odema or edema
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Edema is the medical term for swelling. It is a generalresponse of the body to injury or inflammation.Edema can be isolated to a small area or affect theentire body.
Edema results whenever small blood vessels become
"leaky" and release fluid into nearby tissues. The extrafluid accumulates, causing the tissue to swell
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Swelling caused by edema commonly occurs in thehands, arms, ankles, legs and feet. It is usually linkedto the venous or lymphatic systems. Edema was
formerly known as dropsy or hydropsy .
Edema may be generalized or local. It can appearsuddenly, but usually develops subtly - the patient may
first gain weight, or wake up with puffy eyes. Many patients wait until symptoms are well advanced beforeseeking medical help.
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CAUSES OF EDEMA Causes of Edema
Edema is a normal response of the body to inflammation orinjury. For example, a twisted ankle, a bee sting, or a skininfection will all result in edema in the involved area. Insome cases, such as in an infection, this may be beneficial.Increased fluid from the blood vessels allows moreinfection-fighting white blood cells to enter the affected
area. Edema can also result from medical conditions or problems
in the balance of substances normally present in blood.Some of the causes of edema include:
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Low albumin (hypoalbuminemia): Albumin and otherproteins in the blood act like sponges to keep fluid in theblood vessels. Low albumin may contribute to edema, but
isn't usually the sole cause. Allergic reactions: Edema is a usual component of most
allergic reactions. In response to the allergic exposure, thebody allows nearby blood vessels to leak fluid into theaffected area.
Obstruction of flow: If the drainage of f luid from a body part is blocked, fluid can back up. A blood clot in the deep
veins of the leg can result in leg edema. A tumor blockinglymph or blood flow will cause edema in the affected area.
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Critical illness: Burns, life-threatening infections, orother critical illnesses can cause a whole-body reaction thatallows fluid to leak into tissues almost everywhere.
Widespread edema throughout the body can result. Edema and heart disease (congestive heart
failure): When the heart weakens and pumps blood lesseffectively, fluid can slowly build up, creating leg edema. If fluid buildup occurs rapidly, fluid in the lungs (pulmonary edema) can develop.
Edema and liver disease: Severe liver disease (cirrhosis)results in an increase in fluid retention. Cirrhosis also leadsto low levels of albumin and other proteins in the blood.Fluid leaks into the abdomen (called ascites), and can alsoproduce leg edema.
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Edema and kidney disease: A kidney condition callednephrotic syndrome can result in severe leg edema, andsometimes whole-body edema (anasarca).
Edema and pregnancy: Due to an increase in blood volumeduring pregnancy and pressure from the growing womb, mild legedema is common during pregnancy. However, seriouscomplications of pregnancy such as deep vein thrombosis andpreeclampsia can also cause edema.
Cerebral edema (brain edema): Swelling in the brain can becaused b y head trauma, low blood sodium (hyponatremia), highaltitude, brain tumors, or an obstruction to fluid drainage(hydrocephalus). Headaches, confusion, and unconsciousness orcoma can be symptoms of cerebral edema.
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OTHER COMMON CAUSES OF
EDEMA Edema is most commonly caused by:
Physical inactivity - edema is more prevalent among
people who do not exercise at all, and walk very little.
Standing or sitting still for long - if you stand or sitstill for a long time there is a much higher chance of
swelling. Surgery - there is usually some swelling after a
surgical procedure.
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Burns - the skin reacts to a burn by retaining fluid,causing localized swelling.
Pregnancy - during pregnancy the woman releaseshormones which encourage the body to retain fluids.Pregnant women tend to retain much more sodiumand water than women who are not pregnant. When a
woman is pregnant her face will typically swell, as willher hands, lower limbs and feet.
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Menstruation and pre-menstruation - hormonelevels fluctuate during the menstrual cycle. During the days beforemenstrual bleeding there will be a reduction in the levels of thehormone progesterone, which may cause fluid retention.
Menopause - around the period of the menopause as well as afterit, hormone fluctuations can cause fluid retention. Hormonereplacement therapy after the menopause can also cause edema.
Certain medications - such as vasodilators
vessels), calciumchannel blockers, NSA IDs drugs), estrogens,severalchemotherapy drugs, and some diabetes drugs, such causeedema
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CLASIFICATION
Cutaneous edema is referred to as "pitting" when, afterpressure is applied to a small area, the indentationpersist
Non-pitting edema is observed when theindentation does not persist. It is associated withsuch conditions as lymphedemas for some timeafter the release of the pressure
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NON PITTING EDEMA
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MECHANISM
Six factors can contribute to the formation of edema:
increased hydrostatic pressure;
reduced oncotic pressure within blood vessels;
increased tissue oncotic pressure;
increased blood vessel wall permeability e.g. inflammation;
obstruction of fluid clearance via the lymphatic system;
changes in the water retaining properties of the tissuesthemselves. Raised hydrostatic pressure often reflectsretention of water and sodium by the kidney.
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There are many types of edema.
The most common ones are: Peripheral edema - in the feet (pedal edema), ankles,
legs, hands and arms.
Cerebral edema - in and around the brain (cerebral
edema).
Eye edema - in and around the eyes, e.g. macularedema, corneal edema, periorbital edema (puffinessaround the eys. Macular edema is a seriouscomplication of diabetic retinopathy
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SYMPTOMS OF EDEMA
Symptoms will mainly depend on the underlyingcause. The following refer to generalized edema:
Swelling of the skin. Skin may be stretched and shiny.
The skin may retain a dimple after being pressed forabout ten seconds.
Puffiness of the ankles, face or eyes. Aching body parts.
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Stiff joints.
Weight gain.
Weight loss. Hand and neck veins are fuller.
Raised pulse rate.
Hypertension - raised blood pressure
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DIAGNOSIS The patient will be asked questions about his/her:
Medical history.
Current state of health. How long the signs and symptoms have existed.
How permanent or intermittent the signs andsymptoms are.
Whether the patient has had edema before.
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The physician will also carry out a physical exam.If there are indications that there may be anunderlying medical condition causing the edemathe doctor may order some tests, these may include:
A chest X-ray
Blood tests Urine tests
Liver function
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TREATMENT In order to treat the edema the doctor has to diagnose the
condition that is causing it first.
Diuretics
These are drugs that raise the rate of urination, providing ameans of forced dieresis.
Diuresis is the increased production of urine by the kidney.
There are several types of diuretics - they increase theexcretion of water from the body in various different ways.
Diuretics are not suitable if the patient is pregnant, or haschronic venous insufficiency
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SELF CARE TECHNIQUES
Cut down salt consumption.
If the patient is overweight, to lose weight.
Do regular exercise.
Raise the legs several times per day to improvecirculation.
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Wear supporting stockings. DO NOT sit/stand still for too long.
Get up and walk about regularly when travelling by car,train, boat or plane.
Avoid extremes of temperature, such as hot baths, showers,
and saunas. Dress warmly if it is cold. Massage - if the affected area is stroked firmly in the direction of
the heart it may help move the fluid. It is important that the hand movements do not cause pain. A qualified masseuse or physical therapist will know how to do this more effectively.
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COMPLICATIONS OF EDEMA Edema is usually caused by an underlying disease or
condition. If that condition is not treated, the healthconsequences could be serious. Untreated edema can
cause: Painful swelling. The pain can gradually get worse.
Walking difficulty.
Stiffness.
Awkward gait.
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Skin can become stretched, itchy
The swollen area is more likely to become infected.
Scarring may occur between the layers of tissue.
Poor blood circulation.
Arteries, veins, and joints may lose their elasticity.
Ulcerations of the skin.
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