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| {{Infobox_Disease |
| | #redirect:[[Pedal edema]] |
| Name = Peripheral edema |
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| Image = Extremities massive edema.jpg|
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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)
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| ICD10 = {{ICD10|R|60|0|r|50}} |
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| ICD9 = {{ICD9|782.3}} |
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| }}
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| {{Search infobox}}
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| {{CMG}}
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| {{Editor Help}}
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| ==Overview==
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| 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.
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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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| == Differential diagnosis of causes of peripheral edema==
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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>
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| *[[Cellulitis]]
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| *[[Chronic Heart Failure|CHF]]
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| *[[Cirrhosis]]
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| *[[Constrictive pericarditis]]
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| *[[DVT]]
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| *[[Nephrotic Syndrome]]
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| *[[Venous insufficiency]]
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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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| (Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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| <div align="left">
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| <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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| ==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]]
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| [[Category:Signs and symptoms]]
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| [[Category:Physical examination]]
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