Edema
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More Specific Terms
- angioneurotic edema; angioedema; atrophedema; Bannister's disease; Milton's disease; Quincke's disease; periodic or Quincke's edema; giant urticaria or hives; urticaria gigans, gigantea, or tuberosa.
- bronchial edema (bronchoedema)
- cerebral edema
- chemosis
- corneal edema
- dependent edema
- genital edema
- non-pitting edema
- periorbital edema
- peripheral edema
- pitting edema
- pulmonary edema (pulmonary congestion, PE)
- unilateral upper extremity edema
Introduction
- An increase in the amount of interstitial fluid which is determined by filtration in the arterial capillary bed & resorption in the venous capillary bed.
Etiology
- Factors favoring development of edema
- hydrostatic pressure gradient from capillaries to interstitial fluid
- oncotic pressure gradient from plasma to interstitial tissue
- increased permeability of capillary walls
- obstruction to lymphatic flow
- systemic edema
-
- idiopathic cyclic edema (women)
- lipedema: symmetric nonpitting fat deposition in buttocks & legs, no edema in feet, occurs in women
- increased capillary permeability: angioneurotic edema
- pharmacologic agents [3]
-
- especially amlodipine, felodipine, nifedipine
History
- duration, localized vs generalized, associated pain or redness, dyspnea, history of heart failure, liver disease, renal disease, thyroid disease, pregnancy, estrogens, steroids, vasodilators, exacerbation by menses or position, malnutrition
Clinical-manifestations
- distribution
- bilateral: generally of systemic origin
- unilateral: generally of regional origin
- calf or thigh only without feet or ankles
- sparing of feet ( lipedema)
- overlying skin
-
- reddish-blue - DVT
- cyanotic & bilateral - CHF
- ecchymosis - muscle trauma
- systemic etiology
- interstitial fibrosis with chronic edema may prolong pitting
- onset
- acute: hours to days
- chronic
- systemic process
- medications
- chronic venous insufficiency
- lymphedema
- pain
-
- systemic process
- lymphedema
- painful
- cellulitis
- muscle trauma
- ruptured Baker's cyst
- compartment syndrome
- deep vein thrombosis
- fever & chills
- symptoms associated with CHF
- symptoms of urinary tract disease
- recent Streptococcal sore throat
- recurrent cystitis
- hypertension
Laboratory
- serum chemistries
Radiology
- chest X-ray
- echocardiogram as indicated
- ultrasound to rule out DVT as indicated
Management
- general
- diuretics
- salt restriction < 2 g Na+/day
- fluid restriction < 1.5 L fluid/day
- elastic compression stockings
- digoxin
- vasodilators
- specific treatment depending upon cause
More General Terms
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 207-9
- Chan & Winkle, Diagnostic History & Physical Examination, Current Clinical Strategies Publishing. Laguna Hills, 1996
- Prescriber's Letter 18(9): 2011 Drugs That Commonly Cause Peripheral Edema Detail-Document#: [1] (subscription needed) [2]
- Edema: NIH Institute and Center Resources [3]
