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Lower legs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Bilateral oedema can be due to: Congestive cardiac failure (CCF).Hypoproteinaemia.Nephrotic syndrome.Early lymphoedema.Obesity and/or immobility.Drugs causing salt and water retention, e.g. hormones, anti-hypertensives, calcium-channel blockers, monoamine oxidase inhibitors, systemic steroids.Venous outflow obstruction in pregnancy & abdominal masses.
Circulation of fluid between plasma, interstitium and lymph
Published in Neil Herring, David J. Paterson, Levick's Introduction to Cardiovascular Physiology, 2018
Neil Herring, David J. Paterson
Clinical oedema develops when the plasma protein concentration falls below ~30 g/L, because the fall in plasma COP raises the capillary filtration rate. The oedema fluid again has a low protein concentration, 1-6 g/L, lowering the interstitial COP. This, along with an increased lymph flow (Figure 11.23), helps to limit the severity of the oedema. The hypoproteinaemia can be caused by:malnutrition (inadequate protein intake);intestinal disease (malabsorption and protein loss);nephrotic syndrome (albumin leakage into urine, >20 g/ day, due to a breakdown of the glomerular ultrafilter);hepatic failure (failure to synthesize albumin, fibrinogen, a- and p-globulins). Hepatic failure is often caused by alcoholic cirrhosis. The attendant fibrosis raises portal vein pressure, and hence intra-abdominal capillary pressures. As a result, the oedema is predominantly peritoneal (ascites).
Left thoracic subtotal esophagectomy
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Since the predominant symptom of esophageal carcinoma is difficulty in swallowing, most patients are nutritionally depleted. The nutritional status of the patients is important in predicting the outcome. A poor nutritional status decreases host resistance to infection and affects healing of an anastomosis. Physical examination should look for peripheral edema, specifically in the feet and flanks which, if present, gives an initial clue for very poor nutritional status of the patient. Measurement of the serum albumin is a more objective estimate of the status of the patient. A low value of serum albumin (<34 g/L) increases the risk of surgical complications, including anastomotic leakage. A positive nitrogen balance is important for the patient’s safe passage through the rigors of this major operation and postoperative stress. Hyperalimentation may be necessary for patients with poor nutritional status before surgery. Albumin or blood plasma can be given to supplement nutrition in patients with hypoproteinemia.
The association between lactate dehydrogenase to serum albumin ratio and the 28-day mortality in patients with sepsis-associated acute kidney injury in intensive care: a retrospective cohort study
Published in Renal Failure, 2023
Minghao Liang, Xiuhong Ren, Di Huang, Zhishen Ruan, Xianhai Chen, Zhanjun Qiu
Albumin is an indicator of inflammation and systemic nutritional status, and studies have shown that albumin is associated with the prognosis of patients with sepsis [24]. Hypoproteinemia is considered an independent risk factor for the prognosis of AKI [25]. Some evidence suggests that albumin has a renoprotective mechanism. First, albumin may clear reactive oxygen species and prevent oxidative damage [26]. Second, albumin is essential in maintaining renal perfusion and glomerular filtration [27]. Finally, further studies have demonstrated that albumin can stimulate DNA synthesis in renal tubular cells through a signalling pathway involving Ca2+ [28]. Albumin plays a vital role in protecting the kidney and maintaining renal function. Lower albumin levels often indicate poor prognosis in individuals with AKI.
Report of Four Cases of Endogenous Klebsiella Pneumoniae Endophthalmitis Originated from Liver Abscess with Eye Complaints as the Initial Presentations
Published in Ocular Immunology and Inflammation, 2022
Jun Zhu, Fang Chen, Zhenggao Xie
In summary, all patients had eye problems as the initial complaints and were diagnosed with EE with liver abscess as the primary lesion. The common underlining condition of these patients was diabetes. They all had symptoms of common cold in varying degrees like fever, chills, or fatigue at the onset. Confirming the initial diagnosis of EE was not hard but it was not straightforward to locate the primary lesion. None of the abdominal ultrasonography suggested liver abscesses. Abdominal enhanced CT and MRI were essential to establish the diagnosis. Hypoproteinemia presented in all patients. All patients had sepsis and two of them even suffered from complicated septic shock. Except for case 3, the other patients were referred to relevant department (ICU or endocrine department) for further treatment, so PPV was not performed promptly. Eventually, three patients underwent PPV including one patient, whose sclera had melted and she underwent evisceration instead of PPV. Unfortunately, the inflammation still could not be controlled in the rest of the two patients after PPV so they eventually underwent evisceration (Table 1).
Prognostic Significance of the Preoperative Controlled Nutritional Status Score in Lung Cancer Patients Undergoing Surgical Resection
Published in Nutrition and Cancer, 2021
Jingjing Shao, Jing Li, Xun Lei Zhang, Gaoren Wang
This is the first meta-analysis investigating the use of the CONUT score as a prognostic indicator of lung cancer. Serum albumin is one of the most commonly used indicators to assess nutritional status. Previous studies have shown that low albumin levels were related to poor nutritional status and clinical outcomes in various cancers, including colorectal cancer, stomach cancer, breast cancer, and lung cancer. Patients with good nutrition and healthy livers, producing normal amounts of albumin, have good resistance to disease and tumor growth. Albumin is inhibited by inflammatory cytokines, such as tumor necrosis factor-α, IL-1, and IL-6, which promote tumor development (18). Since cancer affects its metabolism, albumin can be used to reflect physical conditions. Different immune functions, especially cell-mediated immune functions, are affected by hypoproteinemia. Patients with postoperative hypoproteinemia have increased infections. It is not clear whether correcting hypoproteinemia can reduce postoperative complications or cancer recurrence. Further study is needed to investigate whether it can effectively improve the survival rate and reduce postoperative complications and tumor recurrence (5).