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Common Symptoms---Fever and Edema

The First Affiliated Hospital of Liaoning

Medical College

Nephropathy Deparment
Zhou HongLi
1 Introduction
2 Pathlogeny and sort
3 Occurrence Mechanism
4 Clinical occurrence
5 Patterns of fever

1 normal rang: 36-37

2 higher: late afternoon, evening
maximum 8:00-10:00 pm
lower: morning
minimum 3:00-4:00 am
3measure pathway rectum (higher 0.3-0.5)
axillia (lower 0.2-0.4)
Pathlogeny and sort

1 Infective fever-------most common cause

Pathlogeny and sort

2 Noninfective fever
aseptic necrosis mass absorption : tissue is
chemia and infarction,vascularitis, subarach
noid hemorrage
antigen-antibody reaction: acute rheumatic f
ever, still disease ,serum sickness, systemic
lupus erythematosus
familal fever: congenital familial mediterran
ean fever
endocrine disease: endocrine hyperthyroidism
tissue damage:myocardial infarction,
pullmonary infarction
drug reaction and gout
tumor: lymphomas,solid tumors
neuroleptic seizures
psychosocial factitious
Occurrence Mechanism
physiologic temperature elevated----fever
(elevation of hypothalamic set point)

Pathologic temperature elevated-- hyperthermia

( unregulated heat generation, impaired heat exch
Occurrence Mechanism--physiologic

set point (hypothalamus)


Internal temperature

cellular function
Deviation >4

cellular dysfunction
Occurrence Mechanism
increased heat production
decreased heat dissipation Set point change
failure of regulating system
Temperature deviation

exogenous pyrogen (bacterial, viral)
neutrophil, eosinophil, mononuclear macrophage
endogenous pyrogen(interleukin-1(IL-1),TNF, interfero

hypothalamus Set point

heat production heat dissipation

Occurrence Mechanism
Specific patients:
elderly patients
renal failure patients
high doses of corticosteriods

unable to mount
immunocompromised hosts fever
HIV-infected fever
nosocomial fever
require special consideration
Clinical occurrence

low-grade fever:37.3-38

middle-grade fever:38.1-39
high-grade fever:39.1-41
(oral reading)
hyperthemia: 41
Clinical occurrence

effervescence heat production ,heat loss

clinical features altithermal (reach new set point)
defervescence (heat production heat loss )
Patterns of fever
Continuous fever
Remittent fever
Intermittent fever
Undulant fever
Relapsing fever
Episodic fever
Pel-Epstein fever
Continuous fever

temperature: 39-40 ,days or weeks;diurnal variati

on 0.5-1.0
disease: typhoid, acute pneumonia
Continuous fever
Remittent fever

temperature 38 , diurnal variation 2

no normal temeratrue
disease: sapraemia,acute rheumatic fever,
acute infectious endocarditis
Remittent fever
Intermittent fever

suddenly reach climax, continue several h

ours, suddenly fall to normal, intermission
1-several days
disease: malaria, acute pyelonephritis
Intermittent fever
Undulant fever

slowly reach 39 ,slowly return to nor

mal. (repeate the rhythm)
disease: brucellosis,tumor
Undulant fever
Relapsing fever

suddenly reach 39 , continue several day

s, suddenly drop to normal. bout every 5-7
disease: spirochetes infection
Relapsing fever
Episodic fever

last for days or longer, then without fever f

or at least 2 weeks
disease: familial periodic fever
Pel-Epstein fever

continuous or remittent fever bouts sever

al days
disease: Hodgkin disease
FUOfever of unknown origin

Diagnosis criteria:
the illness last at least 3 weeks;
38.3 repeatedly;
no diagnosis after 1 week hospitalization
noninfectious inflammatory disease;
malignancies (hematologic);
50% unexplained
Idiopathic edema
Tropical edema
Pathophysiology hydrostatic and oncotic pressure

A fluid fluid V

filter resorption
interstitial tissues

Keep in balance
equilibrating factors

capillary hydrostatic pressure

interstitial fluid colloid osmotic pressure

serum colloid osmotic pressure

interstitial tissues pressure

Filtration > resorption edema

Factors leading to edema

retention of sodium and water

capillary filtration pressure right heart failure
capillary permeability acute nephritis
serum colloid osmotic pressure (serum albumin )
lymphatic return disturbance (filariasis)
pitting edema detectable:4.5kg fluid accumulate
identify method :
press thumb into the skin against a bony surfa
ce (anterior tibia, fibula,dorsum of foot, sacrum
to demonstrate the presence of edema. when th
thumb is withdrawn, an indention persist for a s
ort time.
Site of edema:

walking patient--feet, ankles gravity

supine patient--posterior calves, sacrum

both legs and symmetricin the pelvis or mor

e proximally
arms and head---superior vena cava
limited one extremity-vascular channels, local
Brawny edema:
chronic edema of the legs leads to fibrosis
of the subcutaneous tissues and skin, so
they no longer pit on pressure.
Clinical occurrence

Localized edema
cause: local vein or lymphatic return,soft tiss
ues disturbance or capillary permeability
disease: Inflammation infection

insufficiency of the venous valves

chemical or physical injuries
arteriovenous fistulas
site: above the diaphragm--superior ve
na cava obstruction
below the diaphragmjugular venou
s press ,portal vein hypertension, loss of
venous tone drugs
Generalized edema:
cardiac edema
renal edema
hepatic edema
nutritional edema (protein losing conditions)
Drug (corticosteroid, NSAID)
Systemic inflammatory response syndrome(SIRS)
Cardic edema

Symptoms: chest distress, short breath, dyspn

Site: lower limbs
Disease right heart failure
renal edema

Symptoms hematuria proteinuria

Site: eyelid legs
Disease: nephrotic syndrome
hepatic edema

Symptoms: anorexia, vomitting,liver funct

ion test abnormal
Site: first lower limbs, then spread all over
the body, ascites is most common
Disease cirrhosis, chronic liver disease
Protein losing conditions

Idiopathic edema

women in 30-50years old without disease,affective di

sorders and obesity may coexist
Mechanism :upright posture --capillary leakage
inappropriate chronic diuretic administration
-----peripheral edema
hormones involved in s
alt and water retention
Tropical edema
Normal adults
condition:48h after traveled from temperate clim
ate to tropics or from cool and dry to warm and
resolve quickly in a few days of acclimatization

Site: face,lips,tongue, larynx----life-threatening

Subcutaneous soft-tissue edema ;Erythema is not prominent.

Causes: hereditary absence of C1 esterase

exposure to allergen
angiotensin-converting enzyme inhibitors
1Reasons of infective fever
2Grades of fever.
3Patterns of fever.
4cause of generaliz edema
5How to distinguish cardiac edema from ren
al edema?