What causes their swelling tenderness
Edema syndrome - excess fluid accumulation intissues of the body and serous cavities, accompanied by an increase in the volume of tissues or a decrease in the serous cavity with a change in physical properties (turgor, elasticity) and the function of tissues and organs.
Differentiation of edema caused by systemicpathological conditions, from those based on local disorders, can vary in complexity from a simple and clear clinical task to a very difficult and complex diagnostic problem. Edema can result from increased capillary permeability, an obstruction to the flow of venous blood or lymph; the fluid can accumulate in the tissues as a result of a decrease in the oncotic pressure in the blood plasma.
What causes edematous syndrome?
Oedemia is an important symptom of manydiseases of organs and system of regulation and in its kind often serves for differential diagnosis of diseases that caused edematic syndrome. Distinguish local (local) edematic syndrome, associated with a violation of the balance of fluid in a limited area of the body or organ, and the general edematous syndrome, as a manifestation of a positive balance of fluid throughout the body. The disease that caused the development of edema, distinguish: cardiac, renal, portal (ascites), lymphostatic, angioedema, etc.
As a separate form, pulmonary edema, edema andswelling of the brain, laryngeal edema, hydrothorax, hydropericardia, etc., present a life threat or complications, as edema is easily infected.
Primary localization and the nature of edema have peculiarities in various diseases that are used for their differential diagnosis.
- Heart Disease
- Kidney Diseases
- Diseases of the liver
- Venous edema
- Lymphatic edema
- Fatty edematous syndrome.
- Neurogenic edematous syndrome
- Idiopathic edematous syndrome (Parkhon's disease).
- Hypothalamic edematous syndrome.
- Trophadem of the Mezh.
- Complex regional pain (reflex sympathetic dystrophy).
- Iatrogenic (medicinal)
- Hormones (korgakosteroidy, female sex hormones).
- Hypotensive drugs (alkaloid rauwolfia, apressin, methyldofa, beta adrenoblockers, clonidine, calcium channel blockers).
- Anti-inflammatory drugs (butadione, naproxen, ibuprofen, indomethacin).
- Other drugs (MAO inhibitors, midantan).
With cardiac edema, there is usually an anamnesisindications of heart disease or cardiac symptoms: dyspnea, orthopnea, palpitations, chest pain. Edema in heart failure develops gradually, usually after the previous dyspnoea. Simultaneous with swelling, swelling of the cervical veins and stagnant liver enlargement are signs of right ventricular failure. Cardiac edema is localized symmetrically, mainly on the ankles and legs in walking patients and in the tissues of the lumbar and sacral regions - in bedridden patients. In severe cases, ascites and hydrothorax are observed. Often there is nocturia.
This type of edema is characterized by a gradual(nephrosis) or rapid (glomerulonephritis) development of edema often on the background of chronic glomerulonephritis, diabetes, amyloidosis, lupus erythematosus, nephropathy of pregnant women, syphilis, thrombosis of renal veins, and some poisoning. Edema is localized not only on the face, especially in the eyelid region (facial swelling is more pronounced in the morning), but also on the legs, lower back, genitals, anterior abdominal wall. Often ascites develops. Dyspnea, usually does not happen. When acute glomerulonephritis is characterized by an increase in blood pressure and possibly the development of pulmonary edema. There are changes in the analysis of urine. With a long-term kidney disease, hemorrhages or exudates on the fundus can occur. With tomography, ultrasound examination, a change in the size of the kidneys is detected. The study of renal function
Diseases of the liver lead to edema usually in latestage of postnecrotic and portal cirrhosis. They are mostly ascites, which is often more pronounced compared with edema on the legs. The examination reveals clinical and laboratory signs of the underlying disease. Most often there is a previous alcoholism, hepatitis or jaundice, as well as symptoms of chronic liver failure: arterial arachnid hemangiomas ("stars"), hepatic palms (erythema), gynecomastia and developed venous collaterals in the anterior abdominal wall. The characteristic signs are ascites and splenomegaly.
Swellings associated with malnutritiondevelop with general starvation (cachectic edema) or with a sharp lack of protein in food, as well as in diseases accompanied by loss of protein through the intestine, heavy beriberi beriberi and alcoholics. Usually there are other symptoms of nutritional deficiency: cheilosis, red tongue, weight loss. With edemas due to bowel diseases, there is often a history of intestinal pain or profuse diarrhea in the anamnesis. Edema is usually small, localized mainly on the legs and feet, often there is a puffy face.
Depending on the cause, venous edema canbe both acute and chronic. For acute deep vein thrombosis pain and soreness are typical for palpation of the affected vein. When thrombosis of larger veins is usually observed, and strengthening the surface venous pattern. If chronic venous insufficiency is caused by varicose veins or insolvency (postphlebitic) deep veins, the symptoms of chronic venous stasis are added to orthostatic edema: stagnant pigmentation and trophic ulcers.
This type of swelling refers to localedema; they are usually painful, prone to progression and are accompanied by symptoms of chronic venous stasis. With palpation, the area of edema is dense, the skin thickened ("pig skin" or orange peel "), while lifting the limb, puffiness decreases more slowly than with venous edemas. Isolate idiopathic and inflammatory forms of edema (the most common cause of the latter is dermatophytosis), as well as obstructive (as a result of surgical intervention, scarring with radiation damage or with neoplastic process in the lymph nodes) leading to lymphostasis. Prolonged lymphatic edema leads to the accumulation of protein in the tissues, followed by the proliferation of collagen fibers and deformation of the organ - elephantiasis.
Puffiness after mechanical trauma also refers to local edema; they are accompanied by pain and pain when palpation and are observed in the area of the transferred trauma (bruise, fracture, etc.)
- Insufficiency of the thyroid gland (hypothyroidism)among other symptoms manifested miksedema - generalized swelling of the skin. Skin pale, sometimes with a yellowish hue, dry, scaly, dense. Expressed mucous edema of subcutaneous tissue, especially on the face, shoulders and legs. When pressing the pits on the skin does not remain (pseudo-puncture). There are accompanying symptoms of hypothyroidism (a decrease in all types of metabolism, bradycardia, depression, decreased attention, hypersomnia, deaf voice, etc.) and reduced thyroid hormone levels in the blood.
- Fatty edemas. This type of swelling occurs in women and manifests a noticeable symmetrical obesity of the legs. The usual complaint that is presented to the doctor is "swelling of the legs," which actually takes place and increases in the orthostatic position. They usually increase before menstruation, when bathing in warm water, with prolonged sitting or uncontrolled use of salt. The area of edema is mild, with depression there is a deepening, there are no symptoms of chronic venous stasis; the prolonged existence of these edemas allows the exclusion of deep vein thrombosis. In a patient with fatty edema, the feet and fingers do not change, while in other types of edema of the lower extremities they swell. Diagnostic difficulties occur with concomitant varicose veins, but the symmetry of the lesion and the typical location of fat deposits, as well as the normal shape of the feet and fingers, should help in establishing the correct diagnosis.
- Idiopathic edematous syndrome (Parkhon's disease)- a clinical symptom, observed mainly in women aged 30-60 years and characterized by a decrease in the amount of urine, lack of thirst and the appearance of swelling, not associated with the pathology of the heart, liver and kidneys. Sometimes there are symptoms of organic cerebral and mild hypothalamic insufficiency: a tendency to obesity, emotional (demonstrative) and vegetative-vascular disorders, residual neurological microsymptoms. A provoking factor is often a trauma. Edema increases with prolonged stay on legs. In addition to edema of the lower extremities, patients can note an increase in the abdomen and mammary glands. Patients often complain of swelling of the face and hands in the morning, which decreases with movement. The study of the hormonal profile can detect an increased content of aldosterone, an imbalance of sex hormones, a change in the activity of renin.
- Hypothalamic edema can develop withinvolvement of (not necessarily direct and immediate) hypothalamus in a pathological process (heart attack, tumor, hemorrhage, meningitis, trauma) and cause a symptom of inadequate secretion of antidiuretic hormone (usually transient) with hyponatremia and water retention in the body.
Symptoms of water intoxication with fluid retentionare also characteristic of Schwartz-Barter disease caused by increased release of ADH-like substance in bronchogenic carcinomas and other non-endocrine tumors. The content of ADH in the posterior lobe of the pituitary gland is normal.
- Trofedema Mezh (edema of the Mezh) - very rarea disease of unknown etiology, manifested by a limited skin swelling that quickly builds up and lasts from a few hours to several days, then regresses, but does not completely go away, leaving residual tumescence. In the future there are relapses of edema at the same place. Edema thick; The pressure does not leave a depression in the finger. Seals of the skin after relapse are becoming more pronounced. The edema is gradually organized. The affected part of the skin loses its normal normal shape. Optional symptoms: fever during swelling, chills, headache, confusion.
Simultaneously with edema on the face or limbsSometimes there may be edema of the lungs or larynx, of the tongue. There are also edema of the gastrointestinal tract, labyrinth, optic nerve. Such edema is also part of the Melkerson-Rosenthal symptoms.
- Complex regional pain (reflexsympathetic dystrophy) at a certain stage of its development can be accompanied by edema of the painful part of the limb. The main complaint of the patient is burning vegetative pain. Trauma and prolonged immobilization are among the main risk factors for oedematous syndrome. Typical allodynia and trophic disorders (including bone tissue).
Among the drugs that can lead toedema, most often marked hormones (corticosteroids and female hormones), antihypertensives (alkaloids Rauwolfia apressin, methyldopa, beta-blockers, klofellin, calcium channel blockers), anti-inflammatory agents (phenylbutazone, naproxen, ibuprofen, indomethacin), MAO inhibitors, midantan (the latter drug sometimes leads to effusion in the pleural cavity).
How is oedematous syndrome manifested?
Clinically, the common edematous syndrome becomesvisible with a delay in the body of more than 2-4 liters of water, local edematous syndrome is detected with less accumulation of fluid. Peripheral edematous syndrome is accompanied by an increase in the volume of the limb or part of the body, swelling of the skin and subcutaneous tissue, a decrease in their elasticity. When palpation is determined by the dough-like consistency of the skin, when pressing with a finger, the pits remain, which quickly disappears, which distinguishes them from false edema, for example, with myxedema, it is difficult to press, the fossa is held for several minutes to several hours, and in scleroderma, local obesity, the fossa generally not formed. Skin pale or cyanotic, can crack with the flow through the cracks of swollen serous fluid or lymph during ulceration, against a background of myxedema.
Develop with left ventricular failureGradually, after the previous dyspnea, they are located on the ankles and lower legs, symmetrical, in the recumbent patients and on the back. The skin is quite elastic, pale or cyanotic, swelling easily pushed, but with prolonged swelling, the skin can become rough. With right ventricular failure, which is determined by a simultaneous increase in the liver and cervical veins swelling, concomitant with edema on the legs, ascites, hydrothorax (more often on the right), and rarely hydropericardium can form. There may be pulmonary edema with previous dyspnoea.
Develops in the earliest stages of acuteglomerulonephritis. Edema is localized mainly on the face, upper and lower extremities. Skin pale, dense, normal temperature. Rarely develops hydrothorax, hydropericardium, there may be pulmonary edema, but without previous dyspnoea.
It develops in subacute chronic glomerulonephritis, amyloidosis of the kidneys, nephropathy of pregnant women, some poisonings, especially alcohol, lupus erythematosus, syphilis, thrombosis of renal veins.
Swelling mainly on the face, more in the areaeyelids and under the eyes, increase in the morning, in addition, can be on the legs, genitals, lower back, anterior abdominal wall. Skin dryish, soft, pale, sometimes shiny. The edema is loose, easily pushed and displaced when the position of the body changes. Often there is ascites, there may be hydrothorax, but they are of small volume, and are not expressed, there is no dyspnea.
Develops with prolonged starvation orinsufficient intake of protein in the body, as well as in diseases accompanied by a large loss of protein (gastroenteritis, ulcerative colitis, intestinal fistula, alcoholism, etc.).
Ocular syndrome is usually small, localized on the feet and legs, the face has a characteristic puffiness, although the patients themselves are depleted. Skin of a testy consistency, dry.
As a manifestation of toxicosis occur after the 25-30thweeks of pregnancy, at an earlier time are manifestations of heart failure or develop due to an exacerbation of renal pathology. In the beginning, edema is localized on the legs, then widens onto the genital organs, the front wall of the abdomen, the lower back, the face. Skin is soft, moist. Edema is easily pushed. Ascites and hydrothorax occur very rarely.
Developed in women prone to obesity,vegetative disorders; in the initial period of menopause. However, there are no other systemic diseases and metabolic disorders. Swelling occurs in the morning, on the face, more under the eyes in the form of blistering bags, on the fingers. Swelling is soft, quickly disappear after a usual light massage.
In hot weather with orthostaticinsufficiency (long standing, sitting) edematous syndrome can manifest itself in the form of edema on the legs, the skin is more often cyanotic, its elasticity is preserved, often hyperesthesia.
The peculiarities are the edema of Quincke allergic and non-allergic edematous syndrome, when, this is a hereditary disease.
Characterized by the suddenness of the development of general orlocal edema of subcutaneous tissue and mucous membranes of the larynx; head and spinal cord, abdominal organs. The onset of the syndrome develops very quickly, the patient feels bursting, but the itching is not characteristic. Laryngeal edema can cause asphyxia.
Given that the edematous syndrome isthe manifestation of the insufficiency of some basic organ or system participating in homeostasis, in identifying common edema, the patient should be directed or advised by a specialist of the appropriate profile. Another thing is localized edema, which mostly are a manifestation of surgical pathology, trauma. These questions doctors consider in each case on nosology or in combination with other diseases.
A special place is occupied by edematic syndrome with gasgangrene. Its special feature is a large volume (2-4 liters of fluid per day in the effusion), rapid growth and spread in the proximal direction, leading to compression of the venous and arterial trunks. Such a rapidly progressive edematous syndrome is pathognomonic for anaerobic clostridial infection. It is detected by the reception of a thread tied around a limb segment, it cuts into the skin in 20-30 minutes. This technique is described by ancient doctors, but it has no author's name. The method itself is unreliable, since the same kind of edema can be caused by other types of infection, especially when the inflammation takes the form of phlegmon, an injury, especially when the vessels are damaged. A distinctive feature is the specific appearance of the skin of the swollen limb in the form of a landscape-shaped spots of unusual color: bronze, blue, greenish. Neclostridial anaerobic edema does not give such a specific picture. But in both cases, patients should be urgently hospitalized or transferred to specialized departments of purulent-septic resuscitation, which are able to carry out hyperbaric oxygenation with high oxygen pressure (2-3 excess atmospheres - "Yenisei" pressure chambers).
How to recognize edematic syndrome?
Electrophoresis of serum proteins,functional hepatic assays, determination of serum T4 and T3, radioimmunoassay for serum TSH, ECG, chest X-ray, echocardiography, chest CT, radioisotope angiography of the heart, Doppler ultrasound of veins, phlebography, renal tomography, CT of organs abdominal cavity, lymphangiography, consultation of a therapist, endocrinologist.