Edema resident survival guide

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Edema Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]

Overview

Edema is an abnormal collection of fluid in interstitial space because of an imbalance in hydrostatic pressure, oncotic pressure, increased capillary permeability, and obstruction in lymphatic drainage.

Causes

Life Threatening Causes of peripheral edema

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes of peripheral edema

Diagnosis

Shown below is an algorithm summarizing the diagnosis of edema.[11][12][13][14][15][16][17][2]


 
 
 
 
 
 
 
 
 
 
 
 
 
Associated injury/illness
 
 
 
 
 
 
 
 
 
 
 
Recent surgery/procedure
 
 
 
 
 
 
 
 
Malygnancy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Painful
 
 
 
 
 
Clinical history
 
 
 
 
 
Onset(acute,chronic)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Aggravated by activity
 
 
 
 
 
 
 
 
Systemic diseases
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Changing in medications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 
 
 
 
 
 
 
 
 
 
 
 
 
Pulse examination
 
 
 
 
 
 
 
 
 
 
 
Ulcer
 
 
 
 
 
 
 
 
lymphadenopathy/masses
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pitting
 
 
 
 
 
Physical examination
 
 
 
 
 
Unilateral/bilateral
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Skin texture,color
 
 
 
 
 
 
 
 
Distribution
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Temperature
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



{{familytree | | | | | | | | | |)|-| R01 |-| R02 | | | |R01=Lymphedema |R02=Lymphatic obstruction,lymph node dissection,[[malignancy],filariasis }}

{{familytree | | | | | | | | | |)|-| G01 |-| G02 | | | |G01=Cellulitis |G02=Increased [[capillary permeability] }}

 
 
 
 
 
 
 
 
 
 
 
 
Heart failure
 
Increased capillary hydrostatic pressure from Systemic venous hypertension,volume overload
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hepatic disease
 
Increased capillary hydrostatic pressure from systemic venous hypertension, decreased oncotic pressure from reduced protein synthesis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mechanism of Edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic venous insufficiency
 
Increased capillary hydrostatic pressure due to venous hypertension, venous reflux, poorly functioning venous valves, incompetent venous valves, reduced venous return, blood pooling, hypoxia, and inflammation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Obstructive sleep apnea
 
Increased capillary hydrostatic pressure due to pulmonary hypertension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Renal disease
 
Increased capillary hydrostatic pressure and plasma volume, decreased plasma oncotic pressure from protein loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Protein losing entropathy
 
Decreased plasma oncotic pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Deep vein thrombosis
 
Increased capillary hydrostatic pressure due to venous obstruction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cellulitis
 
Increased capillary permeability
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pregnancy
 
Increased capillary hydrostatic pressure, increased plasma volume
 
 
 
 
 
 



 
 
 
 
 
 
 
 





 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of edema.[18][19][20][1][21][22][23][24]


 
 
 
 
Diagnostic tools:


Duplex sonography in patients with unilateral lower limb swelling and positive D-dimer, or high clinical suspicion for thrombosis
❑ Abdominal or pelvic CT scan in patients with lower limb swelling and evidence of malygnancy
Magnetic resonance venography of the lower leg in patients with unilateral leg swelling

with out evidence of thrombosis on duplex ultrasonography if there is high clinical suspicion for deep venous thrombosis

Echocardiography in patients with obesity, obstructive sleep apnea, and edema for evaluation of pulmonary arterial pressures and also in patients with evidence ofheart failure for assessment ofejection fraction and pulmonary artery pressure and structural heart disease.
Ankle-brachial index in patients with chronic venous insufficiency and cardiovascular risk factors before compression therapy in suspicion of peripheral arterial disease
Lymphoscintigraphy and magnetic resonance lymphangiography in patients with lymphedema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Congestive heart failure
 
Loop diuretic,sodium restriction,compression stocking
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Nephrotic syndrome
 
Loop diuretic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Edema Treatment
 
 
 
 
Lymphedema
 
Compression stocking,topical steroid,manual lymphatic deraning,bandage
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chronic venous insufficiency
 
Compression stocking,bandage,topical steroid,venoactive drugs such as daflon
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Deep vein thrombosis
 
Anticoagulant therapy,early walking, compression stocking
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cellulitis
 
Antibiotic therapy,compression stocking
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pregnancy
 
External pneumatic compression, compression stockings
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lipedema
 
Suction lipectomy
 
 
 
 
 
 

Do's

Do'ts

References

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  26. 26.0 26.1 Aschwanden M, Labs KH, Engel H, Schwob A, Jeanneret C, Mueller-Brand J, Jaeger KA (January 2001). "Acute deep vein thrombosis: early mobilization does not increase the frequency of pulmonary embolism". Thromb. Haemost. 85 (1): 42–6. PMID 11204585.
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  30. Usmani, N.; Baxter, K.F.; Sheehan-Dare, R. (2004). "Partially reversible common peroneal nerve palsy secondary to compression with four-layer bandaging in a chronic case of venous leg ulceration". British Journal of Dermatology. 150 (6): 1224–1225. doi:10.1111/j.1365-2133.2004.06010.x. ISSN 0007-0963.
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  32. Maleti, Oscar (2016). "Compression after vein harvesting for coronary bypass". Veins and Lymphatics. 5 (1). doi:10.4081/vl.2016.5989. ISSN 2279-7483.
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