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   Caption    = Massive peripheral edema <br> (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)|
   Caption    = Massive peripheral edema <br> (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)|
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{{Peripheral edema}}
{{Pedal edema}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}


{{SK}} Lower extremity edema; leg edema
{{SK}} Lower extremity edema, leg edema
==Overview==
==[[Pedal edema overview|Overview]]==
Competent venous valves, intermittent leg muscle contraction and respiration is required to support normal venous blood return. When these fail, [[venous insufficiency]] and edema occur.  [[Edema]] is caused by an accumulation of an excessive amount of watery fluid in the serous cavities, tissues or cells causing painless, non-reddened swelling.


==Classification==
==[[Pedal edema historical perspective|Historical Perspective]]==
Edema can occur in 2 forms: pitting and non-pitting.


===Pitting Edema===
==[[Pedal edema pathophysiology|Pathophysiology]]==
Pitting occurs when there is fluid movement when pressure is applied.


===Non-Pitting Edema===
==[[Pedal edema causes|Causes]]==
Non-pitting is swelling of the tissue itself, not an excess of fluid surrounding the tissue.


== Causes ==
==[[Pedal edema differential diagnosis|Differentiating Pedal Edema from other Diseases]]==
===Causes by Organ System===
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
[[AV fistula]],
[[Constrictive pericarditis]],
[[Left heart failure]],
[[Myocardial Infarction]],
[[Right heart failure]],
[[Thoracic]] [[aneurysm]],
[[Thrombophlebitis]],
[[Thrombosis]],
[[Varicose veins]],


|-
==[[Pedal edema epidemiology and demographics|Epidemiology and Demographics]]==
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"|
[[Insect bite]],
[[Snakebites]],


|-
==[[Pedal edema risk factors|Risk Factors]]==
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|
[[Carbuncle]],
[[Cellulitis]],
[[Contact dermatitis]],
[[Contusion]],
[[Erysipelas]],
[[Gas gangrene]],


|-
==[[Pedal edema natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[ACE inhibitors]], [[aceon]], [[actos]], [[aldomet]], [[amiodarone]], [[amlodipine]], [[arixtra]], [[atorvastatin]], [[avandia]], [[beta blockers]], [[cardura]], [[casodex]], [[cilostazol]], [[cisplatin]], [[clopidogrel]], [[coreg]], [[crestor]], [[diltiazem]], [[docetaxel]], [[estrogen]], [[evista]], [[flecainide]],  [[fondaparinux]], [[glitazones]], [[hydralazine]], [[ibuprofen]], [[labetalol]], [[lipitor]], [[minipress]], [[minoxidil]], [[motrin]], [[nifedipine]], [[norpace]], [[norvasc]], [[pindol]], [[plendil]], [[tenormin]], [[trentinion]], [[univasc]] [[valproic acid]], [[verapamil]], [[vesinoid]], [[vytorin]], [[xeloda]], [[Taxol]], [[Tamoxifen]], [[Herceptin]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|
[[Addison's Disease]],
[[Cushing's Syndrome]],
[[Hyperthyroidism]],
[[Hypothyroidism]],


|-
==Diagnosis==
|-bgcolor="LightSteelBlue"
[[Pedal edema history and symptoms|History and Symptoms]] | [[Pedal edema physical examination|Physical Examination]] | [[Pedal edema laboratory findings|Laboratory Findings]] | [[Pedal edema chest x ray|Chest X Ray]] | [[Pedal edema CT|CT]] | [[Pedal edema MRI|MRI]] | [[Pedal edema echocardiography and ultrasound|Echocardiography or Ultrasound]] | [[Pedal edema other imaging findings|Other Imaging Findings]] | [[Pedal edema other diagnostic studies|Other Diagnostic Studies]]
| '''Environmental'''
|bgcolor="Beige"|  
Cold (physical stimuli),
[[Frostbite]],
[[Sunburn]],


|-
==Treatment==
|-bgcolor="LightSteelBlue"
[[Pedal edema medical therapy|Medical Therapy]] | [[Pedal edema surgery|Surgery]] | [[Pedal edema primary prevention|Primary Prevention]] | [[Pedal edema secondary prevention|Secondary Prevention]] | [[Pedal edema cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pedal edema future or investigational therapies|Future or Investigational Therapies]]
| '''Gastroenterologic'''
|bgcolor="Beige"|  
[[Exudative enteropathy]],
[[Liver failure]],
[[Malabsorption]],


 
== Case Studies ==
|-
[[Pedal edema case study one|Case #1]]
|-bgcolor="LightSteelBlue"
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| '''Genetic'''
{{WikiDoc Sources}}
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Anemia]],
[[Hypoalbuminemia]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
[[Filariasis]],
[[Trichinosis]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|
[[Fracture]],
[[Gout]],
Ligamentous sprain,
[[Osteomyelitis]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
Peripheral nerve lesion,
 
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
[[Acquired C1-esterase inhibitor deficiency]],
[[Beriberi]],
[[Malnutrition]],
Starvation edema,
 
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|
[[Amniotic band syndrome]],
[[Peripartum cardiomyopathy]],
Premenstrual edema,
 
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|
Mediastinal cancer,
 
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|
[[Anorexia Nervosa]],
[[Bulimia Nervosa]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|
[[Pulmonary hypertension]],
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|
[[Acute glomerulonephritis]],
[[Bartter's Syndrome]],
[[Nephrotic Syndrome]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|
[[Angioneurotic edema]],
[[Cachexia]],
Lymph node mass,
[[Scleroderma]],
[[Sepsis syndrome]],
 
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"|
[[Bruise]],
[[Burn]],
Musculoskeletal trauma,
 
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
Idiopathic edema,
[[Milroy's Disease]],
[[Sepsis syndrome]],
Tight clothing,
 
|-
|}
 
===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
{{MultiCol}}
* [[ACE inhibitor]]
* [[Aceon]]
* [[Acquired C1-esterase inhibitor deficiency]]
* [[Actos]]
* [[Acute glomerulonephritis]]
* [[Addison's Disease]]
* [[Aldomet]]
* [[Amlodipine]]
* Amniotic band
* [[Angioneurotic edema]]
* [[Angiotensin converting enzyme inhibitor]]
* [[Anemia]]
* [[Anorexia Nervosa]]
* [[AV fistula]]
* [[Avandia]]
* [[Bartter's Syndrome]]
* [[Beriberi]]
* [[Beta blockers]]
* [[Boils]]
* [[Bruise]]
* [[Bulimia Nervosa]]
* [[Burn]]
* [[Cachexia]]
* [[Carbuncle]]
* [[Cardura]]
* [[Cellulitis]]
* [[Chemotherapy]]
* [[Cisplatin]]
* Cold (physical stimuli)
* [[Constrictive pericarditis]]
* [[Contact dermatitis]]
* [[Contusion]]
* [[Cushing's Syndrome]]
* [[Diltiazem]]
* [[Drugs]]
* [[Docetax]]
* [[Erysipelas]]
* [[Exudative enteropathy]]
* [[Filariasis]]
* [[Fracture]]
* [[Frostbite]]
* [[Gas gangrene]]
* [[Glitazones]]
* [[Gout]]
* [[Hyperthyroidism]]
* [[Hypoalbuminemia]]
* [[Hypoplasia]]
* [[Hypothyroidism]]
* [[Ibuprophen]]
{{ColBreak}}
* Idiopathic edema
* [[Insect bite]]
* [[Irritant]]
* [[Left heart failure]]
* Ligamentous sprain
* [[Liver failure]]
* [[Lymph node]] mass
* [[Malabsorption]]
* [[Malnutrition]]
* Mediastinal cancer
* [[Milroy's Disease]]
* [[Minipress]]
* [[Motrin]]
* Musculoskeletal [[trauma]]
* [[Myocardial Infarction]]
* [[Neoplasm]]
* [[Nephrotic Syndrome]]
* [[ Nifedipine]]
* [[Norvasc]]
* [[Osteomyelitis]]
* Peripheral nerve lesion
* [[Premenstrual]] edema
* [[Right heart failure]]
* [[Scleroderma]]
*[[Sepsis syndrome]]
* [[Snakebites]]
* [[Starvation]] [[edema]]
* [[Sunburn]]
* Surgical excision
* [[Tendon]]ous strain
* Thoracic [[aneurysm]]
* [[Thrombophlebitis]]
* [[Thrombosis]]
* Tight clothing
* [[[[Trentinion]]
* [[Trichinosis]]
* [[Tumor]]s
* [[Univasc]]
* [[Valproic acid]]
* [[Varicose veins]]
* [[Vesinoid]]
* [[vytorin]]
{{EndMultiCol}}
 
== Epidemiology and Demographics ==
 
25% of the general population suffers from chronic [[venous insufficiency]].
 
==Natural History, Complications and Prognosis==
===Prognosis===
Successful treatment depends on control of the underlying cause.  Severe swelling can cause permanent damage to nerves, resulting in [[peripheral neuropathy]].  Many cases from temporary or minor causes resolve on their own, with no lasting damage.
 
== Diagnosis ==
 
=== History and Symptoms ===
 
*History should include:
:*[[DVT]] risk factors
:*Time lapse
:*Other associated symptoms
:*Unilateral vs. bilateral
:*Pitting and/or non-pitting
 
===Physical Examination===
(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
 
{| align="center"
|-valign="top"
| [[Image:Extremities edema.jpg|thumb|300 px|Moderate edema]]
| [[Image:Extremities massive edema.jpg|thumb|300 px|Massive edema]]
|}
 
=== Laboratory Findings ===
*Labs include:
:*[[Blood cultures]]
:*[[BUN]] / [[creatinine]]
:*[[CBC]]
:*[[Coagulation]]
:*[[Electrolytes]]
:*[[LFT]]s
:*[[Serum albumin]]
:*[[Thyroid function tests]]
:*[[Urinalysis]]
 
=== Chest X Ray ===
*[[Chest X-Ray]] may indicate [[pulmonary edema]] and/or [[cardiomegaly]]
 
=== Echocardiography or Ultrasound ===
*[[Duplex ultrasound]] for [[DVT]]
*[[Echocardiography]] for EF in patients with [[CHF]]
 
=== Other Diagnostic Studies ===
*[[liver biopsy]] for [[cirrhosis]]
 
== Treatment ==
 
=== Acute Pharmacotherapies ===
*[[Congestive heart failure]]: [[Diuretics]], [[ACE inhibitor]]s, [[beta blocker]]s, [[digoxin]]
 
=== Chronic Pharmacotherapies ===
*[[DVT]]: [[Anticoagulation]] with [[unfractionated heparin]], [[low molecular weight heparin]] / [[warfarin]] for 3-6 months
 
=== Indications for Surgery ===
*[[Nephrotic syndrome]]: transplant in adult patients may be necessary
*[[Cirrhosis]]: liver transplant may be necessary
 
=== Additional therapies ===
*[[Venous insufficiency]]: Leg elevation, compression stockings, minimize time standing
*[[Cellulitis]]: extremity elevation and antibiotics
*[[CHF]]: Salt restriction and [[diuretics]], [[preload]] reduction, [[afterload]] reduction
*[[Cirrhosis]]: [[Diuretic]]s & low salt diet
 
==References==
{{Reflist|2}}


[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Medical signs]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
[[Category:Physical examination]]
[[Category:Physical examination]]
[[Category:Primary care]]
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{{WikiDoc Sources}}

Latest revision as of 23:36, 29 July 2020

Peripheral edema
Massive peripheral edema
(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

Pedal edema Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pedal edema from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: M.Umer Tariq [2]

Synonyms and keywords: Lower extremity edema, leg edema

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Pedal Edema from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

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Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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