Edema ,symptoms , causes, management

 Edema

Definition of edema: 

Edema is an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body  

Causes of edema: 

Five factors can contribute to the formation of edema: 

• Increased capillary hydrostatic pressure  
• Reduced plasma oncotic pressure  
• Increased blood vessel wall permeability e.g. Inflammation  
• Obstruction of fluid clearance in the lymphatic system  
• Changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney 

Major Types :

Edema can be majorly classified into following types: 

• Peripheral Edema  
• Pulmonary Edema  
• Cerebral Edema 

*Symptoms include bloating, tightening of skin, and skin that holds an imprint or looks pitted

Diagnosis: 

• History  

• Physical examination 

• Laboratory investigation 

• Urine analysis: heavy proteinuria with nephrotic syndrome 

• CBC: HB decrease in malaborption 

• Electrolyte: elevated urea and creatinine in renal failure 

• Liver function test: abnormal in liver disease 

• Serum albumin: decrease with nephrotic syndrome, liver disease, malabsorption & malnutrition 

• Renal biopsy: to determine the causes of nephritic syndrome in adult 

• Echocardiography 

• Liver biopsy 

• Fecal fat estimation: increase in malabsorption 

• Lymphangiography 

Management of Edema :

• Treatment underlying causes such as heart or kidney disease, are treated with diuretics 

• Decrease sodium and water intake. 

• Increase excretion of sodium and water by the use of diuretics and bed rest o Most common diuretics use include:  (Thiazide diuretics /  Loop diuretics / Potassium – sparing  diuretics )

• Corticosteroid in case of cerebral edema 

• Treatment may also involve positioning the affected body parts to improve drainage. For example, swelling in feet or ankles may be reduced by having the person lie down in bed or sit with the feet propped up on cushions.  

• Intermittent pneumatic compression can be used to pressurize tissue in a limb, forcing fluids both blood and lymph to flow out of the compressed area.