EDEMA
Edema represents the generalized or localized buildup of fluid in the tissues and results in swelling of these tissues. The focus of this summary is edema in the feet and ankles, the most common type. Unless someone is bedridden, generalized edema is usually most obvious in the feet, ankles and lower legs (and in the evening rather than the morning). This is called dependant edema since gravity increases the hydrostatic pressure in dependant areas such as the feet and ankles, and fluid is squeezed out of the blood and into these tissues. At night, the fluid tends to drain from the legs so that foot/ankle edema is usually less obvious when you get up in the morning. Pressing an area of dependant edema firmly with your thumb for 5 seconds and removing the thumb quickly will result in pitting (an indentation where the thumb pressure was applied that takes at least one minute to fill in) CAUSES OF EDEMA & ASSOCIATED SYMPTOMS Slight edema is common and may be quite harmless; this occurs particularly in older people, in people who are overweight, in pregnant and post-menopausal women, and in some women at the time of their menstrual periods; it is particularly noticeable in the evening after prolonged standing, or after long airplane flights or car rides. Heart Failure: Excess fluid accumulates in the body. In ambulatory patients, this results in fairly symmetrical, dependant, pitting edema of the ankle/foot that is most pronounced in the evening. Sometimes, fluid returning to the central circulation when a patient with heart failure goes to bed can cause the medical emergency of acute pulmonary edema (cardiac asthma) when edema accumulates in the lungs and the patient wakes up coughing, wheezing and short of breath. Deep Venous Thrombosis: A thrombus (clot) that develops in the deep veins of the leg can obstruct the blood in the veins from returning to the body, resulting in edema of the affected leg. A significant thrombus resulting in edema usually occurs in only one leg, so that the edema tends to be only in one leg; however, both legs can sometimes be affected. Sometimes, there is a danger of a clot breaking off and going to the lungs (pulmonary embolism). Risk factors for deep venous thrombosis include being bedridden, prolonged sitting or immobilization (such as on long plane or car trips), recent surgery or trauma (especially hip, knee or gynecological surgery), fractures, childbirth within the last 6 months, the use of medications such as estrogen and birth control pills, malignant (cancerous) tumor, inherited or acquired hypercoagulability, and polycythemia vera. The condition is commoner in those over 60 years of age. Medications: Medications that can cause edema include calcium channel blockers (especially amlodipine), female hormones (e.g., birth control pills or hormone
replacement therapy), corticosteroids (e.g., prednisolone) and some types of antidepressants. The mechanism by which medications cause edema is not always clear and may involve local fluid accumulation in the feet and ankles rather than excess accumulation of fluid within the whole body. Calcium channel blockers cause dependent, pitting edema of the foot/ankle. Steroids cause non-pitting swelling (e.g., a moon face). Local Injury, Infection or Inflammation: Injury, infection, inflammation or surgery affecting your ankle or foot can cause local swelling/edema (e.g., in one ankle). Kidney Failure: In kidney failure, the kidney cannot eliminate enough salt and water and the excess fluid accumulates in the body, particularly in the feet, hands, abdomen, or face. Liver Failure: Excess fluid accumulates in the body because the liver does not produce enough proteins to maintain the osmotic concentration of the blood, so that fluid leaks into the tissues, particularly the legs and the abdomen. Myxedema: An underactive thyroid can cause puffy face and hands, and non-pitting edema of the feet and lower leg. Minor Frequent Causes: Fairly minor causes of edema include varicose veins, venous insufficiency, burns, or insect bites or stings. Other Causes of Non-Pitting Edema: A number of other diseases can cause edema. In lymphedema, non-pitting edema is caused by obstruction to the flow of lymph and tends to be local because the obstruction is confined to non-pitting edema of one part of the lymphatic circulation (e.g., one leg or arm). In angioedema, an allergic response causes non-pitting swelling beneath the skin (especially eyes and lips); if laryngeal involvement causes stridor (crowing sound on inspiration), protect the airway and get emergency medical care.
The information above should not be considered medical advice and is not intended to replace consultation with a qualified health care professional. It is based largely on the following articles provided by the US Government's National Institutes of Health: [Link] and [Link]
To answer TMT's Edema questionnaire, go to [Link]
