March
2008
Edema: Swollen Legs, hopefully not swollen heads
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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