A Family Doctor's Tale -EDEMA

DOC I HAVE EDEMA
Edema is a symptom defined as excess of fluid (water and sodium) in extracellular spaces that include a large number of medical conditions.

It usually in the ankle and foot but can spread up the legs to the abdomen where the excessive fluid is known as ascites.

The abdomen will appear bloated.

It can also spread to the lungs causing pulmonary edema and breathlessness.

Of course edema of the face will cause puffiness of the face .

Generalized edema is called anasarca.

The Causes of Edema are:

1.Cardiac edema from right or left heart failure

2.Renal edema from renal failure or nephrotic syndrome


3.Hepatic edema from liver failure or cirrhosis

4.endocrine edema from cushing  syndrome or use of  steroids

5.malnutrition syndrome - lack of protein leads to edema

6.Pregnancy pressure on the lower limbs blood vessels

7.Standing too long resulting in gravity pulling fluid to the feet and ankles

8.local edema from obstruction such as

a.venous obstruction - varicose veins,

b.lymphatic obstruction from filaria or other parasites

c. tight garments

d.local injuries,

e.carcinomatous obstruction

The Signs and Symptoms of Edema are:
Symptoms:

1.The skin of the lower legs may be swollen, stretched and shiny.

2.Gentle pressure on the swollen skin will cause a depression in the swollen area.

3.Abdomen may be swollen or distended due to accumulation of fluid

4.Crepitation can be heard at the bases of the lungs suggesting fluid in the lower prt of the lungs

5. The face may be swollen and puffy

The Complications of edema are :


1.overload of fluid in the body leading to overload on the heart

2.too much fluid in the lungs can cause breathlessness

3.renal failure can be dangerous and may need dialysis

4.Liver failure is also dangerous and may require a liver transplant

The Treatment of Edema is usually by:
1.Medicines like diuretics can force the fluid out through the urine.

The diuretic should be cautiously used in renal cases.


2.Treat the underlying cause whether it is heart , kidney or liver failure.

3.Careful institution of high protein feedings in malnutrition cases

4.surgery may be required  to remove obstruction

5.chemotherapy may also be required in carcinomatous obstruction

General Measures:
1.No strenuous exertion

2.Avoid stress

3.Any breathlessness must be treated quickly


4.Reduce the salt intake

5.Raise the legs when sitting down or lying down

6.Do not stand for long periods

Prognosis of edema:

Mild edema due to excess salts or medicines can be treated easily by reducing the salt or medicine.

Underlying diseases like heart failure, renal failure or liver failure may need specific medication, treatment and may not be completely cured.

Prevention of edema is by:

1.avoid too much salt

2.avoid standing or sitting for too long a period

3.Pregnancy can cause edema of the legs due to pressure of the fetus on the major veins of the legs - avoid over exertion and salty food