Anasarca - it is a diffuse swelling of the soft tissues preferentially localized in the lower half of the body that occurs as a consequence of other diseases and has a progressive flow.Excess liquid component at anasarca observed not only in a localized subcutaneous fluid and exudate accumulation intracavitary development of ascites, pericarditis and pleuritis.
installing conclusion "anasarca" Dr. involve extremely serious condition of the patient, in need of immediate medical application of the correction of this pathology.
pathogenetic mechanisms of anasarca are the following changes:
- increased hydrostatic pressure type of blood circulating in the lumen of the vessel with a simultaneous decrease of plasma oncotic pressure;
- stagnant changes in the blood vessels in the venous;
- the appearance of increased permeability of the vessel wall and the ability to pass the liquid component of blood in extravascular interstitial tissue;
- redistribution of ion
Thus, all the diseases associated with the above pathogenetic link may become the background for the development of hydrops.
Thus, a large category of patients suffering from chronic pathologies cardiac abnormalities followed decompensated heart failure are at risk for the occurrence of complications such as anasarca.Progressive ischemic myocardial injury, dilated cardiomyopathy type and hypertension are the immediate triggers Anasarca underlying diseases in the absence of measures taken by both the patient and the physician.
Anasarca heart failure tends to slow progression over several years and the rapid leveling of symptoms using pharmacological activities.
Severe diseases of the urinary system with concomitant nephrotic syndrome is the second most common occurrence of diseases accompanied by massive hydrops.Unlike generalized edema observed at decompensated cardiac function, anasarca of this type has a malignant and aggressive course for its elimination must be a systematic hemodialysis.The mechanism of this type of hydrops is in violation of renal excretory function and associated disorders of mineral metabolism.
Isolated pathology of thyroid and hypothyroidism longer accompanied by a rapid loss of albumin from the plasma, and a sharp decrease in oncotic pressure type in the lumen of blood vessels, resulting in a progressive accumulation of fluid in the cavity and the soft tissues having nosological name "myxedema".
great importance in the regulation of metabolic processes electrolyte has aldosterone produced by the adrenal cortex, and therefore, any endocrine pathology, accompanied by increased mineralocorticoid production, becomes an agent provocateur for the development of hydrops.
only a pathological condition, triggers the development of the acute form of anasarca is angioedema, which is observed when exposed to allergic factors.
Clinical symptoms and progression of the intensity of hydrops depends on the underlying disease, a complication which it is, but in most cases there is a slowly progressive over a long latency period.
debut anasarca is the appearance of persistent edema syndrome, which is initially limited and then generalized.Localization of edema at various pathologies has its own characteristics.For example, if the patient complained of severe swelling of the eyelids and neck in the morning, it should be assumed the nature of renal anasarca, while the cardiac pathology is accompanied by accumulation of fluid in the subcutaneous tissue of the distal limb in the evening hours.Subsequently, soft tissue swelling increases progressively and disappear without medical correction.
An objective examination of the patient with hydrops, it is first necessary to determine the preferential localization of edema syndrome and depth of its display, which uses a compression trial.
Besides the visual changes in the soft tissue of the patient with a long history anasarca worried progressive shortness of breath, which is the result of soaking liquid in mezhalveolyarnyh space and congestion in the lower parts of the pleural cavity.As a rule, hydrothorax in this case is two-way in nature and is accompanied by severe respiratory disorders, caused by compression of the main structures of the mediastinum.Thus, the emergence of symptoms of pulmonary ventilation shows massive accumulation of fluid in the pleural cavity.
Terminal degree anasarca accompanied by severe hemodynamic disturbances caused by cardiac abnormalities.In a situation where there is an excessive accumulation of fluid in the pericardial cavity, there comes a critical condition patients in need of urgent pharmacological measures aimed at saving the patient's life.
separate clinical form of edema syndrome is fetal hydrops, observed with a frequency of 1 per 1000 births episodes.The appearance of this terrible disease in the child due to immune and immune mechanisms (hemolytic disease of the newborn, severe intrauterine infection of the fetus, rude heart defects with severe cardiac hemodynamics).
Diagnosis of this condition is not difficult, because immediately after birth of the child observed visual changes expressed as total soft tissue swelling.Due to the fact that the anasarca newborn baby has a fulminant course and is accompanied by flagrant respiratory disorders, mortality rate of this category of patients is very high.Due to the fact that currently apply high technology medical imaging tool, allowing the early stages of diagnosing this pathology and drug correction start before birth, pediatric cases more steel to meet the full recovery of a child with hydrops.
In a situation where there is anasarca moderate severity, consisting in a small swelling of the soft tissues of the extremities, does not require an active drug therapy, but rather a correction of eating behavior with limited use of salty foods, as well as the systematic use ofcompression hosiery items.If the laboratory is excluded fact of nature renal anasarca, it recommended the introduction of the patient's diet meal containing a high percentage of protein.
anasarca If the patient is the result of heart failure and its symptoms affect all organs and systems, the patient shows a bed rest and the use of drugs of cardiac glycosides (digoxin maximum initial dose of 0.0005 g with a subsequent transition to maintenance therapeutic dosage - 000015 g for life).In this case, appropriate and pathogenetically justified is the use of drugs with dilatiruyuschim action on the wall of the veins (Nitroglycerin is a single dose of 5 mg a long course).To eliminate the metabolic abnormalities in the heart muscle, the patient must assign a group of drugs cardiotropic metabolites (Mildronat a daily dose of 500 mg intravenous course of 10 injections).
most effective in the relief of signs of hydrops group of drugs are diuretics, and the appointment of a medicament to be considered underlying diseases.So, anasarca with chronic heart disease responds well to treatment with a combination furosemide daily dose of 40 mg veroshpiron at a dosage of 0.025 mg under mandatory supervision amount of daily urine output, which should exceed 800 ml quantity consumed per day of liquid.
If the patient is noted for progressive, untreatable diuretics with concomitant signs of respiratory failure, you need to decide on the surgical removal of excess fluid from the pleural and abdominal cavities by thoraco- and thoracentesis.The events in these patients are classified as palliative interventions in the future, these measures should be complemented by active diuretic therapy.
When an anasarca, as a complication of severe hypothyroidism, the only pathogenetically substantiated treatment is replacement therapy with the use of L-thyroxine in a daily dose of 1.6 mg per 1 kg of body weight, as well as conducting plasma infusions.
If anasarca has kidney origin, often resort to the appointment of corticosteroids (dexamethasone 4 mg 2 times a day intramuscularly).