Swelling on your feet ash splitting skin
10 Nov 2015, 18:28
The project of the company Medical Computer Systems
Edema - this is an excessive accumulation of fluid in the tissues and cells of our body. Usually accompanied by an increase in the volume of organs and structures, which greatly complicates their normal functioning.
Foot edema is considered the most common symptom of the pathology of the heart, liver, kidneys, gastrointestinal tract, lymphatic system and skin.
If it occurs in a specific area of the body, talk about local or localized edema, when it affects the entire body - about general or generalized.
On etiology distinguish: toxic, caused by exposure to the body of harmful substances, increasing vascular permeability, inflammatory, developing in the inflammation focus, allergic, arising as a component of the immune response, postoperative.
Based on localization in the body:
- edema at which there is an accumulation of edematous fluid in the serous cavities;
- ascites, when the transudate accumulates in the abdominal cavity;
- hydrothorax - accumulation of fluid in the pleural cavity;
- hydropericardium - in the pericardial;
- hydrocele - in the cavities of the testicle;
- hydrocephalus - excessive accumulation of cerebrospinal fluid in the brain;
- anasarca - a common swelling of the subcutaneous tissue.
Causes of disturbance of outflow and fluid retention intissues are many. General edema most often occurs with heart disease, liver and kidney disease, as a result of a shift in endocrine regulation, fasting, when critical exhaustion of the body develops dysproteinemia and impairs cardiac activity.
Localized edema of the lower extremities may bevenous or lymphatic. The first type develops due to chronic venous insufficiency, acute vein thrombosis or their obstruction; the second - is formed due to congenital anomalies of lymphatic vessels, transferred filariasis, lymphangitis, various surgical operations or radiotherapy.
The cause of edema in some cases isinflammatory process or allergic reaction to taking medications, for example, hormonal drugs, non-specific anti-inflammatory drugs, antihypertensive drugs, β-blockers.
The appearance of edema in heart diseases andother internal organs is due to the violation of mechanisms that participate in the regulation of water-electrolyte balance in the body and contribute to fluid retention in the vascular bed. In each case, one or two mechanisms of edematous syndrome predominate:
- Increase in hydrostatic pressure in the capillaries of the organ;
- Decreased oncotic plasma pressure;
- Lifting of osmotic pressure of intercellular fluid;
- Increased vascular permeability;
- Violation of venous outflow or lymph.
The initial stage in the formation of edema is a violationinflow of blood to the zones of osmotic regulation. These are receptors for pressure and volume, which are located in the sinocarotid and portal areas of the atria. Already small deviations of blood flow to these centers cause significant negative changes in the blood supply of the extremities. The next stage is an increase in the tone of the sympathetic nervous system and the subsequent release of catecholamines into the bloodstream. As a result, there is a spasm of peripheral vessels and a decrease in the excretion of fluid from the body through the skin, lungs, intestines and so on. A special role in pathogenesis has a change in endocrine regulation: an increase in aldosterone in the bloodstream, which causes a delay in sodium ions in the body, resulting in increased osmotic blood pressure. Osmoreceptors are irritated and send impulses to the hypothalamus, resulting in an antidiuretic hormone. Its synthesis into the bloodstream is also possible with irritation of the baroreceptors, which are located in the low pressure region (atria, large veins) and high (sinocarotid zone). Antidiuretic hormone activates the reverse absorption of water in the kidneys, which enters the venous bloodstream, thereby increasing the total volume of circulating blood. As a result, venous pressure increases together with hydrostatic pressure, which entails an increase in the filtration area and a decrease in reabsorption inside the vessel. The tissue receives more fluid, which compresses the venous and lymphatic vessels. Elevated venous pressure also contributes to the stretching of the vascular tissue and the increase in the distance between the cells - the permeability increases. Due to what the migration of protein into the intercellular space is possible.
Because of this, the oncotic pressure in the tissues is increasingtogether with colloid osmotic. In cells, many different particles are formed (protein breakdown, dissociation of salts), the hydrophilicity of the protein increases. In addition, lymph flow deficit is formed: venous congestion provokes a reflex spasm of lymphatic vessels.
The combination of all the above mechanisms contributes to the predominance of fluid filtration in the tissue over the outflow, which leads to the formation of edemas.
Edema of the legs with heart disease
The onset of edema often indicates the development ofpatient of biventricular or right ventricular heart failure. Most often it is formed due to stagnation of blood in the venous part of a large circle of blood circulation and increase in hydrostatic pressure. In a healthy organism, the hydrostatic pressure in the venous channel of the peripheral blood flow is much less than oncotic, which causes the outflow of fluid from the tissues into the bloodstream. With heart failure, the opposite picture is observed - the hydrostatic pressure in the capillaries increases and water enters the tissues of the lower limbs. Similar disturbances in the regulation of inflow and outflow of water are observed not only in patients with heart failure. but also with adherent or exudate pericardial, with stenosis of the atrioventricular orifice. Therefore, when foot swelling occurs, it is very important to exclude possible heart problems. It is necessary to recognize the developing pathology as early as possible so that it does not develop into a chronic form. A good helper in this for you can become a Kardi.ru service. allowing you to use the Cardiovisor. to recognize the slightest changes in the work of the heart.
In patients with chronic cardiacinsufficiency, peripheral edema for a long time are located on the legs: primarily in the zone of the foot and ankle with subsequent spread to the shin. By location, they are symmetrical, as a rule, combined with acrocyanosis and
the coldness of both legs. In the absence of treatment, trophic changes in the skin can develop further: signs of exhaustion and hyperpigmentation.
In severe patients who are for a long time without movement or comply with bed rest, swelling is localized mainly in the area of the buttock, buttocks, and the back surface of the hips.
In order to confirm the cardiac genesis of edema, attention is also paid to other accompanying symptoms:
- marked swelling of the veins on the neck,
- abdominal-jugular reflux,
- cyanotic color of the lower extremities due to venous stasis,
- a significant increase in liver size,
- accumulation of transudate in the abdominal cavity.
For example, the result of an abdominal-jugular testmakes it possible to clarify the cause of edema of the extremities, especially in the absence of other external symptoms of heart failure. When the result of this test is positive, one can speak of a venous stasis caused by insufficiency right ventricle or the problem of diastolic filling with his blood. The negative result of the sample indicates the absence of heart failure and another cause of the pathology: thrombophlebitis of the deep veins of the shin, for example.
To confirm that the cause of leg swellingare heart diseases. use direct measurement of central venous pressure, examination of echocardiograms, ultrasound examination of the liver and inferior vena cava. The presence of an intensified cardiac shock, pronounced epigastric pulsation, a shift to the right side of the heart border and an increase in absolute stupidity of the myocardium, deaf tones, the presence of proto-diastolic rhythm of the gallop - all this can confirm the diagnosis of right ventricular heart failure.
How leg swelling is treated
Restriction of salt intake, because sodiumis delayed in the body, that is, the appointment of a salt-free diet. It is important in this case not to reduce the intake of water, as a hyperosmotic edema with signs of dehydration of cells can develop.
- Patients are prescribed diuretics that suppressreabsorption of sodium and chlorine in the renal tubules: osmotic (urea), mercury, sulfonamides (chlorothiazide), inhibitors of coal anhydrase (narasnide, diamox).
- Use medicines that increase the volume of filtration (cortisone derivatives and cortisone itself).
- Patients also show the use of drugs that inhibit the secretion of aldosterone (amphenone, methopyrone).
- In addition, often prescribed antagonist substances, aldosterone, which block the action of the hormone directly on the tubules (spironolactone, aldactone).
- Protein components are injected intravenously to increase the oncotic blood pressure.
- Sometimes the removal of excess sodium is carried out by emergency methods, for example, using ion-exchange resins.
- Reduce venous congestion and reduce hydrostatic pressure can be an ancient method - bloodletting, as a result, the intensity of edema decreases.
Development of edema in pathology of other organs
The cause of edema often becomes kidney disease. acute nephritis, acute renal failure,nephrotic syndrome. In the case of acute nephritis, edema is membranous. The permeability of the glomerulus membrane for proteins is increased, so they are excreted in the urine. In addition, there is a release of proteins in the tissue, they are in high concentrations contained in the edematous fluid, which contributes to an increase in osmotic pressure. The defeat of the tubules and the glomerular apparatus of the kidneys in nephrotic syndrome leads to albuminuria due to protein loss. Because of the decrease in protein concentration in the blood, the oncotic pressure falls, the inflow of water in the tissue on the contrary increases, then dynamic lymphatic insufficiency forms. Often acute renal failure of an infectious or toxic genesis leads to problems with excretion of salts and water, and therefore puffiness is formed. Conductivity of different parts of the nephron for urine is disturbed - oliguria and anuria.
Such a disease as cirrhosis of the liver. is accompanied by a violation of albumin synthesis andby plasma dilution. Since aldosterone is practically not destroyed by the liver, which entails the retention of sodium ions. increase osmotic blood pressure and intensive synthesis of antidiuretic hormone. At the same time, fluid accumulates mainly in the abdominal cavity, that is, ascites is formed.
The pathology of water-salt metabolism causes anysurgical interventions. So, for the first time after the operation, water retention occurs in the body. Stressful situation provokes the release of adrenocorticotropic hormone, which in turn stimulates the production and subsequent release into the bloodstream of aldosterone - sodium retention in the body. Pain, trauma and anesthetics increase the synthesis of antidiuretic hormone. Further development of edema and the mechanism is as described above. When the postoperative period is normal, after 5-6 days hypersecretion of corticosteroid hormones damps and water and sodium release is activated - the swelling drops.
Rostislav Jadeyko. especially for the project Kardi.Ru.