angioneurotic edema


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Related to angioneurotic edema: angioedema

an·gi·o·e·de·ma

(an'jē-ō-ĕ-dē'mă),
Recurrent large circumscribed areas of subcutaneous or mucosal edema of sudden onset, usually disappearing within 24 hours; frequently, an allergic reaction to foods or drugs.

angioneurotic edema

(ăn′jē-ō-no͝o-rŏt′ĭk)

angioneurotic edema

angioneurotic edema

Angioedema, Quincke's disease Neurology A chronic and potentially fatal condition characterized by episodic localized subcutaneous, periorbital, periocular and laryngeal edema, abdominal pain Etiology Absent C1 esterase inhibitor Clinical Recurrent edema, abdominal pain, laryngeal edema which can compromise breathing Diagnosis Hx of recurrent angioedema, absent C1 esterase inhibitor in blood Triggering factors Allergies–eg foods, pollen, insect bites, drugs–eg ACE inhibitors, salicylates, stress, exposure to cold, water, sunlight, heat Management Epinephrine, antihistamines, corticosteroids (androgens). See Episodic angioedema, HANE.

an·gi·o·e·de·ma

(an'jē-ō-ĕ-dē'mă)
1. Recurrent large circumscribed areas of subcutaneous edema of sudden onset, usually disappearing within 24 hours; seen mainly in young women, frequently as an allergic reaction to foods or drugs.

Quin·cke dis·ease

(kving'kĕ di-zēz')
A well-localized edematous disorder that may variably involve the deeper skin layers and subcutaneous tissues as well as mucosal surfaces of the upper respiratory and gastrointestinal tracts; occasionally accompanied by arthralgia, purpura, or fever.
Synonym(s): angioedema (2) , angioneurotic edema (2) .

edema

(e-de'ma) (-de'mat-a) plural.edemasplural.edemata [Gr. oidema, swelling, tumor]
Enlarge picture
EDEMA: Edematous arm caused by subclavian vein stenosis
A local or generalized condition in which body tissues contain an excessive amount of tissue fluid in the interstitial spaces. Synonym: hydrops See: anasarca; ascites; dropsy; hydrothorax; pericardial effusion See: illustrationedematous (e-de'mat-us), adjective

Etiology

Edema may result from increased permeability of the capillary walls; increased capillary pressure due to venous obstruction or heart failure; lymphatic obstruction; disturbances in renal function; reduction of plasma proteins; inflammatory conditions; fluid and electrolyte disturbances, esp. those causing sodium retention; malnutrition; starvation; or chemical substances such as bacterial toxins, venoms, caustics, and histamine. Diagnostic studies ( thorough history, physical examination, urinalysis, serum chemistries and liver functions, thyroid function, and chest x-ray) help determine the cause and guide treatment.

Treatment

Bed rest helps relieve lower extremity edema. Sitting with the feet and legs elevated may also reduce edema in the lower extremities. Dietary salt should be restricted to less than 2 g/day. Fluid intake may be restricted to about 1500 ml in 24 hr. This prescription may be relaxed when free diuresis has been attained. Diuretics relieve swelling when renal function is good and when any underlying abnormality of cardiac function, capillary pressure, or salt retention is being corrected simultaneously. Any effective diuretic may be used. Diuretics are contraindicated in preeclampsia and when serum potassium levels are very low (< 3.0 mEq/dl). They may be ineffective in edema associated with advanced renal insufficiency. The diet in edema should be adequate in protein, high in calories, and rich in vitamins. Patients with significant edema should weigh themselves daily to gauge fluid loss or retention.

Patient care

Edema is documented according to type (pitting, nonpitting, or brawny), extent, location, symmetry, and degree of pitting. Areas over bony prominences are palpated for edema by pressing with the fingertip for 5 sec, then releasing. Normally, the tissue should immediately rebound to its original contour; therefore the depth of indentation is measured and recorded. The patient is questioned about increased tightness of rings, shoes, waistlines of garments, and belts. Periorbital edema is assessed; abdominal girth and ankle circumference are measured; and the patient's weight and fluid intake and output are monitored. Fragile edematous tissues are protected from damage by careful handling and positioning and by providing and teaching about special skin care. Edematous extremities are mobilized and elevated to promote venous return, and lung sounds auscultated for evidence of increasing pulmonary congestion. Prescribed therapies, including sodium restriction, diuretics, ACE inhibitors, protein replacement, and elastic stockings are provided, and the patient is instructed in their use.

angioneurotic edema

Angioedema.

Berlin edema

Commotio retinae.

brain edema

Swelling of the brain. It may be caused by increased permeability of brain capillary endothelial cells, focal strokes, swelling of brain cells associated with hypoxia or water intoxication, trauma to the skull, or interstitial edema due to obstructive hydrocephalus.
Synonym: brain swelling; cerebral edema

edema bullosum vesicae

Edema affecting the bladder.

cardiac edema

Edema due to congestive heart failure. It is most apparent in the dependent portion of the body and/or the lungs.

cerebral edema

Brain edema.

dependent edema

Edema of the lower extremities or, if the patient is lying down, of the sacrum.

diabetic macular edema

Swelling of the retina resulting from leakage of fluids from damaged blood vessels in the eye. It is a major cause of visual loss in diabetics, and is related to poor control of blood glucose.

edema of the glottis

Pathological edema in the tissues lining the vocal structures of the larynx. It may result from improper use of the voice, excessive use of tobacco or alcohol, chemical fumes, or viral, bacterial, or fungal infections. Clinically, the patient often presents with hoarseness or, in severe cases, with respiratory distress and stridor. See: epiglottitis

Symptoms

Initially, hoarseness and, later, complete aphonia characterize this condition. Other symptoms are extreme dyspnea, at first on inspiration only, but later also on expiration; stridor; and a barking cough when the epiglottis is involved.

high-altitude pulmonary edema

Abbreviation: HAPE
Pulmonary edema that may occur in aviators, mountain climbers, or anyone exposed to decreased atmospheric pressure.
See: hypoxia

inflammatory edema

Edema associated with inflammation. The cause is assumed to be damage to the capillary endothelium. It is usually nonpitting and localized, red, tender, and warm.

laryngeal edema

Edema of the larynx, usually resulting from allergic reaction and causing airway obstruction unless treated. Therapy consists of intravenous or intratracheal epinephrine, emergency tracheostomy, or both.

malignant edema

Rapid destruction of tissue by cutaneous or subcutaneous infections, such as anthrax or clostridial species.

negative pressure pulmonary edema

Pulmonary edema occurring in a patient with upper airway obstruction and negative intrapleural pressures, e.g., in a child with epiglottitis.

edema neonatorum

Edema in newborn, esp. premature, infants. This condition is usually transitory, involving the hands, face, feet, and genitalia, and rarely becomes generalized.
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PITTING EDEMA: Demonstration of pitting edema
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PITTING EDEMA: Demonstration of pitting edema

pitting edema

Evidence of fluid in soft tissues, esp. those of dependent body parts like the lower extremities. When pressed firmly with a finger, tissues that are swollen with extravascular fluid retain the shape of the depression produced by the finger. See: illustration

post-traumatic edema

Traumatic edema.

pretibial edema

Edema of the lower leg anterior to the shin (the tibia).

pulmonary edema

A potentially life-threatening edema in the interstitium and alveoli of the lungs. The collected fluid may block the exchange of oxygen and carbon dioxide and produce respiratory failure.

Etiology

Fluid may seep out of the alveolar capillaries if these blood vessels are damaged and become excessively permeable to liquids (noncardiogenic pulmonary edema) or if hydrostatic pressures within blood vessels exceed the strength of the normal alveolar capillary wall (cardiogenic pulmonary edema). Cardiogenic pulmonary edema can result from any condition that compromises left ventricular function, causing elevations in pulmonary venous and capillary hydrostatic pressures (congestive heart failure), including myocardial infarction, ischemia, or myocardial stunning; severe valvular heart disease; arrhythmias; excessive intravenous fluid administration; and diastolic dysfunction.

Noncardiogenic pulmonary edema usually results from blood vessel injury, as happens in the adult respiratory distress syndrome (sepsis, shock, aspiration pneumonia, airway obstruction). Occasionally, protein-rich fluid floods the lungs from drug exposure (such as heroin overdose), hypoalbuminemia, high-altitude exposure (mountain sickness), fresh water aspiration in near drowning, hemorrhage in or around the brain, or other conditions. Pulmonary edema can occur as a chronic or acute condition.

Symptoms

Chronic symptoms include dyspnea or exertion, nocturnal dyspnea, orthopnea, and cough. When pulmonary edema develops rapidly, patients experience a rapid onset of shortness of breath and suffocation and often demonstrate labored, noisy breathing; cough producing frothy, bloody sputum; gasping; anxiety; palpitations; and altered mental status caused by inadequate oxygenation. Signs of the condition include a rapid respiratory rate, heaving of the chest and abdomen, intercostal muscle retractions, diffuse crackles on lung exam, and, often, cold, clammy skin with diaphoresis and cyanosis. Tachycardia, jugular vein distension, and a diastolic (S3) gallop occur. As cardiac output decreases, the pulse becomes thready, and blood pressure falls. Pulmonary artery catheterization helps identify left-sided failure (elevated pulmonary wedge pressures), and arterial blood gases show hypoxia. Profound respiratory alkalosis occurs when patients hyperventilate when trying to increase their oxygenation; acidosis may occur with respiratory fatigue and failure. To improve the movement of air into and out of the chest, the patient will often sit upright to breathe and resist lying down.

Treatment

Oxygen (in high concentrations by cannula, face mask, or nonrebreather mask) should be administered immediately. Assisted ventilation (continuous positive airway pressure [CPAP] or intubation with mechanical ventilation) may be needed to reach acceptable levels of PaO2 and improve acid-base balance. Morphine sulfate, nitrate vasodilators (IV nitroglycerin or nitroprusside) and loop diuretics are typically given to patients with cardiogenic pulmonary edema to improve dyspnea, alter preload and afterload on the heart, and promote diuresis. Angiotensin-converting enzyme inhibitors, inotropic drugs (digoxin), antiarrhythmic agents, beta-adrenergic blockers, human B-type natriuretic peptide, and phosphodiesterase inhibitors may be used in selected circumstances. Bronchodilators may also be administered. Depending on the underlying cause, invasive interventions may occasionally include coronary angiography, intra-aortic balloon pump therapy, or surgical interventions such as coronary artery revascularization or valve repair, or ventricular assist device therapy.

Prognosis

The outlook is good if the condition is stabilized or reversed with treatment.

Patient care

The patient's head is elevated; respirations and ventilatory effort are assessed. Oxygen is administered as prescribed, with care taken to limit the flow rate in patients whose respiratory drive is compromised. The lungs are auscultated for adventitious breath sounds such as crackles, gurgles, and wheezes, and the heart is assessed for apical rate and gallops. The patient is monitored for a cough productive of pink, frothy sputum. The skin is checked for diaphoresis and pallor or cyanosis. A medication history is collected, esp. for cardiac or respiratory drugs and use of recreational drugs. The patient's cardiac rate and rhythm, blood pressure, and oxygen saturation levels are monitored continuously. An intravenous (IV) line administering normal saline solution (NSS) is inserted at a keep-vein-open rate to provide access for medication administration. Prescribed first-line drug therapy is administered, and the patient's response to the drugs is evaluated. IV morphine slows respirations, improves hemodynamics, and reduces anxiety. It should be administered before initiating continuous positive air pressure (CPAP). CPAP improves oxygenation and decreases cardiac workload, thus decreasing the need for intubation and ventilation with positive end-expiratory pressure (PEEP). An indwelling urinary catheter is inserted to monitor the patient's fluid status; diuresis should begin within 30 min of administration of an IV loop diuretic. Pulmonary edema is a life-threatening respiratory emergency. Everyone involved with the patient must remain calm and quiet, provide ongoing reassurance, and validate everything occurring through basic and simply understood explanations. After the crisis resolves, health care providers should discuss with the patient his or her feelings about the episode and give thorough explanations of what occurred. The at-risk patient is taught early warning signs to act on immediately (such as weight gain or increasing peripheral edema), in an effort to recognize and prevent future episodes. Medications and dietary and lifestyle restrictions are explained (low-sodium diet, losing weight, smoking cessation), and written information provided for home review. The patient should be encouraged to enroll in a cardiac rehabilitation program (as applicable) for regular exercise tailored to his condition.

purulent edema

Edema caused by a local collection of pus.

reexpansion pulmonary edema

Abbreviation: RPE, REPE
Alveolar flooding that occurs after a collapsed or trapped lung reinflates, e.g., after the draining of a pleural effusion or the evacuation of a pneumothorax.

Reinke edema

See: Reinke edema

salt-induced edema

A form of edema worsened by excess sodium in the diet.

traumatic edema

Tissue swelling occuring after blunt or penetrating injury.
Synonym: post-traumatic edema

an·gi·o·e·de·ma

(an'jē-ō-ĕ-dē'mă)
Recurrent large circumscribed areas of subcutaneous or mucosal edema of sudden onset, usually disappearing within 24 hours; often due to an allergic reaction to foods or drugs.
Synonym(s): angioneurotic edema.

angioneurotic edema

Patient discussion about angioneurotic edema

Q. Is severe diarrhea sign of angioedema? I have sudden onset of painful diarrhea with stomach pain.

A. Severe diarrhea can be a sign of angioedema but it is a very unlikely way of angioedema to show, especially if that is the only symptoms and there is no obvious seen swelling of skin or shortness of breath. Stomach ache with diarrhea is usually caused by an infection, most likely a viral infection, and should pass within a few days. If symptoms are unbarable or continue, you should see your doctor.

Q. What can cause an angioedema on 15 year old girl? I’ve been getting angioedema signs on my left arm for the past few weeks, not severe but it itches and sure don’t help my low-as-it-is self esteem…

A. The following may cause angioedema -

Animal dander
Certain medications (drug allergy)
Emotional stress
Exposure to water, sunlight, cold or heat
Foods (such as berries, shellfish, nuts, eggs, milk, other)
Insect bites
Pollen

Hives or angioedema may also occur after an illness or infection.
Try to see if you were exposed to any of this and report it to your Dr.


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References in periodicals archive ?
Severe reactions included angioneurotic edema, hypotension, dyspnea, bronchospasm, respiratory distress, apnea, and urticaria.
Angioneurotic edema, skin rash, nephrotic syndrome, and anaphylactic shock have rarely been reported after intramuscular injection so that a causal relationship between immunoglobulin and these reactions is not clear.