28
March
2008
Edema is swelling, such as in the legs, face, abdomen, etc. Edema occurs from leakage of fluid in the blood vessels (arteries and veins) into the soft tissue. Sodium in table salt is responsible for many cases of edema if the kidneys don’t excrete enough of it out. So kidney insufficiency can lead to edema, as well as congestive heart failure. Kidney diseases can cause edema. Cirrhosis of the liver in particular causes edema in the abdomen. Low protein drops the osmotic pressure in the vessels so fluid leaks out into soft tissue. Varicose veins and lymphatic obstruction are causes. Pulmonary edema means fluid leaks into the lungs, making it hard to breathe. Bad COPD can increase pressure back to the legs and liver to cause edema there. Women with PMS very well understand edema. Idiopathic edema means we don’t know what is causing the edema.
Pitting edema is a sign in which you push the fluid the side. So like on the legs pushing on the tibia for 10 seconds leaves a dent/imprint. If the edema does not pit, it might mean hypothyroidism or lymphatic obstruction. Lymphatic damage can occur after surgery, like after a mastectomy that causes arm swelling.
Varicose veins are pretty common, but it is important to make sure the edema is not from a blood clot (DVT) or infection of the vein (thrombophlebitis). DVT tends to occur in only one leg so one leg is swollen compared to the other, and is usually a rapid onset.
Treatment: occupational therapy can help with lymphatic massage for those with lymphedema. Compression hose on the legs is a mainstay of treatment to “squeeze” the fluid up the veins, and in turn the fluid from soft tissue goes back into the veins. Diuretics are often used but they can make things worse in some cases due to depleting too much fluid from the body, dropping sodium and potassium, driving the pH up in the blood, and increasing the blood urea nitrogen. Those with cirrhosis have ascites (edema in the belly) and often the fluid has to be drained using a needle. And a low sodium diet is pretty key to reduce edema. Elevation of the legs often help reduce edema of the legs, as many people notice their leg swelling improves after a night in bed.
drjohnhong 
cardiovascular 
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12
March
2008
Raynaud Phenomenon (RP) is when arteries clamp down inappropriately, because of oversensitive response to cold or emotional stress. So the arteries go haywire and over constrict. Occurs mostly in fingers and toes. First the skin color changes to white due to lack of arterial blood flow. Then turns blue because the period of time without oxygen. Blood flow usually takes 15-20min to return and then the skin is red. RP is primary if there is no underlying cause. It is secondary if associated with disease, medications, etc and called Raynaud Syndrome. Everyone can get cold fingers, but RP means the severe color changes, and it hurts (or feels like pins and needles if not so painful)
Risk Factors: Probably 3-5% of people have RP. Family history, women, younger people. Usually starts between ages 15-30.
Fingers are most affected: usually index to ring finger. Starts normally with one finger and then spreads to the other fingers – on both hands. Toes can also be affected, as well as face, ears, nose, nipples, and even knees. Going from warm to cold suddenly is often the precipitating factor, like grabbing ice cream out of the freezer. Even if the whole body is cold, it can precipitate it. Nervousness/stress can do it to.
On the body, like the torso and legs, it is livido reticularis – a spiderweb like pattern of blue skin. It is also associated with antiphospholipid syndrome, vasculitis, and occlusive vascular disease.
Secondary causes: there are a lot. ANA and ESR elevation by blood test can indicate a rheumatologic disease: scleroderma, SLE (systemic lupus erythematosus), polymyositis, rheumatoid arthritis, cryoglobulins (like in Hepatitis B & C patients). Mechanical injuries can cause it such as in vibration syndrome (like a jack hammer), frostbite, not using crutches right and causing vascular damage in the armpit. Migraine patients can have it. Vascular disease in atherosclerosis or emboli. Hypothyroidism, pheochromocytoma. Some meds and cocaine.
If blood flow is poor enough from an extended attack or frequent attacks, tissue can die. That can lead to ulcers or even loss of part of the finger.
Diagnosis is made with a rheumatologist usually. A simple look in the fingernail with oil and an ophthalmascope can see if further workup is needed. Checking the blood pressure of the finger in cold water can confirm RP.
Treatment: keep warm! Wearing gloves and avoiding touching cold objects. Hand warmers. Avoid tobacco, caffeine & stimulants. Biofeedback might help some. If secondary RP, then treating the underlying disorder.
drjohnhong cardiovascular, rheumatology Comments (0) » |
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