Vasculitis is an autoimmune condition where the blood vessels are inflamed. This inflammation narrows the blood vessels thereby making circulation difficult. This causes the vessels to stretch and weaken leading to a chance of internal bleeding. In some situations, the blood vessels might weaken and form a bulge or aneurysm. This can be life-threatening. Typical symptoms of Vasculitis include fever, swelling and pain in affected tissues. While some persons suffer few symptoms, others are badly affected.
Chronic vasculitis can only be controlled with long-term medications but it remains active. When vasculitis affects the skin, a person develops bruises, hives or itchy red spots. For persons who suffer vasculitis in the joints, arthritis or joint aches are common. Vasculitis can affect the gastrointestinal tract, lungs, sinuses, eyes or throat. Those who suffer vasculitis in the brain experience headaches, paralysis and muscle weakness. Urine tests for raised protein levels and RBCs might help in identifying vasculitis. X-rays and ultrasounds of affected organs are done to detect inflamed blood vessels. Steroids might be prescribed to control inflammation. Immunosuppresant drugs or cytotoxic drugs are also used to treat vasculitis.
Edema previously known as hydropsy is a condition where the soft tissue is swollen because of the accumulation of interstitial fluid. Abnormal accumulation of the interstitial fluid presents a noticeable swollen appearance in various areas of the body. The fluid moves from the vascular region to the interstitial region because of preexisting conditions. The distribution of edema in different areas of the body is an effective diagnostic factor to identify various underlying conditions. Edema is broadly classified in to two categories, localized and generalized respectively.
Localized edema is predominantly caused because of the obstruction caused in the lymphatic or venous system. In some cases these edemas can be fatal as they induce conditions such as deep vein thrombosis and allergic reactions like angioedema. Angioedema is also known as non-pitting edema. Localized edema can also occur due to neoplasm and also because of inflammation associated with infections.
Generalized edema is caused because of impaired cardiac or renal function. Fluid retention and increase in the concentration of sodium may result in the swelling of various body parts. This type of edema can also occur because prolonged sitting or standing in one position. The sodium retention associated with renal impairment is generally caused because of vasoconstriction. In conditions such as cirrhosis of the liver, the edema is generally noticed in the peritoneal region which is referred to as ascites. Edema associated with cardiac impairment is usually associated with the right side of the heart and the left side impairment leads to pulmonary edema. Shortness of breath is often associated with edema.
Clinical manifestations and causes associated with edema
Edema (oedema) occurs because of various preexisting health conditions. Any variation in the vital parameters of the body such as fluid imbalance, venous pressure fluctuations and lymphatic impairments lead to edema. Protein insufficiency and hepatic disease increases the occurrence of edema. Many women experience episodes of edema during pregnancy. This happens because of increased fluid distribution to nourish the developing child and mother at the same time. Some forms of edema also occur because of increased capillary permeability. Conditions such as vasculitis and post-anoxic encephalopathy cause increased capillary permeability.
Pitting edema is also one if the important types of edema which occurs in some people who wear tight outfits. The regions covered by the tight clothing generally swells up and after a certain period of time, the tissue returns to the normal appearance. In addition to the conditions mentioned, edema is also caused because of certain drugs. Drugs which block the calcium channels, corticosteroids, birth control pills and antidepressants predominantly induce the onset of edema.
Edema requires medical attention as it may lead to many other complications. The complications associated with edema are swelling with pain, stretched skin with dryness, formation of scarred tissue, and risk of skin ulcers and decreased elasticity of the arteries, veins and muscles.
Diagnosis and Treatment of Edema
Diagnosis of edema is done by identifying the underlying causes associated with it. Complete biochemical analysis is done to identify the factors such as hyperthyroidism, protein insufficiency and fluid electrolyte ratios. Pregnant women are generally advised to avoid standing for prolonged period of time especially during the last trimester of their pregnancy. Patients suffering from consistent edemas are advised to keep in an elevated position with some support. Loose and comfortable clothing is also recommended as it helps in the uniform blood circulation.
Treatment for edema includes dietary restriction of sodium flowed by the administration of diuretics. Diuretics are predominantly used in conditions such as lymphedema, renal disease and obstruction in the venous flow. Since edema is also associated with weight loss, the administration of diuretics has to be reduced once the patient reaches optimal weight.
Infarction means 'tissue death' in medical terminology. It is caused by obstruction of blood supply to the tissue leading to lack of oxygen. Infarct, which refers to the resulting lesion is derived from Latin, 'infarctus' which means 'stuffed into'. Pulmonary infarction refers to the death of a small area of lung resulting from pulmonary embolism. It occurs in a small, dead end pulmonary artery.
How does pulmonary infarction occur ?
Pulmonary infarction results from free floating thrombus, when many material substances including fat, tumor, septic emboli, air, and amniotic fluid and injected foreign material may form an emboli and move to the pulmonary circulation. In other words, plugging of a branch of the pulmonary artery by a clot (thrombosis) or by a piece of clot carried by the blood stream to the lung from a thrombus located elsewhere can result in pulmonary infarction. The involved area of the lung ceases to function and complication of the thrombosed veins leads to heart disease.
Causes of pulmonary infarction
The most common cause of pulmonary infarction is pulmonary embolism, but there are other conditions which can cause pulmonary infarction including cancer, and autoimmune diseases such as lupus. Sometimes, this condition may occur following a surgery. Other underlying conditions especially in children with pulmonary emboli include sickle cell disease, nephrotic syndrome, chemotherapy and Inherited hyper coagulable state and Vasculitis.
Symptoms of pulmonary infarction
Symptoms associated with pulmonary infarction include shortness of breath, chest pain, and blood sputum or hemoptysis. Sudden piercing pain in the chest which often radiates to the shoulder is noticed. Difficulty in breathing, irritating cough and blood tinged sputum are other signs. Persistent hiccups are present. Most often the patient is anxious with a rapid pulse, sweats profusely and has an elevated body temperature. In some severe cases, the patient may be in a state of shock.
Diagnosis of pulmonary infarction
Reflex broncho constriction is often associated with pulmonary embolism. Increased breathing and decreased pulmonary compliance with diminished surfactant levels may occur due to pulmonary infarction. This contributes to increased work of breathing and diminished oxygen levels. In sickle cell disease, there is sickling of RBCs within the small blood vessels of the lungs due to dehydration as a result of fever, Tachypnea (rapid breathing) and decreased intake, which can precipitate in a cycle of relative de oxygenation that further exacerbates the sickling tendency. Many also suffer a component of reactive airway disease and oxygenation is further decreased due to this factor.
Morbidity may include pulmonary hypertension, right ventricular failure and Cor Pulmonale, paradoxical embolization in patients with intracardiac defects, and sometimes side effects of medications used to treat pulmonary embolism. If pulmonary embolism is large, there could develop right ventricular strain and right heart failure as there is sudden increase in pulmonary artery pressure leading to right heart failure. A sudden pressure in the right ventricle can cause a leftward shift of the intraventricular septum, which may result in a classic obstructive shock, thereby impairing left ventricular filling.
Treating pulmonary infarction
It is timely treatment that is vital. If symptoms of pulmonary infection develop while at home, consult a physician at once. In case, shock develops, it is essential to get first aid treatment. Many times, patients are already in the hospital when pulmonary infarction occurs. Administration of oxygen, use of anticoagulants and prevention of infection are some other suggested line of treatment. Surgery may also be indicated.
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Bibliography / Reference
Collection of Pages - Last revised Date: April 5, 2020