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You must have JavaScript enabled in your browser to utilize the functionality of this website. Edema is the noticeable swelling resulting from fluid accumulation in certain body tissues. The swelling, also referred to as dependent edema, is brought about by the accumulation of excess fluid beneath the skin in the interstitial spaces or compartments within the body tissues that are outside of the blood vessels.
Occasionally pitting edema and non-pitting edema can occur without an underlying disease and it is then known as idiopathic edema.
Pregnancy can cause edema in the legs as the uterus puts pressure on the vena cava, a major blood vessel that returns blood to the heart from the legs, and progesterone relaxes the walls of the blood vessels.
Standing or sitting for long periods of time particularly in hot weather can cause excess fluid to accumulate in feet, ankles and lower legs. Low protein levels in the blood caused by malnutrition, kidney and liver disease can also cause edema.
Congestive heart failure is a condition in which the heart can no longer pump efficiently, and causes fluid buildup in the lungs and other parts of the body. Severe chronic (long-term) lung diseases, including emphysema and chronic bronchitis, increase pressure in the blood vessels that lead from the heart to the lungs.
Tiny valves inside the veins of the legs can become weakened, causing a common problem called venous insufficiency.
Most incidences of edema in children and infants are related to serious health conditions, so changes in your child should be monitored to avoid complications. Children with acute or chronic upper airway obstruction are at risk for negative-pressure pulmonary edema, associated with upper airway obstruction.
While quite rare, Nephrotic Syndrome (NS), a disorder of the kidneys, can cause edema in children. Periorbital edema should be closely monitored, as it may be the result of a more serious condition, such as congestive heart failure and liver diseases. Children and infants with diabetes may also experience edema as a side effect from insulin treatment.
The diagnosis of pitting and non-pitting edema are determined by the symptoms on physical examination. Edema itself is usually a symptom of an underlying condition and can be noticed as swelling or puffiness of your face, hands, feet, legs, or around your eyes. If you experience shortness of breath, chest pain, redness or heat in a swollen edematous area, or a swelling of only one limb, consult a doctor immediately.
Depending on the causes of edema and whether it is temporary or permanent, treating edema usually focuses on treating the condition that is causing it. If a blocked or damaged blood vessel is suspected as one of the causes of edema, surgery may be needed to improve the flow of blood.
Treating edema should include protecting any swollen, edematous areas of the body from pressure, injury and extreme temperatures. Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. In non-pitting edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation.
The focus of the rest of this article is on pitting edema, as it is by far the most common form of edema. Edema is caused by either systemic diseases, that is, diseases that affect the various organ systems of the body, or by local conditions involving just the affected extremities.
The most common local conditions that cause edema are varicose veins and thrombophlebitis (inflammation of the veins) of the deep veins of the legs. In some cases, however, edema may be a sign of a more serious underlying medical condition. This disease causes scarring of your liver, which interferes with liver function, causing changes in the hormones and chemicals that regulate fluids in your body, as well as increasing pressure within the large blood vessel (portal vein) that carries blood from your intestine, spleen and pancreas into your liver. When you have kidney disease, your kidneys may not be able to eliminate enough fluid and sodium from your blood.
Damage to the tiny blood vessels in your kidneys (glomeruli) that filter waste and excess water from your blood can result in nephrotic syndrome. Hand edema, or “puffy hand syndrome,” is seen frequently in primary care practice, and given its broad differential diagnosis (Table A Table B), presents physicians a significant diagnostic challenge.
Figure 1 – A former heroin addict with hepatitis C virus infection has bilateral “puffy hands.” The hand edema begins as pitting edema, followed by thickening and fibrosis of the subcutaneous tissue. It is most commonly found in the feet, ankles and legs although it may also affect the face, hands and other parts of the body and body organs.

Excess fluid accumulation in the lower regions of the body, such as the ankles, feet, and legs, is referred to as peripheral edema.
Pitting edema is the term used to describe edema when pressure applied to the skin of the swollen area is released and an indentation is left behind (e.g. This is most common in women who experience it in their legs and feet when they are pre-menstrual or pre-menopausal – it is then often known as cyclical edema. Fluid retention during pregnancy also can be caused by a more serious condition called pre-eclampsia.
The proteins help to hold water inside the blood vessels so fluid does not leak out into the tissues.
This pressure backs up in the heart and the higher pressure causes swelling in the legs and feet. This makes it more difficult for the veins to pump blood back to the heart, and leads to varicose veins and a buildup of fluid.
This condition may also occur after head injury, seizure, or accidental chemical ingestion or inhalation.
As the main symptom of NS, edema is commonly seen around one or both of the eyes, also referred to as periorbital edema, but may be found in other parts of the body such as the legs. Other causes of periorbital edema in children and infants may include allergies or infections, such as conjunctivitis. However, children with diabetes should report this to their pediatrician, as it may be a symptom of cerebral edema (brain swelling), a rare but serious complication of diabetes. The doctor will examine the skin over the swollen area to check whether it may be stretched or shiny. Amongst others edema can indicate disease of the heart, liver, thyroid, lymphatic system or kidneys (causing salt retention).
A low dose of a diuretic (water pill) may be prescribed to reduce the swelling and help you expel the excess fluid, but it is important to remember this just treats the symptom and is not necessarily addressing the cause.
Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. An accumulation of fluid in the interstitial air spaces (alveoli) in the lungs occurs in a disorder called pulmonary edema. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, or congenitally. The most common systemic diseases associated with edema involve the heart, liver, and kidneys.
These conditions can cause inadequate pumping of the blood by the veins (venous insufficiency).
This swelling (edema) is the result of excessive fluid in your tissues — often caused by congestive heart failure or blockage in a leg vein. These problems can result in fluid accumulating in your legs and your abdominal cavity (ascites).
One result of nephrotic syndrome is low levels of protein (albumin) in your blood, which can lead to fluid accumulation and edema. Chronic venous insufficiency (CVI) is a condition in which the veins in your legs are weakened or damaged and can't pump enough blood back to your heart. Pregnant women and older adults are often affected with this condition, but it can happen to anyone. If a blood protein, called albumin, gets too low, fluid leaks out the blood vessels and edema occurs, especially in the feet, ankles and lower legs.
Because edema can be a symptom of a serious underlying disorder, and can cause serious consequences itself, it is always important to seek medical advice. Cuts, scrapes and burns in areas that have edema take much longer to heal and are open to infection. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism.
In these diseases, edema occurs primarily because of the body's retention of too much salt (sodium chloride).
The resulting increased back-pressure in the veins forces fluid stay in the extremities (especially the ankles and feet). In addition, the history can be instrumental in ruling out the more common rheumatologic causes, such as rheumatoid arthritis (RA), gout, and pseudogout.

The latter resulted in repeated exposure to HCV infection (and subsequent development of chronic liver disease).
Hepatitis C virus prevalence and outcomes among injecting drug users on opioid replacement therapy. Upper-extremity deep vein thrombosis after central vein catheterization via the axillary vein. The diagnosis and treatment of peripheral lymphedema: consensus document of the International Society of Lymphology. Our mission is to save precious time by offering the best and latest on rheumatology in an easy-to-read format, always hyperlinked for more in-depth reading later. What's inside? All tissues of the body are made up of cells and connective tissues that hold the cells together. Anasarca refers to the severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time.
Now this is an essential diagnosis to consider in such patients who have unilateral or bilateral puffy hands. News summaries based on studies published in leading medical journals and specialty medical journals, conference coverage, case-based quizzes and more.
Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.
In this article, we discuss the history taking and physical examination for patients who present with puffy hands. We also publish case studies and practice-related articles by rheumatologists and other specialists.
In various diseases, excess fluid can accumulate in either one or both of these compartments. Significant IV drug use resulting in chronically puffy hands strongly supports a diagnosis of HCV infection. In addition to RA, gout, and pseudogout, the history may help rule out anasarca resulting from cardiac, renal, or liver disease. A history of infection or trauma would suggest an infectious cause or fracture; a history of autoimmune disease (eg, scleroderma or Sjgren syndrome) often is associated with hand edema. PHYSICAL EXAMINATION The physical examination should start with evaluation of the patient’s general appearance; the presence of scleral icterus, jaundice, and anasarca should be noted. On abdominal examination, tender hepatomegaly, splenomegaly, or lymphadenopathy may be elicited. Patients may have purpura resulting from coagulopathy or encephalopathy resulting from chronic hepatic disease.
Patients also should be examined for cardiac murmurs or scars suggesting previous cardiac surgery.
Renal disease may be suggested as the cause of edema by oliguria, hypertension, foamy urine, or hematuria.
Patients’ hands may suggest an association with RA with the appearance of symmetrical inflammation of the metacarpophalangeal and proximal interphalangeal joints and finger deformities, such as ulnar deviation.
Evaluating whether upper extremity edema is unilateral or bilateral and whether the edema involves the whole arm or is isolated to the hand helps delineate the cause of the puffy hands. Many of the possible diagnoses are the ones that are most often involved (eg, congestive heart failure, nephrotic syndrome, and liver disease). Portal hypertension ensues with liver failure, often resulting in encephalopathy, hepatosplenomegaly, and formation of varices because of collateral blood flow.5 Another common clinical feature of HVC infection is bilateral puffy hands.
When first described by Abeles6 in 1965, this variation of hand edema was attributed to poor venous return because of thrombosis of antecubital veins after years of injected drug use. Recurrent infections at the injection site also were thought to contribute.6 Schneiderman1 suggested that the cause is lymphedema associated with the sclerosing properties of the drugs. Neviaser and colleagues7 and Foldi8 suggested that lymphatic obstruction persists after injected drug use stops, along with scarring resulting from chronic inflammation. In addition, heroin often is diluted with quinine, which is notable for destroying lymphatics.7 The hand edema begins as pitting edema, followed by thickening and fibrosis of the subcutaneous skin (see Figure 1). Primary thrombosis, known as Paget-Schroetter syndrome, occurs in healthy, young adults with strenuous exercise. Fibrocytes are then activated and, with time, connective tissue overgrowth occurs as fibrosis ensues (Figure 3).15 Figure 3 – Right-arm lymphedema occurred in this patient after axillary lymph node dissection. Primary conditions are differentiated by age and are hereditary or spontaneous disorders of lymphatic architecture.15-18 Secondary causes are responsible for most lymphedema.

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