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.

Thrombophlebitis

Thrombophlebitis is derived from the word 'thrombo' which means clot. Phlebitis indicates a swollen or inflamed vein. Thrombophlebitis is a blood circulatory condition that is caused by blood clots. It occurs mostly in the legs. Thrombophlebitis can occur at a superficial or deeper level. Superficial thromboplebitis occurs more commonly and is seldom life threatening. On the other hand, deep venous thrombosis affects larger and deeper veins. Sometimes there may be a condition of both superficial and deep vein components. In cases where there is superficial thromboplebitis, care must be taken to ensure that it does not cascade into condition where the deep veins are involved. Most cases of superficial thrombophlebitis resolve by themselves in a couple of weeks. It is when the deeper veins are affected that the clot can hamper or even cut off the bloodstream. The clot can travel through the blood and block circulation in vital organs such as the heart or lungs.

One of the common causes for thrombophlebitis is hospitalization due to surgery or bed rest. This is because thrombophlebitis is caused from long periods of inactivity. Long airplane journeys can reduce blood flow through the veins and lead to the formation of clots. Varicose veins, pregnancy or complication of IV tubes can lead to thrombophlebitis. Women using oral contraceptives or undergoing HRT are at increased risk of developing thrombophlebitis. If you have a family history of blood clots, you may be at risk of thrombophlebitis. When a patient suffers from thrombophlebitis, the leg veins become swollen and hard to touch. There is redness and swelling in the affected area. When a person suffers from superficial thrombophlebitis, he/she might feel a hard and tender cord barely under the surface of the skin.

Diagnostic tools such as Doppler ultrasound or blood coagulation studies help in examining a patient for thrombophlebitis. For mild cases of superficial thrombophlebitis, you can take analgesics to reduce pain and non steroidal anti-inflammatory drugs for inflammation. To reduce the pain or discomfort and the swelling, support stockings and elevation of the affected extremity are usually recommended. In cases of deep venous thrombophlebitis, Thrombolytic drugs are prescribed to melt the clots. Antibiotics are prescribed to treat any infection. Supportive hose or stockings can help in reducing swelling. Keeping the leg elevated prevents excess fluid in the affected area. Application of moist heat on the affected area helps in reducing pain. In high-risk cases of deep venous thrombophlebitis, surgery is used to strip out the affected vein or bypass the clot. Anticoagulants or blood thinners to prevent new clots from forming.

Scald

Scald refers to a burn from a hot liquid or steam. The injury that occurs by scalding is usually regional. Severe scalding occurs when hot liquids enter an orifice. Scald burns can range from reddened skin to blisters. There could be oozing of fluid when severe scalding occurs. Scalding does not cause death. However, death has occurred in unusual cases, say when the victim had accidentally broken a steam pipe.

Scald and children

It is estimated that each year at least 4000 children under age 14 are scalded by hot water in the US. Scalding usually occurs while they are in the bath tub. It takes just three seconds for a child to sustain a third degree burn from water at 140 degree F or higher. Bath and shower water and sink faucets can cause common threats to children. Scalding is the second common cause of serious burn injuries in children. Scalding usually occurs in children less than five years of age. This is because an infant's reflexes do not quickly respond to hot temperature threats. The child's skin is thinner than an adult's skin and therefore more prone to scalding.

Measures to prevent scald in the bathroom

• Test how hot the hot water is before using it.
  
• To ensure that bathing is safe, the water heater's thermostat should be set at low or warm.
  
• Anti scald devices are available. They could be installed in the shower and bathtub fixtures so that it will stop water flow if the temperature exceeds 120 degrees F.
  
• There is a tendency for young children to turn on the hot water on by themselves. Therefore, kids in the tub should always be under supervision.
  
• Children should be taught to turn on cold water faucets first before the hot water faucets.

Measures to prevent scald in the kitchen

• Hot foods and drinks should be kept away from the edge of tables and counters.
  
• Never hold a child when hot liquids or food is being held.
  
• Never drink hot liquids when small children are around.
  
• Never pour hot liquids when a child in underfoot.
  
• Check the food that has been warmed in a microwave before feeding the child.
  
• Cool mist humidifier should be used. It is advised not to use hot mist humidifiers.

When severe scalding occurs, always check for airway, breathing and circulation. Difficulty in breathing could be a significant clue to inhalation injury. Serious scald burns that cover a large area of the body of the child could be life threatening. Seek medical help without any delay.

First aid for scald burns

• The burnt area should be immersed in cool water. Cool compresses should be applied to burns on the trunk or face. This should continue for at least thirty minutes until the child is out of pain.
  
• Never break blisters that occur by scalding.
  
• Ice, butter or oil should not be applied on the injury.
  
• The scald area could be covered by a non stick bandage after immersing the extremity in cool water.