Peripheral edema

Definition: Excessive accumulation of fluid in called oedema.

Classification:

[A] On the basis of extent of oedema:

1. Localized oedema:
• Acute inflammatory oedema.
• Hypersensitivity oedema.
• Venous oedema.
• Lymphatic oedema.
2. Generalized oedema:
• Cardiac oedema.
• Renal oedema.
• Oedema in pregnancy

[B] Clinically:

1. Pitting oedema: e.g. CCF, hepatic oedema, renal oedema
2. Non pitting oedema: e.g. Lymphatic obstruction.

[C] On the basis of nature of oedema:

1. Exudative.
2. Transudate.
Site: It usually occurs in sub-cutaneous tissue usually notice in =lower legs, Feet, Ankle.

Site: It usually occurs in sub-cutaneous tissue usually notice in =lower legs, Feet, Ankle.

Causes and symptoms:

Many ordinary factors can upset the balance of fluid in the body to cause edema, including:

• Immobility.
• Heat.
• Medications.
• Intake of salty foods.
• Menstruation and pregnancy.

Some medical conditions may also cause edema, including:

• Heart failure.
• Kidney disease.
• Thyroid or liver disease.
• Malnutrition.

Some conditions that may cause swelling in just one leg include:

• Blood clots.
• Weakened veins.
• Infection and inflammation.
• Lymphedema.
• Tumor.

Symptoms vary depending on the cause of edema. In general, weight gain, puffy eyelids, and swelling of the legs may occur as a result of excess fluid volume. Pulse rate and blood pressure may be elevated. Hand and neck veins may be observed as fuller.

Clinical features: Pitting or pressure in superficial tissue.

Mechanism:

Six factors can contribute to the formation of edema:

1. increased hydrostatic pressure;
2. reduced oncotic pressure within blood vessels;
3. increased tissue oncotic pressure;
4. increased blood vessel wall permeability e.g. inflammation;
5. obstruction of fluid clearance in the lymphatic system;
6. changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.

Diagnosis:

Edema is a sign of an underlying problem, rather than a disease unto itself. A diagnostic explanation should be sought. Patient history and presenting symptoms, along with laboratory blood studies, if indicated, assist the health professional in determining the cause of the edema.

Treatment

Treatment of edema is based on the cause. Simple steps to lessen fluid build-up may include:

• Reducing sodium intake. A high sodium level causes or aggravates fluid retention.
• Maintaining proper weight. Being overweight slows body fluid circulation and puts extra pressure on the veins.
• Exercise. Regular exercise stimulates circulation.
• Elevation of the legs. Placing the legs at least 12 in (30.5 cm) above the level of the heart for 10-15 minutes, three to four times a day, stimulates excess fluid re-entry into the circulatory system.
• Use of support stocking. Elastic stockings, available at most medical supply or drug stores, will compress the leg vessels, promoting circulation and decreasing pooling of fluid due to gravity.
• Massage. Massaging the body part can help to stimulate the release of excess fluids, but should be avoided if the patient has blood clots in the veins.
• Travel breaks. Sitting for long periods will increase swelling in the feet and ankles. Standing and/or walking at least every hour or two will help stimulate blood flow.

The three "Ds"—diuretics, digitalis, and diet-are frequently prescribed for medical conditions that result in excess fluid volume. Diuretics are medications that promote urination of sodium and water. Digoxin is a digitalis preparation that is sometimes needed to decrease heart rate and increase the strength of the heart's contractions. Dietary recommendations include less sodium in order to decrease fluid retention. Consideration of adequate protein intake is also made.

For patients with lymphedema, a combination of therapies may prove effective. Combined decongestive therapy includes the use of manual lymph drainage (MLD), compression bandaging, garments and pumps, and physical therapy. MLD involves the use of light massage of the subcutaneous tissue where the lymph vessels predominate. Massage begins in an area of the body trunk where there is normal lymph function and proceeds to areas of lymphatic insufficiency, in an effort to stimulate new drainage tract development. (MLD should not be used for patients with active cancer, deep vein clots, congestive heart failure, or cellulitis.) MLD sessions are followed by application of compression garments or pumps. Physical therapy is aimed at strengthening the affected limb and increasing joint mobility.

Alternative treatment:

Dietary changes, in addition to cutting back the amount of sodium eaten, may also help reduce edema. Foods that worsen edema, such as alcohol, caffeine, sugar, dairy products, soy sauce, animal protein, chocolate, olives, and pickles, should be avoided. Diuretic herbs can also help relieve edema. One of the best herbs for this purpose is dandelion (Taraxacum mongolicum), since, in addition to its diuretic action, it is a rich source of potassium. (Diuretics flush potassium from the body and it must be replaced to avoid potassium deficiency.) Hydrotherapy using daily contrast applications of hot and cold (either compresses or immersion) may also be helpful.