Edema

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Dropsy
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Edema
Other namesOedema, œdema, fluid retention, water retention, dropsy, hydropsy, swelling
physical exam[3]
TreatmentBased on cause[2]

Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue.[1] Most commonly, the legs or arms are affected.[1] Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness.[1] Other symptoms depend on the underlying cause.[2]

Causes may include

liver problems, deep vein thrombosis, infections, angioedema, certain medications, and lymphedema.[1][2] It may also occur in immobile patients (stroke, spinal cord injury, aging), or with temporary immobility such as prolonged sitting or standing, and during menstruation or pregnancy.[1] The condition is more concerning if it starts suddenly, or pain or shortness of breath is present.[2]

Treatment depends on the underlying cause.

support stockings may be useful for edema of the legs.[3] Older people are more commonly affected.[3] The word is from the Greek οἴδημα oídēma meaning 'swelling'.[4]

Signs and symptoms

Specific area

An edema will occur in specific organs as part of inflammations,

, for instance. Certain organs develop edema through tissue specific mechanisms. Examples of edema in specific organs:

Generalized

A rise in

hydrostatic pressure occurs in cardiac failure. A fall in osmotic pressure occurs in nephrotic syndrome and liver failure.[7]

Causes of edema which are generalized to the whole body can cause edema in multiple organs and peripherally. For example, severe heart failure can cause pulmonary edema, pleural effusions, ascites and peripheral edema. Such severe systemic edema is called anasarca. In rare cases, a parvovirus B19 infection may cause generalized edemas.[8]

Although a low plasma oncotic pressure is widely cited for the edema of nephrotic syndrome, most physicians note that the edema may occur before there is any significant protein in the urine (proteinuria) or fall in plasma protein level. Most forms of nephrotic syndrome are due to biochemical and structural changes in the basement membrane of capillaries in the kidney glomeruli, and these changes occur, if to a lesser degree, in the vessels of most other tissues of the body. Thus the resulting increase in permeability that leads to protein in the urine can explain the edema if all other vessels are more permeable as well.[9]

As well as the previously mentioned conditions, edemas often occur during the late stages of pregnancy in some women. This is more common with those of a history of pulmonary problems or poor circulation also being intensified if arthritis is already present in that particular woman. Women who already have arthritic problems most often have to seek medical help for pain caused from over-reactive swelling. Edemas that occur during pregnancy are usually found in the lower part of the leg, usually from the calf down.

Hydrops fetalis is a condition in a baby characterized by an accumulation of fluid in at least two body compartments.

Cause

Heart

The pumping force of the

diuretics; otherwise, the water retention may cause breathing problems and additional stress on the heart.[10]

Kidneys

Another cause of severe water retention is

lupus. This type of water retention is usually visible in the form of swollen legs and ankles.[11]

Liver

Cirrhosis (scarring) of the liver is a common cause of edema in the legs and abdominal cavity.[12]

Veins

Phlebetic lymphedema (or phlebolymphedema) is seen in untreated chronic venous insufficiency and is the most common type of edema (approx. 90%).[13] It is a combination venous/lymphatic disorder that originates in defective "leaky" veins that allows the blood to back flow (venous reflux), slowing the return of the blood to the heart (venous stasis). The venous pressure in the legs changes dramatically while standing compared to lying down. How much pressure there is depends on the person's height, in the average adult person, it is 8 mm Hg while lying down and 100 mm Hg while standing.[14]

In venous insufficiency, venous stasis results in abnormally high venous pressure (venous hypertension) and greater permeability of blood capillaries (capillary hyperpermeability), to drain the blood through the lymphatic system. The lymphatic system slowly removes excess fluid and proteins from the veins in the lower legs towards the upper body; however, as it is not as efficient as an unimpaired circulatory system, swelling (edema) is visible, particularly in the ankles and lower leg. Unfortunately, the chronic increased fluid in the lymphatic system and capillary hyperpermeability causes an inflammatory response which leads to tissue fibrosis of both veins and lymphatic system, opening of arteriovenous shunts, all of which then worsens the condition in a vicious cycle.[13][14]

Others

Swollen

pelvis. It usually clears up after delivery of the baby, and is mostly not a cause for concern,[15]
though it should always be reported to a doctor.

Lack of exercise is another common cause of water retention in the legs. Exercise helps the leg

bed-rest, immobility caused by disability and so on, are all potential causes of water retention. Even very small exercises such as rotating ankles and wiggling toes can help to reduce it.[17]

Certain

Mechanism

Six factors can contribute to the formation of edema:[23]

  1. increased
    hydrostatic pressure
    ;
  2. reduced colloidal or oncotic pressure within blood vessels;
  3. increased tissue colloidal or oncotic pressure;
  4. increased blood vessel wall permeability (such as 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 kidneys.[24]

Generation of interstitial fluid is regulated by the forces of the

semi-permeable membrane wall that allows water to pass more freely than protein. (The protein is said to be reflected and the efficiency of reflection is given by a reflection constant of up to 1.) If the gaps between the cells of the vessel wall open up then permeability to water is increased first, but as the gaps increase in size permeability to protein also increases with a fall in reflection coefficient.[26]

Changes in the variables in Starling's equation can contribute to the formation of edemas either by an increase in hydrostatic pressure within the blood vessel, a decrease in the oncotic pressure within the blood vessel or an increase in vessel wall permeability. The latter has two effects. It allows water to flow more freely and it reduces the colloidal or oncotic pressure difference by allowing protein to leave the vessel more easily.[citation needed]

Another set of vessels known as the

bloodstream. But even the lymphatic system can be overwhelmed, and if there is simply too much fluid, or if the lymphatic system is congested, then the fluid will remain in the tissues, causing swellings in legs, ankles, feet, abdomen or any other part of the body.[27]

Diagnosis

Grading of edema[28]
Grade Definition
Absent Absent
+ Mild: Both feet / ankles
++ Moderate: Both feet,
plus lower legs,
hands or lower arms
+++ Severe: Generalised
bilateral pitting edema,
including both feet,
legs, arms and face

Edema may be described as pitting edema, or non-pitting edema.[29] Pitting edema is when, after pressure is applied to a small area, the indentation persists after the release of the pressure. Peripheral pitting edema, as shown in the illustration, is the more common type, resulting from water retention. It can be caused by systemic diseases, pregnancy in some women, either directly or as a result of heart failure, or local conditions such as varicose veins, thrombophlebitis, insect bites, and dermatitis.[30]

Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedema, lipedema, and myxedema.

Edema caused by malnutrition defines kwashiorkor, an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates.

Treatment

A man with a swollen face
Vein obstruction causes facial edema while lying down to sleep.
The same man with no swelling in his face
After being upright all day, the swelling disappears.

When possible, treatment involves resolving the underlying cause. Many cases of

diuretics.[10]

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.[31]

References

  1. ^ a b c d e f g h Causes and signs of edema. Institute for Quality and Efficiency in Health Care (IQWiG). 2016.
  2. ^ a b c d e f g h i "Edema - Cardiovascular Disorders". Merck Manuals Professional Edition. Retrieved 8 December 2019.
  3. ^ a b c "Edema: Causes, Symptoms, Diagnosis & Treatment". Family doctor. Retrieved 23 December 2019.
  4. ^ Liddell H. "οἴδ-ημα". A Greek-English Lexicon. Tufts. Retrieved 8 December 2019.
  5. ^ Hogan CM (2008). Strömberg N (ed.). "Western poison-oak: Toxicodendron diversilobum". GlobalTwitcher. Archived from the original on July 21, 2009.
  6. PMID 23776921
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  11. ^ "Edema - Symptoms and causes". Mayo Clinic. Retrieved 2022-07-19.
  12. ^ "Edema - Symptoms and causes". Mayo Clinic. Retrieved 2022-12-23.
  13. ^ a b Publishing L, Guiboles (2009-11-24). "The causes of edema in chronic venous insufficiency". Servier - Phlebolymphology. Retrieved 2023-09-01.
  14. ^
    PMID 24527138
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  15. The Merck Manual
    . Retrieved 9 August 2017.
  16. .
  17. .
  18. ^ "Estrogens (Conjugated/Equine)". The Merck Manual. Archived from the original on 2 December 2007. Retrieved 9 August 2017.
  19. ^ "Beta-Blockers for High Blood Pressure". WebMD. Retrieved 9 August 2017.
  20. .
  21. .
  22. .
  23. ^ Scallan J, Huxley VH, Korthuis RJ (2010). Pathophysiology of Edema Formation. Morgan & Claypool Life Sciences. Retrieved 11 July 2022.
  24. .
  25. ^ Boron WF, Boulpaep EL (2012). "2e". Medical Physiology: A Cellular and Molecular Approach. Philadelphia: Saunders/Elsevier.
  26. PMID 20375889
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  27. .
  28. ^ Nutrition in Emergencies > Measuring œdema Archived 2017-02-18 at the Wayback Machine. Erin Boyd, reviewed by Diane Holland, Nutrition in Emergencies Unit, UNICEF. Retrieved Nov 2012
  29. ^ Booth S. "Pitting Edema". WebMD. Retrieved 1 January 2023.
  30. ^ Causes and signs of edema. Institute for Quality and Efficiency in Health Care (IQWiG). 30 December 2016. Retrieved 26 July 2022.
  31. PMID 25748341
    .

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