Edema Syndrome Causes Treatment of Idiopathic Edema
Oedemia syndrome is the accumulation of a fluid rich inprotein, in the alveoli, alveolar courses, bronchi and connective (interstitial) tissue. This definition can be found on many popular medical sites. It completely reflects the essence of the problem, which we will talk about today, but is more likely to be addressed to medical workers than to an ordinary person. And given that complaints of swelling are one of the most frequent reasons for the first visit to a doctor, most patients would prefer a more understandable explanation, not supersaturated with unfamiliar terms.
Unfortunately, edematous syndrome (OC) of variousgenesis in most sources is described by far not the most understandable language. And the point here is not so much in the tongue-tied authors, as in the ambiguity of the pathology itself. Differential diagnosis of the OS is not so simple as it seems, the reasons are not fully understood, the connection with diseases that increase the risk of heart failure is not so obvious, and the treatment is often aimed at stopping the symptoms, rather than eradicating the underlying causes that caused the ailment.
Even more discussion raises the question: is edematous syndrome possible in children and newborns? Theorists argue that the OS is in many ways the "age" pathology, which is possible only in adults. More reliable figures lead to reliable statistics that the edematous syndrome in the practice of any pediatrician is not at all rare than that of an "adult" doctor.
Because we decided that the standard feeding schemematerial (forms of OS, causes, differential diagnosis, treatment, prevention and possible complications) would not be entirely correct. And after some hesitation, we decided to invite you, dear readers, to build our conversation in the form of questions and answers. Thus, we will not only simplify the delivery of a complex material for perception, but we will also be able, without loss of informativity, to stress the practical side of the issue.
What negative factors of edematous syndrome in the greatest degree can influence well-being?
Because the OS is not "monolithic"disease, and a complex of clinical manifestations arising from pathologies of various genesis and nature, its effect on the body can be mixed. Therefore, the treatment of the OS proper should begin only after the underlying disease and the causes that triggered its onset are identified. And for this it is necessary to understand which pathological changes and clinical manifestations of the syndrome are the most probable.
- Increase in the permeability of the walls of blood vessels. First of all, the increasing dysfunction of endotheliocytes (cells lining the walls of small vessels - sinuses, capillaries and sinusoids) is "to blame" for this. But if you do not start the appropriate treatment in time, local hyperproduction of some mediators (most often kinin) may begin.
- Delay in the body of sodium. The inadequacy of primary renal Na treatment is explained by the damage to the nephron (the functional structural element of the kidney tissues), as a result of which the activity of the rotary countercurrent multiplying system is disrupted. Excessive reabsorption of sodium can also be a consequence of the hyperactivity of the corresponding humoral (endocrine) systems.
- Reduction of oncotic blood pressure, one ofthe main task of which is to block the passage of fluid from the blood into the tissues and organs of man. This condition (a decrease in albumin concentration in the serum up to 35 g / l and below) can be a consequence of two factors: insufficient absorption of proteins or excessive loss of albumin in the urine. The most likely clinical manifestation is pronounced edema of peripheral tissues.
What types of edema exist?
Classification of edema that occur during OS, canbased on two criteria: the causes (conditions) of their occurrence and the characteristic localization sites. But here it should be clearly understood that this division is rather arbitrary. It somewhat simplifies the treatment, but it negatively affects the primary detection of the OS, since accurate diagnosis of the syndrome with all possible types and types of edema becomes a rather nontrivial task.
1. Depending on the etiology
- giponokoticheskie edema: kidney disease, cachexia (extreme degree of exhaustion of the body), various kidney pathologies (hypoproteinemia);
- edema of lymph nodes: elephantiasis, lymphangitis;
- endocrine edema: various "female" pathologies (one of the manifestations of premenstrual syndrome, dropsy of pregnant women), a deficiency of thyroid hormones (myxidem);
- cardiac edema: they are, in fact, one of the typical manifestations of heart failure, but because of an implicit, hidden connection with the pathologies of the heart, to identify this relationship (as well as prescribe adequate treatment) is quite difficult;
- venous edema: thrombophlebitis, varicose veins;
- membranogenic swelling: excessive accumulation of fluid caused by toxic or allergic causes;
- medicinal (iatrogenic) edemas: one of the side effects of taking some potent pharmacological drugs. In the conditional "risk zone" get corticosteroids, sex hormones, antihypertensive and anti-inflammatory drugs. Negative action is greatly enhanced in case of exceeding the recommended doses or non-adherence to the regimen;
- other benign edema: idiopathic and orthostatic.
- local: violation of the balance of the fluid is limited to one organ or site, can be both inflammatory (exudate) and non-inflammatory (transudate) origin. Provoked by diseases of lymphatic vessels and veins, as well as acute allergic conditions;
- generalized: develop due to total hyperhydration of the body and are divided into cavitary (hydropericarditis, hydrothorax, ascites) and peripheral.
What diseases can be associated with OS?
In part, we already touched on this topic in the previousquestion, although in the general case the classification of the OS and the list of reasons that cause it are not the same. But, we will repeat, the correct diagnosis of the underlying disease with suspicion of OS is the most important condition for successful therapy of the syndrome, because the treatment "blindly" (that is, in effect, relief of symptoms) is not able to provide a stable remission.
1. Diseases of the cardiovascular system
- edema in heart failure develops gradually, and most often it is preceded by shortness of breath;
- the most characteristic complaints: orthopnea, pain in the chest, increased heart rate;
- clinical manifestations (most often observedat right ventricular heart failure): a significant increase in the liver and swelling of the cervical veins, in severe cases - hydrothorax, severe ascites and nocturia;
- typical places of localization: the shin and ankle (for walking patients), the sacral and lumbar zones (in the recumbent), edema often have a symmetrical arrangement.
- edema can develop both gradually (nephrosis) and rapidly (glomerulonephritis);
- Possible concomitant diseases: diabetes, lupus erythematosus, syphilis, acute poisoning, amyloidosis, nephropathy of pregnant women, thrombosis of renal veins;
- places of localization: the face (especially in the eyelid region), lower back, limbs, anterior abdominal wall, genitalia;
- associated pathology: ascites;
- possible clinical manifestations: pulmonary edema and increased blood pressure (BP), which is not always a sign of heart failure (especially in newborns);
- with chronic pathologies of the kidneys, exudates and hemorrhages in the eyes, as well as changes in the size of the kidneys.
- edema becomes noticeable in later stages of cirrhosis (portal and postnecrotic);
- the most probable clinical signs are ascites and an increase in the size of the spleen (splenomegaly);
- probable causes: hepatitis, chronic alcoholism, jaundice and chronic hepatic insufficiency (arterial hemangiomas, erythema, venous collaterals of the anterior abdominal wall).
4. Hypoproteinemia (a critically low level of protein in the blood plasma)
- probable causes: insufficient or unbalanced diet, cachectic edema, pathologies in which there is a loss of protein through the intestine, severe avitaminosis (beriberi disease);
- characteristic symptomatology includes weight loss, reddened tongue and obvious signs of cheilosis (a disease that affects the lips), puffiness of the face, profuse diarrhea and pain in the intestines;
- edema is usually small, localized on the shin and feet;
- signs of heart failure are mild or absent.
- palpation of the skin over the affected vein is accompanied by considerable pain;
- manifestation of superficial venous pattern (with deep vein thrombosis);
- characteristic signs of chronic venous congestion: trophic ulcers and skin pigmentation.
- the edema area is painful and has a dense structure (the so-called "pig skin" or "orange peel");
- in contrast to the venous form, when the limb is raised, the swelling decreases much more slowly;
- Possible forms: inflammatory, idiopathic and obstructive;
- causes: radiation damage, the consequence of surgical intervention, CLL - chronic lymphocytic leukemia;
- prolonged edema often leads to accumulation in the tissues of the protein, the growth of collagen fibers and elephantiasis.
- severe soreness in palpation;
- almost always localized in the area of injury (fracture, bruise).
8. Endocrine OS I type (thyroid insufficiency, hypothyroidism)
- generalized puffiness of the skin (myxedema);
- on the shoulders, shin and face manifested externally swelling of the subcutaneous tissue;
- all signs of hypothyroidism: a bradycardia, a decrease in the concentration of attention, a muffling of the voice, a decrease in the intensity of metabolic processes in the body, depression, hypersomnia);
- the concentration of thyroid hormones is significantly reduced.
9. Endocrine OS II type (observed exclusively in women)
- symmetrical obesity of the legs and their swelling;
- swelling is enhanced by bathing in warm water, before menstruation, with prolonged sitting or as a result of uncontrolled consumption of salt;
- signs of chronic venous stasis, heart failure, deep vein thrombosis or lower limb edema are absent.
10. Neurogenic (idiopathic) OS (Parkhon's disease)
- is observed mainly in adult women (30-60 years);
- the classical triad of symptoms: oliguria (decrease in the volume of daily urine), lack of thirst, and also significant puffiness, not associated with certain diseases of the liver, heart and kidneys;
- signs of hypothalamic and cerebral insufficiency (a tendency to obesity, vegetovascular and neurological disorders) are weak or nonexistent;
- the main risk factor is a trauma;
- morning swelling of the hands and face, increasing during movement;
- laboratory tests show a violation of the natural ratio of sex hormones, an increase in the concentration of aldosterone and a change in the activity of renin.
- usually develop against a background of a pathological condition (malignant tumor, heart attack, meningitis, internal hemorrhage), often with signs of heart failure;
- possible complications: hyponatremia, water retention in the body, failure of the secretion of antidiuretic hormone;
- Diagnosis of OS caused by hypothalamic edema should take into account the similarity of its clinical manifestations with Schwartz-Barter's disease (syndrome).
12. Edema (trofedema) of the Meizha
- exceptionally rare (orphan) disease, manifested by local skin edema, which can last from 2-3 hours to several days with the formation of a persistent residual tumescence;
- there may be a re-edema in the same place;
- edema is quite dense, and with each new relapse such a constitution becomes more pronounced;
- probable (but not mandatory) symptoms: chills, confusion, headache;
- possible (rarely seen) clinical manifestations: edema of the larynx, lungs and tongue;
- unlikely manifestations: signs of heart failure, swelling of the larynx, lungs, tongue, organs of the gastrointestinal tract and optic nerve.
13. Reflex sympathetic dystrophy
- at a certain stage may be accompanied by a painful edema of the limb;
- the main complaint is: severe (often unbearable) vegetative pain;
- risk factors: prolonged immobility (immobilization) and trauma;
- possible associated pathologies: trophic disorders and allodynia.
14. Iatrogenic OS (provoked by drug exposure)
- hormonal preparations;
- antihypertensive drugs;
- anti-inflammatory drugs;
- MAO inhibitors;
- midantan (this drug can lead to effusion in the pleural cavity).
Can I completely get rid of edema?
The question is not as simple as it seemssome patients. Formally, "swiping" puffiness is really possible, but you should definitely consider several important points, which are usually overlooked. First, if you start symptomatic treatment (that is, to fight with the manifestations of the syndrome, rather than the cause that caused them), swelling sooner or later will return. Secondly, doctors categorically do not recommend self-medication, as thoughtless medication can cause very (!) Big problems. Third, not all cases of puffiness are manifestations of OS. In general, for therapy of the syndrome (some recommendations are equally applicable even for newborns), the following measures and drugs can be used:
- reduce salt intake to 1-5 g per day (depends on the severity of clinical manifestations);
- the daily volume of the liquid being drunk - no more than 600-1200 ml (be careful: excessive restrictions can provoke hypernatremia);
- give preference to products with a high content of potassium (bananas, grapes, peaches, cherries, apricots, potatoes, parsley, cabbage, dried fruits);
- at the acute stage observe a strict bed rest;
- the elastic bandages will help to reduce the edema;
- in the case of hypoproteinemia (provided thatthe patient has no signs of hepatic, renal or heart failure) it is recommended to give preference to foods and foods with high protein content.
2. Drug therapy (unfortunately, many drugs in the treatment of newborns can not be used)
- vitamins B1, C, P: reduction of membrane edema by decreasing capillary permeability;
- Thiazide diuretics (chlorthalidone, hypothiazide): acceleration of the output of potassium, sodium and magnesium;
- loop diuretics (bumetanide, furosemide, triflocin): increase the secretion of sodium in the urine, have a good diuretic effect;
- potassium-sparing diuretics (triamterene, veroshpiron): the effect is less pronounced, but the likelihood of side effects is lower;
- diuretics of the new generation: indapamide, arifon-retard, indap (due to lack of data on possible side effects, it is strictly not recommended to use in the treatment of newborns);
- natural flavonoids: red wine, citrus juice, grape seed extract;
- synthetic flavonoids: rutin (vitamin P), venoruton, gliwenol, esflazid.