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 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
- 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

'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
after harvesting of leg veins for bypass graft surgery , mild compression stocking about 15-20 mmHg , reduced leg edema significantly. PMID: 25478535 . https://doi.org/10.4081/vl.2016.5989

he results of several studies have demonstrated a beneficial postoperative effect of mild compression following harvest of leg veins for bypass graft surgery.^78–81 Post-reconstructive oedema is very common after revascularisation and also occurs after bypass surgery. A prospective RCT involving patients with peripheral arterial disease treated with autologous femoro-popliteal bypass reconstruction demonstrated superior oedema reduction with 15–21 mmHg compression stockings compared with IPC treatment.⁸²

Oedema and/or venous ulcers in patients after arterial bypass surgery or stenting

Oedema or venous ulcerations may occur or persist after arterial bypass surgery or arterial stenting.

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

References

Template:WikiDoc Sources