Edema resident survival guide: Difference between revisions
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* Early mobilization in acute deep vein thrombosis will not increase the risk of pulmonary thromboembolism '''PMID: 11204585''' | * Early mobilization in acute deep vein thrombosis will not increase the risk of pulmonary thromboembolism '''PMID: 11204585''' | ||
*in acute phase of DVT ,calf compression reduces irriversible skin signs, edema and pain '''PMID: 29856509''' | *in acute phase of DVT ,calf compression reduces irriversible skin signs, edema and pain '''PMID: 29856509''' | ||
*in compensated heart failure NYHA । and ॥ , mild compression both legs may | *in compensated heart failure NYHA । and ॥ , mild compression of both legs may increase cardiac preload '''DOI:10.1002/ehf2.12848 Corpus ID: 68752450''' | ||
*correction the sizing of compression therapy is recommended in diabetic neuropathy for prevention of peripheral nerve damage especially proneal nerve pulsy and foot drop.https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.1111/j.1365-2133.2004.06010.x | *correction the sizing of compression therapy is recommended in diabetic neuropathy for prevention of peripheral nerve damage especially proneal nerve pulsy and foot drop.https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.1111/j.1365-2133.2004.06010.x | ||
*obstructive sleep apnea in obese patients may cause bilateral leg edema due to pulmonary hypertension induced by hypoxia '''doi:10.1001/archinte.160.15.2357''' | *obstructive sleep apnea in obese patients may cause bilateral leg edema due to pulmonary hypertension induced by hypoxia '''doi:10.1001/archinte.160.15.2357''' | ||
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Revision as of 08:35, 16 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]
Overview
Edema is abnormal collection of fluid in interstitial space because of imbalance in hydrostatic pressure, oncotic pressure, increased capillary premeablity and obstruction in lymphatic derenage.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- acute decompensated heart failutre
- deep vein thrombosis leading acute pulmonary embolism
Common Causes of peripheral edema
- Renal
- (1) Advanced kidney disease of any cause
- (2) Nephrotic syndrome PMID: 30697163
- Cardiovascular
- (1) Systolic or diastolic heart failure (HF)PMID: 22287864
- (2) Constrictive pericarditis
- (3) Pulmonary hypertension
- Renal
- Hematologic: anemia
- GI :
- Nutritional deficiency or malabsorption leading to hypoalbuminemia
- (2) Refeeding edema
- deep vein thrombosis PMID: 22287864
- cellulitis
- superficial thrombophlebitis
- baker cyst
- venous hypertension or chronic venous insufficiency including varicose veins, post thrombotic syndrome, lymphedema PMID: 31453511
- hormons related such as pregnancy and menstrual cycle, hyperthyroidism PMID: 22935075. cushing disease
- medications:
- dihydropyridines calcium channel blocker amlipidine, nifedipine ,
- escitalopram PMID: 24574569 .
- Direct vasodilators (hydralazine, minoxidil,
- non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen),
- gabapentin, hormones (such as oral contraceptives),
- prednisone,
- thiazolidinediones (such as pioglitazone or rosiglitazone),
- obesity
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.10.3122/jabfm.19.2.148
| Edema | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Generalized | Localized | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| JVP estimation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal JVP | Elevated JVP | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| serum albumin,urine protein | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Checking thyroid function tests for finding myxedema | Checking thyroid function tests for finding myxedema | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
'PMID: 9753021
'PMID: 16513903
PMID: 31461980
PMID: 31348293
https://doi.org/10.1016/B978-0-323-04107-2.50011-9
central venous pressure by determining jugular venous pressure (JVP). The distance from the manubrium sterni to the fluid meniscus in the jugular vein should be ≤2 cm at 45 degrees or 5 cm from the left atrium.
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Treatment is specific to the etiology of the edema, but compression stockings, elevation, exercise, and weight loss remain the cornerstone in most cases.
leg elevation, compression therapy, exercise, weight loss, reduced dietary salt intake, and diuretics PMID: 24707668
Do's
- before initiation of medical compression therapy, checking the arterial circulation is recommended . if foot pulse or ankle pulse are weak or not palpable, ankle brachial index(ABI) should be measured.
- in proximal dvt , using compression bandage or medical compression stockings and walking accompanied with anticoagulant therapy will lessen the pain and swelling PMID: 11054217
- In DVT and SVT using medical compression will not increase the risk of pulmonary thromboembolism and post thrombotic syndrome. PMID:11054217, PMID: 29217387,PMID: 11204585, PMID: 18480967
- Early mobilization in acute deep vein thrombosis will not increase the risk of pulmonary thromboembolism PMID: 11204585
- in acute phase of DVT ,calf compression reduces irriversible skin signs, edema and pain PMID: 29856509
- in compensated heart failure NYHA । and ॥ , mild compression of both legs may increase cardiac preload DOI:10.1002/ehf2.12848 Corpus ID: 68752450
- correction the sizing of compression therapy is recommended in diabetic neuropathy for prevention of peripheral nerve damage especially proneal nerve pulsy and foot drop.https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.3928/0147-7447-20001001-29 https://doi.org/10.1111/j.1365-2133.2004.06010.x
- obstructive sleep apnea in obese patients may cause bilateral leg edema due to pulmonary hypertension induced by hypoxia doi:10.1001/archinte.160.15.2357
-
Don'ts
- do not use medical compression device in the conditions include:
- severe prepheral arterial occlusive disease when ankle-brachial index (ABI)< 0.6, ankle pressure<60 mmHg, transcutaneous oxygen pressure<20 mmHg
- suspected compression of epifacial bypassed arteries
- severe decompensated heart failure (NYHA 4) because of increasing right arterial pressure leading to deterioration right and left ventricular function DOI:10.1002/ehf2.12848
- history of allergic reaction to compression material
- severe diabetic neuropathy with sensory loss, microangiopathy and risk of skin necrosis