Algorithm of swelling
There are 2 types of leg edema: Venous type and lymphatic. Venous type of edema occurs with low or high viscosity of blood, poor in intercellular fluid protein, increased capillary filtration, which can not be compensated by normal lymph drainage.
The most common cause of edema on the legs in the elderage groups of patients - venous insufficiency. One common common cause in women in the premenopause and menopause is idiopathic leg swelling, formerly known as "cyclic" edema. Not infrequently, the cause of leg edema is pulmonary hypertension (pulmonary heart), which is often associated with sleep apnea.
Key elements of anamnesis include:- duration of swelling (acute onset <72 hours) or chronic (more than 72 hours)? If the onset is acute and one-sided, then the diagnosis of deep vein thrombosis should be carefully considered.
- What is the intensity of soreness of swelling withpalpation? Thrombophlebitis of deep veins and inflammatory changes in tissues with dystrophy are usually painful. Chronic venous insufficiency, can cause minimal pain or be painless. Lymphatic edema. as a rule, painless.
--It should be specified in detail what medicines orDrugs are taken by the patient? It is not uncommon for calcium channel blockers, prednisone, antidepressants and some drugs to be the common cause of swelling in the legs. (A short list of medications and drugs often causing leg swelling is presented in.
- It is necessary to clarify whether the patient has signs or history of systemic disease (heart, liver, kidneys, etc.)?
- Particular attention should be paid to the history of the disease, indicating the diseases of the pelvic organs, abdominal organs, including neoplasms and radiotherapy.
- Clarify the intensity of edema at different times of the day and find out possible episodes of sudden disappearance of edema.
n Interview the patient in detail if he has signs of sleep apnea?
n Apnea can be combined with pulmonary hypertension, which is frequent
cause edema on the legs.
Symptoms of possible sleep apnea include loudsnoring or episodes of stopping breathing in a dream, marked by the surrounding, daytime drowsiness, or the circumference of the short neck more than 17 inches (43 cm). Pulmonary hypertension usually accompanies patients with sleep apnea and is recognized by many as the cause of edema and can be diagnosed including ECG. At the same time, the specificity and sensitivity of this trait are not yet definitively indicated.
The procedure for diagnosing pulmonary hypertension as the cause of edema on the legs is recommended for persons over 45 years of age and in patients with obvious "pulmonary anamnesis".
The main objective signs noted in the assessment of edema on the legs include: · Body mass index, and it is known that obesity is associated with sleep apnea and venous insufficiency
Symmetry and distribution of edema on the legs: one-sided localization of the edema is more often associated with a local cause, such as deep vein thrombophlebitis, venous insufficiency or lymphadenopathy. Bilateral edema may also be associated with a local cause or systemic disease, such as heart failure or kidney disease.
· Sensitivity: deep vein thrombophlebitis produces commonly intense painful swelling.
Palpation: edema with deep vein thrombophlebitis and venous insufficiency and lymphatic edema in the early stages of the disease usually leave a fossa on the skin when pressing with a finger. Edema with fibrous form of lymphatic edema and mexidemia fossa when pressing the skin of the tibia do not leave.
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