CLINICAL DIAGNOSIS OF OEDEMA

Edema (American English) or oedema (British English; both words from the Greek οἴδημα), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body.

Generally, the amount of interstitial fluid is determined by the balance of fluid homeostasis, and increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.

Five factors can contribute to the formation of edema:

·         It may be facilitated by increased hydrostatic pressure or,

·         reduced oncotic pressure within blood vessels;

·         by increased blood vessel wall permeability as in inflammation;

·         by obstruction of fluid clearance via the lymphatic; or,

·         by changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney

Sites of Oedema:

Sites of oedema collection is predominately determined by the gravity.

Common Sites of Oedema are

·         Legs, thigh, back, face and limbs

·         Sacral oedema is common in bedridden patients

·         Abdominal wall oedema can occur in patients with anasarca (pinch a fold of skin of abdominal wall and look for oedema) 

Pedel oedema                                                                                    

Causes:

·         Acute glomerulonephritis

·         Nephrotic syndrome

·         Cirrhosis of liver

·         Congestive cardiac failure

·         Hypoalbuminemia as nutritional

Elicitation of oedema

Apply firm pressure over the lower part of the tibia above the medial malleolus or dorsum of feet for about 20-30 secs.

Observe for pitting nature of oedema

Facial Oedema

Loose subcutaneous tissue favours the accumulation of the fluid around the eyes

Periorbital puffiness occurs predominantly in the morning hours

Causes:

·         Acute glomerulonephritis

·         Nephrotic syndrome

·         Superior venacaval obstruction

·         Angioneurotic oedema

·         Cushing’s syndrome

·         Myxedema

Non-pitting oedema

Causes

·         Chronic lymphedema (Elephantiasis)

·         Myxedema (collection of firm mucinous material in the subcutaneous tissues)

Other oedemas:

·         Odema of upper part of the body can be  caused by intrathorasic tumours

·         Conjunctival oedema can be caused by Grave’s disease, Superior venacaval obstruction,hypoalbuminemia

·         Localised oedema  can be  caused by venous or lymphatic obstruction, Allergic disorders, Inflammatory disorders

·         Generalised oedema can be  caused by Nephrotic syndrome, Cirrhosis of liver, Congestive cardiac failure, Hypoalbuminemia, nutritional

·         Allergic oedema – Angioneurotic oedema

·         Unilateral oedema can be  caused by Cellulitis, Lymphatic obstruction, Deep vein Thrombosis.

·         Lymphatic oedema due obstruction can be  caused by recurrent filarial lymphangitis(limbs,breast, genitalia), after radical mastectomy or radiation of breast carcinoma(upper limb on affected side),

·         Milroy’s disease – congenital hypoplasia of the lymphatic vessels of legs associated with pedel oedema.