Edema resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, 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.
- Generalized edema caused by decompensated heart failure
- Unilateral leg edema caused by proximal deep vein thrombosis leading acute pulmonary embolism
Common Causes of peripheral edema
- Renal
- Advanced kidney disease
- Nephrotic syndrome[1] PMID: 30697163
- Cardiovascular
- Systolic or diastolic heart failure
- Constrictive pericarditis
- Pulmonary hypertension
- Renal
- Deep vein thrombosis
- Cellulitis
- Superficial thrombophelebitis
- Baker cyst
- Chronic venous insufficiency
- lymphedema [2]PMID: 31453511
- Hormones
- Pregnancy
- Menstrual cycle
- hyperthyroidism[3] ,hypothyroidism[4] https://www.ncbi.nlm.nih.gov/pubmed/24665353 PMID: 22935075.
- Cushing disease
- Medications
- Obstructive sleep apnea[5]
Diagnosis
Shown below is an algorithm summarizing the diagnosis of edema[6]
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 | | | | | | | | | |)|-| R1 |-| R2 | | | | | | | | |R1=Lymphedema |R2=Lymphatic obstruction,lymph node dissection,[[malignancy],filariasis| }}
{{familytree | | | | | | | | | |)|-| G01 |-| G02 | | | | |G01=Cellulitis| G02=Increased [[capillary permeability]}}
Heart failure | Increased capillary permeability from Systemic venous hypertension,volume overload | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Hepatic disease | Increased capillary permeability from systemic venous hypertension, decreased oncotic pressure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Mechanism of Edema | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Chronic venous insufficiency | venous reflux, poorly functioning venous valves, incompetent venous valves, reduced venous return, blood pooling, hypoxia, and inflammation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Obstructive sleep apnea | Pulmonary hypertension, increased capillary hydrostatic pressure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Renal disease | Increased plasma volume, decreased plasma oncotic pressure from protein loss | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Protein losing entropathy | Decreased plasma oncotic pressure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Deep vein thrombosis | Increased capillary permeability | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cellulitis | Increased capillary permeability | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pregnancy | Increased plasma volume | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Laboratory Tests should be obtained: | |||||||||||||||||||||
Medications Associated With Edema:
| |||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[peripheral edema]] according to the [...] guidelines[7][8][9][1][10][11][12][13] ''PMID: 2987483 PMID: 22336900
Diagnostic tools:
with out evidence of thrombosis on duplex ultrasonography if there is high clinical suspicion for deep venous thrombosis
| |||||||||||||||||||||
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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Lipedema | Suction lipectomy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Before initiation of medical compression therapy, checking the arterial circulation is recommended. if foot pulses or ankle pulses is weak or not palpable, theankle-brachial index(ABI) should be measured.
- In proximaldeep vein thrombosis(DVT), using compression bandage or medical compression stockings and walking accompanied with anticoagulant therapy will lessen the pain and swelling[10] PMID: 11054217
- In DVT, using medical compression will not increase the risk of pulmonary thromboembolism and post thrombotic syndrome.[10][14][15] [16] PMID:11054217, PMID: 29217387,PMID: 11204585, PMID: 18480967
- Early mobilization in acute deep vein thrombosis will not increase the risk of pulmonary thromboembolism.[15]PMID: 11204585
- In the acute phase of DVT, calf compression reduces irreversible skin alteration, edema, and pain.[17]PMID: 29856509
- In compensated heart failure NYHA । and ॥, mild compression of both legs may increase cardiac preload.[8]
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 peroneal nerve palsy and foot drop.[18][19]
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.[5]
doi:10.1001/archinte.160.15.2357
- After harvesting of leg vein for bypass graft surgery, mild compression stocking about 15-20 mmHg, reduced leg edema significantly.[20] [21]
PMID: 25478535 . https://doi.org/10.4081/vl.2016.5989
- Daflon or micronized purified flavonoid fraction (MPFF) has an anti-inflammatory effect and increases venous contractility, is recommended in chronic venous insufficiency because of anti-inflammatory effect and enhancing venous contractility.[9]PMID: 29874834
Don'ts
- Do not use medical compression device in the conditions include:
- Severe peripheral arterial occlusive disease when the 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[8]
DOI:10.1002/ehf2.12848
- History of an allergic reaction to compression material
- Severe diabetic neuropathy with sensory loss, microangiopathy, and risk of skin necrosis
References
- ↑ 1.0 1.1 Gupta S, Pepper RJ, Ashman N, Walsh SB (2018). "Nephrotic Syndrome: Oedema Formation and Its Treatment With Diuretics". Front Physiol. 9: 1868. doi:10.3389/fphys.2018.01868. PMC 6341062. PMID 30697163.
- ↑ Borman P (September 2018). "Lymphedema diagnosis, treatment, and follow-up from the view point of physical medicine and rehabilitation specialists". Turk J Phys Med Rehabil. 64 (3): 179–197. doi:10.5606/tftrd.2018.3539. PMC 6657795 Check
|pmc=
value (help). PMID 31453511. - ↑ Volke V, Matjus S (August 2012). "Unilateral pitting edema of the leg as a manifestation of Graves' disease: a case report". J Med Case Rep. 6: 258. doi:10.1186/1752-1947-6-258. PMC 3443661. PMID 22935075.
- ↑ Kazama I, Mori Y, Baba A, Nakajima T (2014). "Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade". Am J Case Rep. 15: 111–4. doi:10.12659/AJCR.889854. PMC 3962324. PMID 24665353.
- ↑ 5.0 5.1 Blankfield, Robert P.; Hudgel, David W.; Tapolyai, Amy Artim; Zyzanski, Stephen J. (2000). "Bilateral Leg Edema, Obesity, Pulmonary Hypertension, and Obstructive Sleep Apnea". Archives of Internal Medicine. 160 (15): 2357. doi:10.1001/archinte.160.15.2357. ISSN 0003-9926.
- ↑ Joob B, Wiwanitkit V (2014). "Acute bilateral leg edema due to levofloxacin". J Family Med Prim Care. 3 (4): 475–6. doi:10.4103/2249-4863.148158. PMC 4311373. PMID 25657974.
- ↑ Papadopoulou MC, Tsiouri I, Salta-Stankova R, Drakou A, Rousas N, Roussaki-Schulze AV, Giannoukas AD (March 2012). "Multidisciplinary lymphedema treatment program". Int J Low Extrem Wounds. 11 (1): 20–7. doi:10.1177/1534734612438436. PMID 22336900.
- ↑ 8.0 8.1 8.2 Urbanek, Tomasz; Juśko, Maciej; Kuczmik, Wacław B. (2020). "Compression therapy for leg oedema in patients with heart failure". ESC Heart Failure. doi:10.1002/ehf2.12848. ISSN 2055-5822.
- ↑ 9.0 9.1 Mansilha A, Sousa J (June 2018). "Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy". Int J Mol Sci. 19 (6). doi:10.3390/ijms19061669. PMC 6032391. PMID 29874834.
- ↑ 10.0 10.1 10.2 Partsch H, Blättler W (November 2000). "Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin". J. Vasc. Surg. 32 (5): 861–9. doi:10.1067/mva.2000.110352. PMID 11054217.
- ↑ Kayıran O, De La Cruz C, Tane K, Soran A (2017). "Lymphedema: From diagnosis to treatment". Turk J Surg. 33 (2): 51–57. doi:10.5152/turkjsurg.2017.3870. PMC 5508242. PMID 28740950.
- ↑ Sullivan T, de Barra E (March 2018). "Diagnosis and management of cellulitis". Clin Med (Lond). 18 (2): 160–163. doi:10.7861/clinmedicine.18-2-160. PMC 6303460. PMID 29626022.
- ↑ Warren Peled A, Kappos EA (2016). "Lipedema: diagnostic and management challenges". Int J Womens Health. 8: 389–95. doi:10.2147/IJWH.S106227. PMC 4986968. PMID 27570465.
- ↑ Ten Cate-Hoek AJ, Amin EE, Bouman AC, Meijer K, Tick LW, Middeldorp S, Mostard G, Ten Wolde M, van den Heiligenberg SM, van Wissen S, van de Poel MH, Villalta S, Serné EH, Otten HM, Klappe EH, Bistervels IM, Lauw MN, Piersma-Wichers M, Prandoni P, Joore MA, Prins MH, Ten Cate H (January 2018). "Individualised versus standard duration of elastic compression therapy for prevention of post-thrombotic syndrome (IDEAL DVT): a multicentre, randomised, single-blind, allocation-concealed, non-inferiority trial". Lancet Haematol. 5 (1): e25–e33. doi:10.1016/S2352-3026(17)30227-2. PMID 29217387. Vancouver style error: initials (help)
- ↑ 15.0 15.1 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.
- ↑ Roumen-Klappe EM, den Heijer M, van Rossum J, Wollersheim H, van der Vleuten C, Thien T, Janssen MC (May 2009). "Multilayer compression bandaging in the acute phase of deep-vein thrombosis has no effect on the development of the post-thrombotic syndrome". J. Thromb. Thrombolysis. 27 (4): 400–5. doi:10.1007/s11239-008-0229-7. PMID 18480967.
- ↑ Amin EE, Joore MA, Ten Cate H, Meijer K, Tick LW, Middeldorp S, Mostard G, Ten Wolde M, van den Heiligenberg SM, van Wissen S, van de Poel M, Villalta S, Serné EH, Otten HM, Klappe EH, Prandoni P, Ten Cate-Hoek AJ (June 2018). "Clinical and economic impact of compression in the acute phase of deep vein thrombosis". J. Thromb. Haemost. doi:10.1111/jth.14163. PMID 29856509. Vancouver style error: initials (help)
- ↑ . doi:10.3928/0147-7447-20001001-29. Missing or empty
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(help) - ↑ 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.
- ↑ Alizadeh-Ghavidel A, Ramezannejad P, Mirmesdagh Y, Sadeghpour-Tabaei A (May 2014). "Prevention of edema after coronary artery bypass graft surgery by compression stockings". Res Cardiovasc Med. 3 (2): e17463. doi:10.5812/cardiovascmed.17463. PMC 4253792. PMID 25478535.
- ↑ Maleti, Oscar (2016). "Compression after vein harvesting for coronary bypass". Veins and Lymphatics. 5 (1). doi:10.4081/vl.2016.5989. ISSN 2279-7483.