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| Caption = Massive peripheral edema <br> (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)| | | 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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| {{Peripheral edema}} | | {{Pedal edema}} |
| {{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}} | | {{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}} |
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| {{SK}} Lower extremity edema; leg edema | | {{SK}} Lower extremity edema, leg edema |
| ==Overview== | | ==[[Pedal edema overview|Overview]]== |
| 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]] 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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| ==Classification== | | ==[[Pedal edema historical perspective|Historical Perspective]]== |
| Edema can occur in 2 forms: pitting and non-pitting.
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| ===Pitting Edema=== | | ==[[Pedal edema pathophysiology|Pathophysiology]]== |
| Pitting occurs when there is fluid movement when pressure is applied.
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| ===Non-Pitting Edema=== | | ==[[Pedal edema causes|Causes]]== |
| Non-pitting is swelling of the tissue itself, not an excess of fluid surrounding the tissue.
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| == Causes == | | ==[[Pedal edema differential diagnosis|Differentiating Pedal Edema from other Diseases]]== |
| ===Causes by Organ System===
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| {|style="width:70%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
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| [[AV fistula]], | |
| [[Constrictive pericarditis]],
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| [[Left heart failure]],
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| [[Myocardial Infarction]],
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| [[Right heart failure]],
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| [[Thoracic]] [[aneurysm]],
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| [[Thrombophlebitis]],
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| [[Thrombosis]],
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| [[Varicose veins]],
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| | ==[[Pedal edema epidemiology and demographics|Epidemiology and Demographics]]== |
| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"|
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| [[Insect bite]], | |
| [[Snakebites]],
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| | ==[[Pedal edema risk factors|Risk Factors]]== |
| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"|
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| [[Carbuncle]], | |
| [[Cellulitis]],
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| [[Contact dermatitis]],
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| [[Contusion]],
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| [[Erysipelas]],
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| [[Gas gangrene]],
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| | ==[[Pedal edema natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[ACE inhibitors]], [[aceon]], [[actos]], [[aldomet]], [[amiodarone]], [[amlodipine]], [[arixtra]], [[atorvastatin]], [[avandia]], [[beta blockers]], [[cardura]], [[casodex]], [[cilostazol]], [[cisplatin]], [[clopidogrel]], [[coreg]], [[crestor]], [[diltiazem]], [[docetaxel]], [[estrogen]], [[evista]], [[flecainide]], [[fondaparinux]], [[glitazones]], [[hydralazine]], [[ibuprofen]], [[labetalol]], [[lipitor]], [[minipress]], [[minoxidil]], [[motrin]], [[nifedipine]], [[norpace]], [[norvasc]], [[pindol]], [[plendil]], [[tenormin]], [[trentinion]], [[univasc]] [[valproic acid]], [[verapamil]], [[vesinoid]], [[vytorin]], [[xeloda]], [[Taxol]], [[Tamoxifen]], [[Herceptin]]
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| | '''Endocrine'''
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| |bgcolor="Beige"|
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| [[Addison's Disease]],
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| [[Cushing's Syndrome]],
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| [[Hyperthyroidism]],
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| [[Hypothyroidism]],
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| |- | | ==Diagnosis== |
| |-bgcolor="LightSteelBlue" | | [[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]] |
| | '''Environmental''' | |
| |bgcolor="Beige"| | |
| Cold (physical stimuli),
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| [[Frostbite]], | |
| [[Sunburn]], | |
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| |- | | ==Treatment== |
| |-bgcolor="LightSteelBlue" | | [[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]] |
| | '''Gastroenterologic''' | |
| |bgcolor="Beige"| | |
| [[Exudative enteropathy]], | |
| [[Liver failure]], | |
| [[Malabsorption]], | |
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| | | == Case Studies == |
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| | [[Pedal edema case study one|Case #1]] |
| |-bgcolor="LightSteelBlue"
| | {{WikiDoc Help Menu}} |
| | '''Genetic'''
| | {{WikiDoc Sources}} |
| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| [[Anemia]],
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| [[Hypoalbuminemia]],
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"|
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| [[Filariasis]],
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| [[Trichinosis]],
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| | '''Musculoskeletal / Ortho'''
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| [[Fracture]],
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| [[Gout]],
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| Ligamentous sprain,
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| [[Osteomyelitis]],
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| Peripheral nerve lesion,
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| | '''Nutritional / Metabolic'''
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| [[Acquired C1-esterase inhibitor deficiency]],
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| [[Beriberi]], | |
| [[Malnutrition]],
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| Starvation edema,
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| | '''Obstetric/Gynecologic'''
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| [[Amniotic band syndrome]],
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| [[Peripartum cardiomyopathy]],
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| Premenstrual edema,
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| | '''Oncologic'''
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| Mediastinal cancer,
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| | '''Psychiatric'''
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| [[Anorexia Nervosa]],
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| [[Bulimia Nervosa]],
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| | '''Pulmonary'''
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| |bgcolor="Beige"|
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| [[Pulmonary hypertension]],
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"|
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| [[Acute glomerulonephritis]],
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| [[Bartter's Syndrome]],
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| [[Nephrotic Syndrome]],
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"|
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| [[Angioneurotic edema]],
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| [[Cachexia]],
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| Lymph node mass,
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| [[Scleroderma]],
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| [[Sepsis syndrome]],
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| | '''Trauma'''
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| [[Bruise]],
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| [[Burn]],
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| Musculoskeletal trauma,
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"|
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| Idiopathic edema,
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| [[Milroy's Disease]],
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| [[Sepsis syndrome]],
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| Tight clothing,
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| |}
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| ===Causes 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>===
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| {{MultiCol}} | |
| * [[ACE inhibitor]]
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| * [[Aceon]]
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| * [[Acquired C1-esterase inhibitor deficiency]]
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| * [[Actos]]
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| * [[Acute glomerulonephritis]]
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| * [[Addison's Disease]]
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| * [[Aldomet]]
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| * [[Amlodipine]]
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| * Amniotic band
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| * [[Angioneurotic edema]]
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| * [[Angiotensin converting enzyme inhibitor]]
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| * [[Anemia]]
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| * [[Anorexia Nervosa]]
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| * [[AV fistula]]
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| * [[Avandia]]
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| * [[Bartter's Syndrome]]
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| * [[Beriberi]]
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| * [[Beta blockers]]
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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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| * [[Cardura]]
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| * [[Cellulitis]]
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| * [[Chemotherapy]]
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| * [[Cisplatin]]
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| * Cold (physical stimuli)
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| * [[Constrictive pericarditis]]
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| * [[Contact dermatitis]]
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| * [[Contusion]]
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| * [[Cushing's Syndrome]]
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| * [[Diltiazem]]
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| * [[Drugs]]
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| * [[Docetax]]
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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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| * [[Glitazones]]
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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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| * [[Ibuprophen]]
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| {{ColBreak}} | |
| * 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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| * [[Milroy's Disease]]
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| * [[Minipress]]
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| * [[Motrin]]
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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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| * [[ Nifedipine]]
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| * [[Norvasc]]
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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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| * [[Tendon]]ous 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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| * [[[[Trentinion]]
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| * [[Trichinosis]]
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| * [[Tumor]]s
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| * [[Univasc]]
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| * [[Valproic acid]]
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| * [[Varicose veins]]
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| * [[Vesinoid]]
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| * [[vytorin]]
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| {{EndMultiCol}}
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| == Epidemiology and Demographics ==
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| 25% of the general population suffers from chronic [[venous insufficiency]].
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| ==Natural History, Complications and Prognosis==
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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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| == Diagnosis ==
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| === History and Symptoms ===
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| *History should include:
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| :*[[DVT]] risk factors
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| :*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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| ===Physical Examination===
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| (Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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| {| align="center"
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| |-valign="top"
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| | [[Image:Extremities edema.jpg|thumb|300 px|Moderate edema]]
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| | [[Image:Extremities massive edema.jpg|thumb|300 px|Massive edema]]
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| |}
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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]]: [[Diuretics]], [[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 and antibiotics
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| *[[CHF]]: Salt restriction and [[diuretics]], [[preload]] reduction, [[afterload]] reduction
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| *[[Cirrhosis]]: [[Diuretic]]s & low salt diet
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| ==References==
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| {{Reflist|2}}
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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]] |
| [[Category:Primary care]]
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| {{WikiDoc Sources}}
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