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 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 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.
Lower Extremity Edema
Edema refers to a condition that is often associated with accumulation of fluids in the tissues. It is predominantly caused because of an inflamed or infected tissue. The nature and type of edema caused can depend on various reasons such as trauma, infections or hereditary diseases. Edema is prominently noticed in few areas of the body especially in the legs. In most cases edema is also associated with an existing cardiac or renal condition. The edema associated with vital organs is because of fluid retention. Edema of the lower extremities is often associated with disorders of the vital organs or sometimes because of any prolonged activity such as standing or even sitting.
Fluid electrolyte balance is an important factor in understanding various edematous conditions, especially pertaining to lower extremities. In many cases, it is because of an inflammatory response to the trauma caused to a tissue or an internal organ. Other factors such as urinary infections and cystitis, which are common renal diseases, cause edema in the legs. It is essential to classify the type of edema in order to arrive at an appropriate diagnosis and treatment. Physicians upon general examination and history of the patient can evaluate the edema in to two - pitting and non-pitting.
Pitting edema of the lower extremities is often associated with indentation to the edematous region for a specific amount of time upon applying pressure. Non-pitting edema does not show indentation. Characteristic pitting edema is generally bilateral in nature. Infections caused by Streptococcus especially rheumatoid arthritis cases present prominent edematous appearances. Sometimes, Gout's disease and cellulitis cause edema of the legs. The physiology associated with all these medical conditions have common diagnostic affirmations related to fluid electrolyte balance. Another important factor associated with edema is the protein intake. Higher protein intake can lead to increased uric acid levels causing edema. Decreased protein intake in conditions such as nephrotic syndrome and starvation can lead to edema.
The production of endothelin protein is prominent in edematous conditions. The relevance to this protein production is an important factor for the onset of hydrostatic condition leading to increase systolic pressure causing arterial vasoconstriction. A cascade of metabolic changes occur because of this condition leading to disturbances in renin Angiotensin mechanism and also increased capillary permeability.
The common treatment options for treating edema are the administration of diuretics and vasodilators. In case of infections of bacterial and fungal origin, antibiotics are given to facilitate prophylaxis. Coumadin and Flavonoids are used as therapeutics in addition to vasodilators. Surgical interventions such as liposuction also benefit the patient to a larger extent.
Mountain sickness or altitude sickness occurs as a result of lower oxygen at higher altitude along with reduced air pressure. It is a series of symptoms such as dizziness, headache, nausea and loss of appetite.
Acute Mountain Sickness (AMS) is a mild form of Altitude sickness which is caused by climbing to greater than 8000 feet (2400 meters above sea level). Hypoxemia - the hypoxia resulting from high altitude, in susceptible individuals can occur owing to poor acclimatization. High Altitude Pulmonary Edema (HAPE) is a serious condition that may affect people prone to Acute mountain sickness. This edema is the accumulation of fluid from pulmonary blood vessels in lungs. This results in shortness of breath, rapid pulse and cough with bloody sputum. If not treated in time, coma and then death might be a possibility.
High Altitude Cerebral Edema (HACE), though rare is the most life threatening form of Altitude sickness where cerebral edema occurs with symptoms other than those of Mountain sickness can include severe headache, loss of coordination, speech abnormalities, altered level of consciousness and seizures. This condition is fatal unless treated in time. Treatment begins with descent to a lower altitude and oxygen therapy. It is suggested to take Dexamethasone to reduce cerebral edema.
Mountain sickness happens with those who have tried to reach faster. If a person suffering from a severe episode of altitude sickness, problems such as shortness of breath, cyanosis, chest constriction and inability to walk might be noticed. It is easier to treat the early signs of mountain sickness. Returning to lower altitude is the safest step. Additional oxygen must be given. Severe symptoms that might arise are pulmonary edema, cerebral edema or retinal hemorrhage. Rest and oxygen usually helps most persons suffering mountain sickness. Aspirin can be taken for headache but sleeping medications must not be taken as they can slow down breathing. A diuretic like Acetazolamide is prescribed. High altitude edema is best treated with Nifedipine.
Bibliography / Reference
Collection of Pages - Last revised Date: February 17, 2019