1. DIURETICS How do they work? What do they do? WHEN DO I USE THEM? How do I use them?

2. DEFINITION OF EDEMA The Accumulation of Abnormal Amounts of Extravascular, Extracellular Fluid. ANASARCA: Severe, widely distributed pitting edema.

4. MECHANISMS OF EDEMA FORMATION  IS P cap  cap P IS  alance of Starling Forces (Capillary Permeability)  nterstitial Space Filtration < or = Lymphatic Drainage Filtration > Lymphatic Drainage  o  dema  DEMA

6. CARDIAC EDEMA Pathophysiology HEART DISEASE Left Ventricular Dysfunction Right Ventricular Dysfunction Increased Pulmonary Venous Pressure Pulmonary Edema Systemic Edema Hypotension Renal Na Retention

8. LIVER DISEASE Neurohumoral Activation (Increased “Volume Hormones”) Liver Cirrhosis Increased Pressure in Hepatic Sinusoids Exudation of Fluid Into Peritoneal Cavity Systemic Edema Ascites Renal Na Retention HEPATIC EDEMA Pathophysiology Functional Renal Insufficiency (Hepatorenal Syndrome)

11. RENAL EDEMA Pathophysiology RENAL DISEASE Urinary Loss of Albumin Reduced GFR Hypoalbuminemia Altered Starling Forces Systemic Edema Renal Na Retention NEPHROTIC PATHWAY NEPHRITIC PATHWAY

12. CARDIAC Dependent Edema HEPATIC RENAL Proteinuria Facial Edema Ascites Hypoalbuminemia Severe Absent Absent Absent/Mild Severe Absent/Mild Severe Moderate/Mild Absent Absent/Trace Absent/Trace Severe/Moderate Moderate Mild Severe

14. IDIOPATHIC EDEMA Pathophysiology  IS P cap  cap P IS  alance of Starling Forces (Capillary Permeability)  nterstitial Space    Filtration > Lymphatic Drainage  DEMA