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| | __NOTOC__ |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = {{PAGENAME}} | | | Name = Peripheral edema | |
| Image = Massive edema.jpg| | | Image = Extremities massive edema.jpg| |
| Caption = Massive pretibial edema. <br> (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)| | | Caption = Massive peripheral edema <br> (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)| |
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| }} | | }} |
| {{SI}} | | {{Pedal edema}} |
| {{CMG}} | | {{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}} |
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| {{Editor Help}} | | {{SK}} Lower extremity edema, leg edema |
| | ==[[Pedal edema overview|Overview]]== |
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| ==Overview== | | ==[[Pedal edema historical perspective|Historical Perspective]]== |
| Competent venous valves, intermittent leg muscle contraction and respiration is required to support normal venous blood return. When these fail, [[venous insufficiency]] and edema occur. Edema can occur in 2 forms: pitting and non-pitting. Pitting occurs when there is fluid movement when pressure is applied. Non-pitting is swelling of the tissue itself, not an excess of fluid surrounding the tissue. [[Edema]] is caused by an accumulation of an excessive amount of watery fluid in the serous cavities, tissues or cells causing painless, non-reddened swelling
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| == Epidemiology and Demographics == | | ==[[Pedal edema pathophysiology|Pathophysiology]]== |
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| 25% of the general population suffers from chronic venous insufficiency.
| | ==[[Pedal edema causes|Causes]]== |
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| == Complete Differential Diagnosis == | | ==[[Pedal edema differential diagnosis|Differentiating Pedal Edema from other Diseases]]== |
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| In alphabetical order: <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| | ==[[Pedal edema epidemiology and demographics|Epidemiology and Demographics]]== |
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| * [[Abscess]]
| | ==[[Pedal edema risk factors|Risk Factors]]== |
| * [[Acquired C1-esterase inhibitor deficiency]]
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| * [[Acute glomerulonephritis]]
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| * [[Addison's Disease]]
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| * Amniotic band
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| * [[Angioneurotic edema]]
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| * [[Anemia]]
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| * [[Anorexia Nervosa]]
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| * [[AV fistula]]
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| * [[Bartter's Syndrome]]
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| * [[Beriberi]]
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| * [[Boils]]
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| * [[Bruise]]
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| * [[Bulimia Nervosa]]
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| * [[Burn]]
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| * [[Cachexia]]
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| * [[Carbuncle]]
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| * [[Cellulitis]]
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| * Cold (physical stimuli)
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| * [[Contact dermatitis]]
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| * [[Contusion]]
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| * [[Cushing's Syndrome]]
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| * [[Drugs]]
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| * [[Erysipelas]]
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| * [[Exudative enteropathy]]
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| * [[Filariasis]]
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| * [[Fracture]]
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| * [[Frostbite]]
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| * [[Gas gangrene]]
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| * [[Gout]]
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| * [[Hyperthyroidism]]
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| * [[Hypoalbuminemia]]
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| * [[Hypoplasia]]
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| * [[Hypothyroidism]]
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| * Idiopathic edema
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| * [[Insect bite]]
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| * [[Irritant]]
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| * [[Left heart failure]]
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| * Ligamentous sprain
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| * [[Liver failure]]
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| * [[Lymph node]] mass
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| * [[Malabsorption]]
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| * [[Malnutrition]]
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| * Mediastinal cancer
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| * [[Melkersson-Rosenthal Syndrome]]
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| * [[Milroy's Disease]]
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| * Musculoskeletal trauma
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| * [[Myocardial Infarction]]
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| * [[Neoplasm]]
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| * [[Nephrotic Syndrome]]
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| * [[Osteomyelitis]]
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| * Peripheral nerve lesion
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| * [[Premenstrual]] edema
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| * [[Right heart failure]]
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| * [[Scleroderma]]
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| *[[Sepsis syndrome]]
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| * [[Snakebites]]
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| * [[Starvation]] [[edema]]
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| * [[Sunburn]]
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| * Surgical excision
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| * Tendonous strain
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| * Thoracic [[aneurysm]]
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| * [[Thrombophlebitis]]
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| * [[Thrombosis]]
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| * Tight clothing
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| * [[Trichinosis]]
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| * [[Tumor]]s
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| * [[Varicose veins]]
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| == Diagnosis == | | ==[[Pedal edema natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| === History and Symptoms === | | ==Diagnosis== |
| | [[Pedal edema history and symptoms|History and Symptoms]] | [[Pedal edema physical examination|Physical Examination]] | [[Pedal edema laboratory findings|Laboratory Findings]] | [[Pedal edema chest x ray|Chest X Ray]] | [[Pedal edema CT|CT]] | [[Pedal edema MRI|MRI]] | [[Pedal edema echocardiography and ultrasound|Echocardiography or Ultrasound]] | [[Pedal edema other imaging findings|Other Imaging Findings]] | [[Pedal edema other diagnostic studies|Other Diagnostic Studies]] |
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| *History should include:
| | ==Treatment== |
| :*[[DVT]] risk factors
| | [[Pedal edema medical therapy|Medical Therapy]] | [[Pedal edema surgery|Surgery]] | [[Pedal edema primary prevention|Primary Prevention]] | [[Pedal edema secondary prevention|Secondary Prevention]] | [[Pedal edema cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pedal edema future or investigational therapies|Future or Investigational Therapies]] |
| :*time lapse
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| :*other associated symptoms
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| :*unilateral vs. bilateral
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| :*pitting and/or non-pitting
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| | | == Case Studies == |
| (Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
| | [[Pedal edema case study one|Case #1]] |
| | | {{WikiDoc Help Menu}} |
| <div align="left">
| | {{WikiDoc Sources}} |
| <gallery heights="175" widths="175">
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| Image:Extremities edema.jpg|Moderate edema
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| Image:Extremities massive edema.jpg|Massive edema
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| </gallery>
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| </div>
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| === Laboratory Findings ===
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| *Labs include:
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| :*[[Blood cultures]]
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| :*[[BUN]] / [[creatinine]]
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| :*[[CBC]]
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| :*[[Coagulation]]
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| :*[[Electrolytes]]
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| :*[[LFT]]s
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| :*[[Serum albumin]]
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| :*[[Thyroid function tests]]
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| :*[[Urinalysis]]
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| === Chest X Ray ===
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| *[[Chest X-Ray]] may indicate [[pulmonary edema]] and/or [[cardiomegaly]]
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| === Echocardiography or Ultrasound ===
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| *[[Duplex ultrasound]] for [[DVT]]
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| *[[Echocardiography]] for EF in patients with [[CHF]]
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| === Other Diagnostic Studies ===
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| *[[liver biopsy]] for [[cirrhosis]]
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| == Treatment ==
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| === Acute Pharmacotherapies ===
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| *[[Congestive heart failure]]: [[ACE inhibitor]]s, [[beta blocker]]s, [[digoxin]]
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| === Chronic Pharmacotherapies ===
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| *[[DVT]]: [[Anticoagulation]] with [[unfractionated heparin]], [[low molecular weight heparin]] / [[warfarin]] for 3-6 months
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| === Indications for Surgery ===
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| *[[Nephrotic syndrome]]: transplant in adult patients may be necessary
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| *[[Cirrhosis]]: liver transplant may be necessary
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| === Additional therapies ===
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| *Venous insufficiency: Leg elevation, compression stockings, minimize time standing
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| *[[Cellulitis]]: extremity elevation
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| *[[CHF]]: Salt restrictions
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| *[[Cirrhosis]]: [[Diuretic]]s & low salt diet
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| ==Prognosis==
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| Successful treatment depends on control of the underlying cause. Severe swelling can cause permanent damage to nerves, resulting in [[peripheral neuropathy]]. Many cases from temporary or minor causes resolve on their own, with no lasting damage.
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| == Acknowledgements ==
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| The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.
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| ==References==
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| {{Reflist|2}} | |
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| ==Additional Resources==
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| * {{cite journal | author = Cho S, Atwood J | title = Peripheral edema. | journal = Am J Med | volume = 113 | issue = 7 | pages = 580–6 | year = 2002 | pmid = 12459405 | doi = 10.1016/S0002-9343(02)01322-0}}
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| {{SIB}} | |
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| | [[Category:Medical signs]] |
| | [[Category:Symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Physical examination]] | | [[Category:Physical examination]] |
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