Case - In poor health; feet swell
Hints page 1


I. The Case (& preliminary "hints")

Case - In poor health; feet swell

II. The Chart

We examine the information revealed in HUMAN by selecting < Your Patient's Chart > ...

... noting that the vital signs are largely within normal range but that there is, significantly, a report of peripheral edema [ "feet swell"].

III. The output data table

The 'normality' of the basic vital signs profile is further stressed in our initial output.

All values appear to be of a baseline normative nature.

IV. Other - Examining the edema and its possible causes

The peripheral edema ("feet swell") and, in a general sense, all edemas, are due to some factor(s) that unbalances the normal relationship between

• factors causing fluid to leave the vascular system and
• factors that cause fluid to reenter the vascular system.

A] Determining in HUMAN which factors cause fluid exit and entry at the capillary bed level

Web-HUMAN has built into it the classical Starling fluid balance hypothesis.
How this can be explored in HUMAN is outlined below.

1] We can begin by picking any of the four classical forces and asking for them in Help as is done below for plasma colloid osmotic pressure (PCOP).

2] This reveals a Help screen (below) that outlines the four forces for us and how their balance determines the net exit/entrance of fluid out of/into the vascular system at a systemic capillary bed level.

The second paragraph (above) explains the "Starling fluid balance" hypothesis and provides for users links to the other three primary forces.

We note that there are
2 opposing hydrostatic forces [ for example, capillary pressure (PCAP), an outward force ] and
2 opposing osmotic forces [ for example, excess protein-caused plasma colloid osmotic pressure (PCOP), an inward force ].

3] The balance of these forces and their directions can perhaps be better visualized utilizing the diagram below.

The case:
We now apply our understanding of web-HUMAN's representation of the Starling fluid balance hypothesis to this case.

A] Determining the balance of fluid movement forces in this case

1] Setup:
We can change our
View Output: settings to read out these four forces and also lymph flow (LYMPH) and body weight (WGHT) as below:

2] Data readout:
Running this readout for for an hour yields both the values of the basic four forces at the beginning of this case (table below- line 1) and gives us a sense of the direction in which they may be changing.


3] Interpretation/ questions:
There are some sharply abnormal values revealed above. Here are some crucial issues to think upon/ calculate.

1) Which of the four basic Starling forces appears to be most askew?

2) Calculate (numerically) the balance of outward vs. inward forces (i.e. net force for fluid to move) and compare the resulting number with the value in a normal* subject.

* To obtain normal subject values use either a series of Help Help info on: inquiries or run a normal subject ( i.e." Physiologyl experiment ) with these View Output: variables.

3) Is lymph flow abnormally elevated as one might expect in peripheral edema?

4) Is there a tendency visible here that suggests edema accumulation?

A single additional hint: you might explore urine values to obtain a clue as to why there are unusual forces present here.

V. More

This ends the hints section on this case.

You should attempt again at this point to arrive at a diagnosis and a treatment. To do so

Return to the HUMAN model's Physiology Lab section for this patient and verify

- the diagnosis by finding the appropriate variables to support your argument and

- the treatment by changing parameters so as to stabilize the patient.

VI. Hints section, part 2

If you wish further hints on this case click the link to the right [ second hint page ]

VII. Analysis

If you wish further analysis and a diagnosis on this case and information on how it was created, click on this link ( analysis ) and log in as requested.

* Note: Case hints and analyses are based heavily on Drs. Randall and Coleman's HUMAN-80 Instructor's Manual supplemented by notes of Dr. Coleman's in the model code itself and findings by myself and other colleagues over our years of use of these cases.