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    Thread: Physiological edema Vs pathological edema

    1. #1
      vitrag24's Avatar
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      Cool Physiological edema Vs pathological edema

      1. How'll you differentiate between Physiological edema & pathological edema in pregnancy? mechanism of both?

      2. Differential diagnosis of edema of LL in pregnancy and mechanism.

      3. Physiological edema appears first in in which limb and why?


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    2. #2
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      Lightbulb Answers..

      1.How'll you differentiate between Physiological edema & pathological edema in pregnancy? mechanism of both?
      Physiological edema in pregnancy is common particularly after the 2nd trimester..Occurs in dependent parts like the feet and the sacral region.It is mediated by a fall in plasma osmolarity(due to hemodilution?) leading to increased retention of fluid in the interstitium.Also the enlarging uterus causes mechanical obstruction to the IVC and pelvic veins;the reduced venous return manifesting as edema.
      Pathological edema:Edema in the 1st or early 2nd trimester might be due to multiple pregnancy,hydramnios,hydatidiform mole.Other conditions causing pathological edema in pregnancy-CCF,anemia,hypoproteinemia associated with malnutrition,pre-ecclampsia,PIH,renal or hepatic pathology.
      If unilateral non-pitting pedal edema is seen,then filarial elephantiasis,lymphangitis,cellulitis,venous thrombosis may be considered.
      To rule out pathological causes of edema,a detailed history must be elicited.
      • Physiological edema occurs only in the dependent parts.A periorbital edema is indicative of renal disease.Vulval edema signifies pelvic pathology.
      • Physiological edema is usually maximum at the end of the day..And it is relieved when the woman lies on her side coz this relieves the pressure off the IVC..
      • A weight gain of more than 500g/week is an indicator of occult edema.
      • Absence of other corroborative findings for pathological edema

      2. Differential diagnosis of edema of LL in pregnancy and mechanism.
      Multiple pregnancy,hydramnios,hydatidiform mole,pre-ecclampsia,PIH,CCF, anemia,hypoproteinemia associated with malnutrition,renal or hepatic pathology.Mechanisms differ with the cause.
      If unilateral non-pitting pedal edema is seen,then filarial elephantiasis,lymphangitis,cellulitis,venous thrombosis may be considered.

      3. Physiological edema appears first in in which limb and why?
      May be in the left limb coz the left common iliac vein crosses the midline to drain into the IVC and hence is liable to earlier compression.Not sure.
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    3. #3
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      Smile clinical tip..

      To find out if pitting pedal edema is due to renal/cardiac cause, note the pit refilling time..If the pit refills in less than 40 secs,it is due to renal cause.. If refilling takes more than 40 secs,cardiac cause is more likely..
      O you who believe! Seek help in patience and As-Salāt (the prayer). Truly! Allāh is with As-Sābirin (the patient ones). (Al-Baqarah 2:153)

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      Great answer Fathima. It seems you're studying hard now a days.
      Even i don't know answer to 3rd question. I asked to one resident, but she wasn't sure too. I think it's right.


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    5. #5
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      hw much pressure is applied to check for pitting edema?i was asked dis question in viva...

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      sheenu7 is offline MedicalGeek Verified
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      ans is till d nail of finger blanches!only applicabe 4 obs....

    7. #7
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      Answer for 3rd question is right limb because the uterus in pregnancy is dextrorotated and presses on right common iliac vein. (btw, that's why you ask pregnant woman to sleep on left side)
      I've looked for this answer since a long time in our books but it's not there. An OBG specialist told us long time back but till now i've not seen this written anywhere.

    8. #8
      dr.rdbis is offline MedicalGeek Verified
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      so it is right limb and that why patients are asked to lay on left lateral ! ...

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