in interstitiu, localizata sau generalizata, ce duce la marire de sau generalizata, ce duce la marire de volum si stergerea reliefurilor anatomice volum si stergerea reliefurilor anatomice normalenormale
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Mecanisme de formare a edemelor:
I. Alterarea schimburilor lichidiene la nivel capilar, astfel incat volumul de fluid care paraseste vasul la nivelul ansei arteriale a capilarului depaseste volumul resorbit la nivelul ansei venoase
II. Retentia renala de sodiu si apa
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II permeabilitatii capilare permeabilitatii capilare (edem inflamator sau (edem inflamator sau alergic)alergic)
presiunii hidrostatice presiunii hidrostatice in capilar (edem cardiac in capilar (edem cardiac sau din insuficienta sau din insuficienta venoasa)venoasa)
presiunii coloid-presiunii coloid-osmotice in plasma osmotice in plasma (hipoalbuminemie)(hipoalbuminemie)
presiunii coloid-presiunii coloid-osmotice tisulare osmotice tisulare (alterare structurala a (alterare structurala a proteinelor tisulare – proteinelor tisulare – mixedem)mixedem)
drenajului limfatic drenajului limfatic (limfedem)(limfedem)
IIII fluxului plasmatic fluxului plasmatic renal (insuficienta renal (insuficienta cardiaca, unele cardiaca, unele nefropatii)nefropatii)
Factori hormonali:Factori hormonali:
Aldosteron sau alti Aldosteron sau alti mineralocorticoizimineralocorticoizi
ADHADH estrogeniestrogeni
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CARACTERELE CARE TREBUIE CARACTERELE CARE TREBUIE APRECIATE LA UN EDEMAPRECIATE LA UN EDEM
TEGUMENTE SUPRAIACENTE:TEGUMENTE SUPRAIACENTE:
- aspect- aspect
- culoare- culoare
- temperatura- temperatura
PREZENTA / ABSENTA DURERIIPREZENTA / ABSENTA DURERII
CONSISTENTACONSISTENTA - apreciata prin “godeu”- apreciata prin “godeu”
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TIPURI DE EDEM
EDEM
GENERALIZAT LOCALIZAT
(afectiuni sistemice) (cauze locale)
- edemul cardiac
- edemul renal
- edemul hepatic
- edemul carential
- edemul inflamator
- edemul alergic
- edemul venos
- edemul limfatic
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EDEMEEDEME
GENERALIZATEGENERALIZATE
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EDEMUL CARDIACEDEMUL CARDIAC
Cianotic (albastrui) +/- dermatita ocraCianotic (albastrui) +/- dermatita ocra
ReceRece
Relativ dur (dar lasa godeu)Relativ dur (dar lasa godeu)
Nedureros (exceptie: edemele Nedureros (exceptie: edemele complicate cu fisuri tegumentare si complicate cu fisuri tegumentare si suprainfectie)suprainfectie)
DeclivDecliv
ANASARCA
Forma particulara – edemul pulmonar acut
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EDEMUL RENALEDEMUL RENAL
Alb (infiltrarea pielii cu indepartarea de Alb (infiltrarea pielii cu indepartarea de suprafata a retelei vasculare suprafata a retelei vasculare subcutanate + anemie in I Ren)subcutanate + anemie in I Ren)
Temperatura normalaTemperatura normala
Moale, pufos (lasa usor godeu)Moale, pufos (lasa usor godeu)
Predomina la fata (pleoape)Predomina la fata (pleoape)
ANASARCA
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EDEMUL HEPATICEDEMUL HEPATIC
Alb / galben (icter)Alb / galben (icter)
Temperatura normalaTemperatura normala
Moale, pufos (lasa usor godeu)Moale, pufos (lasa usor godeu)
In prezenta HTPortale predomina la In prezenta HTPortale predomina la membrele inferioaremembrele inferioare
(dar spre deosebire de insuficienta (dar spre deosebire de insuficienta cardiaca, apare intai ascita)cardiaca, apare intai ascita)
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EDEMUL CARENTIAL EDEMUL CARENTIAL (hipoproteinemic)(hipoproteinemic)
AlbAlb
Temperatura normalaTemperatura normala
Moale, pufos (lasa usor godeu)Moale, pufos (lasa usor godeu)
Predomina la nivelul tesuturilor laxe Predomina la nivelul tesuturilor laxe (palpebral)(palpebral)
Albuminemie < 2,5 g/dl (insuficienta de aport proteic, insuficienta de sinteza hepatica, malabsorbtie, pierdere de proteine)
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ALTE TIPURI DE EDEME ALTE TIPURI DE EDEME GENERALIZATEGENERALIZATE
Edemul de sarcinaEdemul de sarcinaEdemul catamenial sau ciclicEdemul catamenial sau ciclicEdemul iatrogen – la corticosteroizi, Edemul iatrogen – la corticosteroizi, estrogeni, AINSestrogeni, AINSEdemul posturalEdemul posturalEdemul prin ingestie excesiva de sareEdemul prin ingestie excesiva de sare
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EDEME EDEME LOCALIZATELOCALIZATE
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EDEMUL INFLAMATOREDEMUL INFLAMATOR
RosuRosu
CaldCald
DurerosDureros
Lasa greu sau deloc godeuLasa greu sau deloc godeu
Semnele inflamatorii: calor, tumor, rubor, dolor,
functio laesa
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EDEMUL ALERGICEDEMUL ALERGIC(edemul Quincke)(edemul Quincke)
RozatRozat
Pruriginos, usor durerosPruriginos, usor dureros
Predomina palpebral si la buza Predomina palpebral si la buza superioara (“buza de tapir”)superioara (“buza de tapir”)
Intereseaza frecvent mucoaseleIntereseaza frecvent mucoasele
Risc vital daca se instaleaza edem Risc vital daca se instaleaza edem supragloticsupraglotic
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EDEMUL PRIN OBSTRUCTIE EDEMUL PRIN OBSTRUCTIE VENOASAVENOASA
TROMBOFLEBITA SUPERFICIALATROMBOFLEBITA SUPERFICIALA
- edem inflamator, in jurul “cordonului venos”- edem inflamator, in jurul “cordonului venos”
TROMBOFLEBITA PROFUNDATROMBOFLEBITA PROFUNDA
- - alb / cianotic (“phlegmatia coerulea dolens”)alb / cianotic (“phlegmatia coerulea dolens”)
- dureros- dureros
- mai frecvent la membrele inferioare- mai frecvent la membrele inferioare
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EDEMUL PRIN COMPRESIE EDEMUL PRIN COMPRESIE VENOASA EXTRINSECAVENOASA EXTRINSECA
SDR. DE VENA CAVA SUPERIOARASDR. DE VENA CAVA SUPERIOARA
““edem in pelerina” (jumatatea edem in pelerina” (jumatatea superioara a toracelui si membrele superioara a toracelui si membrele superioare) – cianotic, recesuperioare) – cianotic, rece
Circulatie colaterala venoasa Circulatie colaterala venoasa evidentaevidenta
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EDEMUL DIN INSUFICIENTA EDEMUL DIN INSUFICIENTA VENOASA CRONICAVENOASA CRONICA
VARICE HIDROSTATICEVARICE HIDROSTATICE
SDR. POSTTROMBOTICSDR. POSTTROMBOTIC
Cianotic, frecvent dermatita ocraCianotic, frecvent dermatita ocra
Afecteaza membrele inferioareAfecteaza membrele inferioare
Se accentueaza in ortostatismSe accentueaza in ortostatism
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EDEMUL LIMFATICEDEMUL LIMFATIC (ELEPHANTIAZIS )(ELEPHANTIAZIS )
La debut moale, apoi devine indurat, nu lasa godeuLa debut moale, apoi devine indurat, nu lasa godeu
LIMFEDEM PRIMAR LIMFEDEM PRIMAR (afectarea vaselor limfatice)(afectarea vaselor limfatice) - predomina distal- predomina distal - congenital- congenital - consecutiv limfangitelor sau erizipelurilor - consecutiv limfangitelor sau erizipelurilor
repetate, filariozarepetate, filarioza
LIMFEDEM SECUNDAR LIMFEDEM SECUNDAR (invazie neoplazica / excludere (invazie neoplazica / excludere chirurgicala a ganglionilor limfatici)chirurgicala a ganglionilor limfatici)
- apare proximal si se extinde distal- apare proximal si se extinde distal - varice limfatice- varice limfatice
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EDEMUL CEREBRAL SI AL EDEMUL CEREBRAL SI AL FUNDULUI DE OCHIFUNDULUI DE OCHI
In In encefalopatia hipertensivaencefalopatia hipertensiva, prin , prin cresterea brusca si importanta a TA ce cresterea brusca si importanta a TA ce depaseste capacitatea de autoreglare a depaseste capacitatea de autoreglare a circulatiei cerebralecirculatiei cerebrale
FO: exudate moi, “vatoase” +/- hemoragiiFO: exudate moi, “vatoase” +/- hemoragii
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Exemple:Exemple:
Edemul din neoplaziiEdemul din neoplazii
Edemul din ciroza hepaticaEdemul din ciroza hepatica
Edemul renalEdemul renal
Cel mai adesea edemul nu are mecanism unic!
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CIRCULATIECIRCULATIE
COLATERALACOLATERALA
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ARTERIALAARTERIALA - inaccesibila examenului clinic direct- inaccesibila examenului clinic direct
- boala coronariana, arteriopatia obliteranta cronica a - boala coronariana, arteriopatia obliteranta cronica a membrelor inferioaremembrelor inferioare
VENOASA SUPERFICIALAVENOASA SUPERFICIALA - in obstructia unui trunchi venos profund- in obstructia unui trunchi venos profund
- desenarea sistemului venos subcutan ce devine - desenarea sistemului venos subcutan ce devine proeminent, turgidproeminent, turgid
TIPURI
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CIRCULATIA COLATERALA CIRCULATIA COLATERALA TORACOBRAHIALATORACOBRAHIALA
Dilatarea venelor superficiale din Dilatarea venelor superficiale din regiunea deltopectoralaregiunea deltopectorala
UnilateralaUnilaterala obstructia / compresia obstructia / compresia venei subclavii / axilare de partea venei subclavii / axilare de partea respectivarespectiva
BilateralaBilaterala sdr de cava superioarasdr de cava superioara
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CIRCULATIA COLATERALA CIRCULATIA COLATERALA ABDOMINO-FEMURALAABDOMINO-FEMURALA
Dilatarea venelor superficiale din treimea Dilatarea venelor superficiale din treimea superioara a coapsei si peretele superioara a coapsei si peretele abdominal invecinatabdominal invecinat
In obstructia / compresia vv iliace In obstructia / compresia vv iliace (externa/ comuna)(externa/ comuna)
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CIRCULATIA COLATERALACIRCULATIA COLATERALA CAVO-CAVA CAVO-CAVA
Retea pe flancuri prin dilatarea venelor Retea pe flancuri prin dilatarea venelor superficiale abdominale, hipogastrica si superficiale abdominale, hipogastrica si epigastricaepigastrica
In obstructia / compresia uneia din vv In obstructia / compresia uneia din vv cave (inferioara sau superioara)cave (inferioara sau superioara)
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CIRCULATIA COLATERALACIRCULATIA COLATERALA PORTO-CAVA PORTO-CAVA
Dilatarea venelor abdominale superficiale in Dilatarea venelor abdominale superficiale in zona periombilicalazona periombilicala
Dilatare importanta, aspect varicos – “cap de Dilatare importanta, aspect varicos – “cap de meduza” meduza” sdr Cruveilhier-Baumgarten sdr Cruveilhier-Baumgarten
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Edem periorbitar la un pacient de 27 ani, HIV pozitiv, cu sarcom Kaposi
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Edem alergic
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Edem inflamator, erizipel
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Edem de staza
venoasa si limfatica
autoindus prin aplicarea
unei benzi compresive la o pacienta de 38 ani cu
tulburari psihice
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Edem unilateral
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Limfedem congenital membru inferior
drept prin agenezie de
vase limfatice
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Elefantiazis
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Edem cardiac
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Insuficienta venoasa cronica – insuficienta cardiaca ?
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Tromboflebita superficiala – pacienta, 56 ani
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Tromboflebita profunda
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Edem si ulcer varicos
Edem postmortem
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Ascita
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Circulatie colaterala venoasa in
sindromul de vena cava superioara
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“Cap de meduza”