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Case studies of different diseases
Typology: Assignments
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Electrolyte Imbalance Introduction Edema is defined as the abnormal accumulation of fluid in the interstitial spaces of the body's tissues due to an imbalance in fluid movement across capillary walls and this leads to swelling. The fluid buildup in edema develops due to physiological mechanisms such as increased capillary filtration pressure, reduced capillary osmotic pressure, heightened capillary permeability, or blocked lymphatic drainage (Porth et al., 2019). Edema may be either localized or widespread. Generalized edema often results from an increase in vascular volume where swelling in the hands and feet can occur. In cases of starvation and malnutrition, edema occurs due to an insufficient supply of amino acids needed for plasma protein production (Porth et al., 2019). About one third of the anorexia nervosa patients develop edema (Gibson et al., 2020). Edema caused by reduced capillary osmotic pressure typically results from insufficient production or excessive loss of plasma proteins, primarily albumin (Porth et al., 2019). Role of Albumin in Edema The protein that was low in the anorexia patient’s blood is albumin. Albumin, the most abundant protein in blood plasma, is produced by the liver. It is essential for maintaining osmotic pressure, which helps retain fluids within the blood vessels. Albumin, due to its size and negative charge, attracts water molecules and helps retain fluid within the bloodstream. In cases of severe malnutrition, such as anorexia nervosa, protein intake is insufficient, leading to reduced synthesis of albumin in the liver. A drop in albumin concentration lowers osmotic pressure, meaning the
blood loses its ability to pull water back from the tissues into the capillaries. As a result, fluid accumulates in the interstitial spaces causing edema. Physiology of Pitting vs Non-Pitting Edema Edema is the swelling caused by excess fluid trapped in the body's tissues. Edema can also put pressure on blood vessels. Additionally, edema can cause physical deformities, leading to psychological impacts. The swelling may also lead to tight fitting clothes and shoes. There are two types of edemas: pitting and non-pitting. Pitting edema develops when excess interstitial fluid surpasses the tissue gel’s ability to absorb it. In this type of edema, the fluid remains mobile and can be displaced when pressure is applied with a finger. Nonpitting edema typically indicates a buildup of plasma proteins in the tissue spaces, leading to coagulation. It is most commonly observed in cases of localized infection or trauma, where the affected area appears firm and discolored (Porth et al., 2019). Effect of Immobility on Edematous Tissues Being mostly in bed or moved in a wheelchair reduces muscle contractions, which are essential for venous and lymphatic return. Physical activity supports blood circulation and lymphatic drainage, preventing fluid buildup. When a person remains immobile, fluid tends to pool in the tissues, particularly in the lower extremities due to gravity, leading to increased swelling and discomfort and increases the severity of her edema. To help manage edema, patients are encouraged to perform gentle movements and exercises as recommended by their healthcare provider.