Swelling of the child's hand
Edema is an excessive accumulation of fluid in the tissues of the body.
To identify the causes of edema, a diagnosticmeaning is the definition of localization, consistency (soft or dense), color (pale or hyperemic), skin temperature above the area of edema. Diagnose edema by pressing on the skin with your finger. The appearance of the fossa indicates an increase in the hydrophilicity of the skin and a decrease in its elasticity. The more dense the edema, the smaller the footprint from the pressure. When the skin fold is stiffened between the fingers, a doughy consistency of the tissue is felt in the place of the edema, the fold is slowly smoothed out, and the fossa remains at the site of compression. Edema should be distinguished from subcutaneous emphysema, in which pressure allows you to feel crepitus.
General (generalized) edema - positive water balance of the body as a whole. With a slight fluid retention, they speak of concealed edemas that do not have clinical manifestations of a general edema and can be diagnosed by increasing body weight and diuresis. In generalized edema it is important to find out the initial place of its formation and determine whether there is an effusion in the body cavity.
Local (localized) edema - violation of the balance of fluid in a limited area of the body or in the body.
False swelling is a swelling-like skin change. In contrast to the true edema, with a false swelling, pressing the finger does not leave holes on the skin.
The most common causes of general edema in children are diseases of the cardiovascular system and kidneys.
For heart failure is characteristicsymmetrical localization of edema on the ankles, and as the disease worsens - on the shins of walking patients; in the tissues of the back, lumbar and sacral regions of the recumbent. Swelling develops slowly, intensify toward evening, and after sleep decrease or disappear.
With kidney diseases, edema is localized on the face(especially in the eyelids), are most pronounced in the morning. With the expressed edema of the eyelids, the child's eyes are half-closed, which gives him a drowsy appearance. The skin over the swelling is pale.
General exhaustion in combination with not very pronouncededema of the shins, feet, puffiness of the face, pollakiuria, polyuria and polydipsia occurs with cachectic edema that develops with general starvation or with a severe shortage of protein in food, as well as in diseases accompanied by hypoproteinemia: exudative enteropathy, Crohn's disease, ulcerative colitis, celiac disease.
The tendency to delay a large amountfluid is observed in viral hepatitis. The presence of ascites is also characteristic of this disease. If the cause of the development of generalized edema is cirrhosis of the liver, the patient can detect arterial arachnid hemangiomas (vascular sprouts) on the skin, erythema on the palms (hepatic palms), spleno-megalii.
It should be remembered that the delay in the bodythe child's fluids and the development of general edema can result in the use of certain medications, in particular non-steroidal anti-inflammatory drugs, which are now widely used in the treatment of fever in children.
With the rapid development of more often unilaterallimited edema more often on the face (ears, lips, eyelids), on the hands and feet, one should think about angioedema. Swelling of the lungs and the brain is also referred to as local edema.
False edema on the outer surface of the thighs, buttocks occurpremature babies with sclera. It is very important in the newborn period and in the first months of life to exclude congenital hypothyroidism, in which a characteristic appearance appears due to false mucinous edema of the eyelids, lips, cheeks. Lymphatic edema of the hands and feet, as well as the presence of "excess" skin on the back of the neck in newborn infants requires the exclusion of the Shereshevsky-Turner syndrome.
In newborns, especially premature infants),The 3-4th day of life may lead to the development of minor edema on the hands, feet, genitals, which is a consequence of the sexual crisis, the peculiarities of water-salt metabolism, low concentration ability of the kidneys, transient hypoproteinemia and high permeability of the capillary walls. With a sexual crisis, swelling occurs without treatment for about a week. These edema should be distinguished from edema in the hemolytic disease of newborns.
For infants, especially withlymphatic-hypoplastic and exudative-catarrhal anomalies of the constitution, paratrophy is characterized by hydrolysis, which manifests itself in rapid retention and in the same rapid loss of fluid, depending on the quality of nutrition and the occurrence of any diseases. In children of this age, the cause of edema is often a deficiency of protein, microelements and vitamins, the pathology of urinary organs.
Features of examination of children with edema
Anamnesis. When swelling appears, it is necessary to clarify, notwhether the child had had an acute respiratory disease, a sore throat 10-14 days before the onset of edema (a suspicion of kidney disease), find out the frequency of the stool, clarify the nature of the diet and the intake of pharmacological drugs, and collect an allergic medical history. In young children, it is necessary to evaluate the neuropsychological development, to clarify the presence or absence of constipation.
Objective examination. Objectively determine the type of edema (general, local, false), measure blood pressure, auscultatory and percussion assess the state of the cardiovascular system.
Laboratory examination. General urine analysis, a clinical blood test,coprological research. Other laboratory tests to exclude diseases of the urinary, cardiovascular, GI diseases are carried out in the hospital.
Consultations of specialists. In the absence of indications for emergency hospitalization, the child should be referred to a nephrologist, cardiologist, endocrinologist, allergist.
Hospitalization. All patients with generalized edema are hospitalized to determine the cause of their development.