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Pulmonary Embolism

When an artery in the lungs gets blocked, it is referred to as a medical condition of Pulmonary embolism. This condition can be life threatening. Often deep vein thrombosis (DVT) can lead to pulmonary embolism. The blood clots may originate in any other part of the body such as the arm, pelvis or legs. These clots travel through the bloodstream and enter the pulmonary arteries. Recent surgery or injury can lead to a blood clots. Persons with heart disease or those on estrogen therapy are at increased risk of pulmonary embolism. Typical symptoms experienced by those suffering from pulmonary embolism are chest pain, sudden shortness of breath and rapid heartbeat. A patient might have wheezing and weak pulse. The symptoms of pulmonary embolism depend on the extent and size of clots. Embolus can also be the result of fat from the bone marrow that has escaped into the bloodstream. It can also occur due to air bubbles formed during intravenous infusion or surgery. While large emboli cause considerable distress such as chest pain, smaller ones cause shortness of breath. Patients suffering from pulmonary embolism tend to have cough that produces sputum. There may be bluish discoloration on the skin and pain in the legs. Fainting spells or seizures might occur due to sudden decrease in oxygen-rich blood to the brain and other organs. Bluish tint on the skin (cyanosis) is observed when one or more large pulmonary arteries are obstructed.


Diagnostic procedures to detect pulmonary embolism:

  • Chest X-ray helps in identifying any lung infections
  • CAT scan
  • ECG
  • Perfusion Scan of the lung - This test helps in outlining the blood flow to the lungs and helps in detecting any obstructions.
  • V/Q scan involves a a nuclear ventilation-perfusion study of the lungs.
  • Pulmonary angiogram involves injection of a special dye into the pulmonary arteries to detect obstructive clots.
  • D-dimer test is a test that spots d-dimer molecules released by the clots.

One of the initial steps to help a person suffering from pulmonary embolism is administration of oxygen and analgesics. Oxygen is administered through a nasal cannulae or face mask. Blood clots are treated with anticoagulant drugs like heparin or warfarin. But the duration and dosage of anticoagulants needs to be monitored so that it does not result in bleeding in other body organs. Thrombolysis is a procedure whereby Thrombolytic agents (clot-dissolving agents) are injected into the bloodstream to dissolve existing blood clots. Surgery (Pulmonary embolectomy) is often resorted to for removal of clots.

Edema

Edema previously known as hydropsy is a condition where the soft tissue is swollen because of the accumulation of interstitial fluid. Abnormal accumulation of the interstitial fluid presents a noticeable swollen appearance in various areas of the body. The fluid moves from the vascular region to the interstitial region because of preexisting conditions. The distribution of edema in different areas of the body is an effective diagnostic factor to identify various underlying conditions. Edema is broadly classified in to two categories, localized and generalized respectively.


Localized edema

Localized edema is predominantly caused because of the obstruction caused in the lymphatic or venous system. In some cases these edemas can be fatal as they induce conditions such as deep vein thrombosis and allergic reactions like angioedema. Angioedema is also known as non-pitting edema. Localized edema can also occur due to neoplasm and also because of inflammation associated with infections.

Generalized edema

Generalized edema is caused because of impaired cardiac or renal function. Fluid retention and increase in the concentration of sodium may result in the swelling of various body parts. This type of edema can also occur because prolonged sitting or standing in one position. The sodium retention associated with renal impairment is generally caused because of vasoconstriction. In conditions such as cirrhosis of the liver, the edema is generally noticed in the peritoneal region which is referred to as ascites. Edema associated with cardiac impairment is usually associated with the right side of the heart and the left side impairment leads to pulmonary edema. Shortness of breath is often associated with edema.

Clinical manifestations and causes associated with edema

Edema (oedema) occurs because of various preexisting health conditions. Any variation in the vital parameters of the body such as fluid imbalance, venous pressure fluctuations and lymphatic impairments lead to edema. Protein insufficiency and hepatic disease increases the occurrence of edema. Many women experience episodes of edema during pregnancy. This happens because of increased fluid distribution to nourish the developing child and mother at the same time. Some forms of edema also occur because of increased capillary permeability. Conditions such as vasculitis and post-anoxic encephalopathy cause increased capillary permeability.

Pitting edema is also one if the important types of edema which occurs in some people who wear tight outfits. The regions covered by the tight clothing generally swells up and after a certain period of time, the tissue returns to the normal appearance. In addition to the conditions mentioned, edema is also caused because of certain drugs. Drugs which block the calcium channels, corticosteroids, birth control pills and antidepressants predominantly induce the onset of edema.

Edema requires medical attention as it may lead to many other complications. The complications associated with edema are swelling with pain, stretched skin with dryness, formation of scarred tissue, and risk of skin ulcers and decreased elasticity of the arteries, veins and muscles.


Diagnosis and Treatment of Edema

Diagnosis of edema is done by identifying the underlying causes associated with it. Complete biochemical analysis is done to identify the factors such as hyperthyroidism, protein insufficiency and fluid electrolyte ratios. Pregnant women are generally advised to avoid standing for prolonged period of time especially during the last trimester of their pregnancy. Patients suffering from consistent edemas are advised to keep in an elevated position with some support. Loose and comfortable clothing is also recommended as it helps in the uniform blood circulation.

Treatment for edema includes dietary restriction of sodium flowed by the administration of diuretics. Diuretics are predominantly used in conditions such as lymphedema, renal disease and obstruction in the venous flow. Since edema is also associated with weight loss, the administration of diuretics has to be reduced once the patient reaches optimal weight.



Ankle swelling

A sign of fluid buildup or inflammation of joint and tissue, ankle swelling is also called ankle edema. It can also result from serious infections, trauma or circulatory disorders, cardiac disorders or any other abnormal processes. Mild ankle swelling is common after standing for a long period of time. Painless swelling of the ankles is a common problem among older people. Swollen ankles may indicate potentially serious disorders such as congestive heart failure, deep vein thrombosis and liver failure. Ankle swelling could also occur during pregnancy, being overweight or vascular problems or some orthopedic conditions such as bone fracture or a sprained ankle.


Swelling can also be caused by injury involving surgery in ankle. Long car rides and flight travel can lead to ankle edema. Many women notice ankle edema during pregnancy. It is complicated by Preeclampsia, a serious condition that includes high blood pressure and swelling. Certain medications, like antidepressants, calcium channel blockers, and hormones like estrogen and testosterone and steroids can cause swelling. Ankle swelling is common in those who are overweight, suffer blood clots in the leg or those who suffer leg infections.


Swollen legs are also often a sign of failure of heart, kidney and liver. This is an indication of too much fluid in the body. Gout is caused by accumulation of uric acid crystals within the fluid of the ankle. Those suffering from gout exhibit abnormal accumulation of uric acid within joints leading to inflammation and resultant swelling. Ankle arthritis is another degenerative change is the joint, though less common, which can be quite painful and could cause swelling. Blood clot, known as DVT, is a common vascular obstruction of blood flow which can cause swelling around the ankles and can also extend further up to the legs.


Since swollen ankles could be due to serious diseases and injuries, seek treatment without delay. Treatment depends upon the analysis of the underlying disease condition and its diagnosis.

  • Keep ankle lifted so that the leg falls on a straight line. An ice pack or ice in a plastic bag can be wrapped in a clean dish bowl and kept on the raised ankle.
  • Reduce intake of salt.
  • Cut down on processed food especially fast foods that overflow with salt.
  • To soothe tendinitis, sprains, strains and aches, alternate hot and cold vinegar wraps can do good.
  • Drink plenty of water as it moves through kidneys, bladder, diluting the urine and since urine has some fluid-retaining salt in it, the more it is diluted, the easier it is to remove salt and prevent edema.
  • Exercise such as as walking or swimming regularly helps.
  • Support stockings which are sold at most drug and medical supply stores can be worn.
  • Avoid wearing tight clothing or garters around thighs.
  • Lose weight if need to.
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Collection of Pages - Last revised Date: September 14, 2019