Edema

Edema
Skin: Pitting Edema; Gross, close-up of dorsum of hand with marked pitting edema. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Martin Nino, M.D. [2]

Synonyms and keywords: oedema or œdema

Overview

Edema (American English), formerly known as dropsy or hydropsy, is the increase of interstitial fluid in any organ — swelling. Generally, the amount of interstitial fluid is in the balance of homeostasis. Increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema. Cutaneous edema is referred to as "pitting" when, after pressure is applied to a small area, the indentation persists after the release of the pressure.

Classification

Edema can be classified into pitting edema and non piting edema. Peripheral pitting edema is the more common type, resulting from water retention. It can be caused by systemic diseases, pregnancy in some women, either directly or as a result of heart failure, or local conditions such as varicose veins, thrombophlebitis, insect bites, and dermatitis. Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedema, lipedema, and myxedema.

Pathophysiology

Generation of interstitial fluid is regulated by the Starling equation of tissue fluid which states that it depends on the balance of osmotic pressure and of hydrostatic pressure which act in opposite directions across the semipermeable capillary walls. Consequently, anything that increases oncotic pressure outside blood vessels (for example inflammation), or reduces oncotic pressure in the blood (states of low plasma osmolality, for example cirrhosis) will cause edema. Increased hydrostatic pressure inside the blood vessel (for example in heart failure) will have the same effect. If the permeability of the capillary walls increases, more fluid will tend to escape out of the capillary, as can happen when there is inflammation.

Causes

Causes of edema can be grouped by its extension as generalized and localized edema. Other way to classify it is by its primary mechanism: Increased capillary hydraulic pressure, hypoalbuminemia, increased capillary permeability, lymphatic obstruction or increased interstitial oncotic pressure.

Life Threatening Causes

Life threatening causes of edema are:

• Acute kidney failure
• Acute pulmonary edema
• Adult respiratory distress syndrome
• Anaphylaxis
• Anthrax
• Burns
• Eclampsia
• Ischemic heart disease
• Sepsis

Common Causes

• Cirrhosis
• Drugs
• Heart failure
• Nephrotic syndrome and other forms of renal disease
• Pregnancy
• Premenstrual edema
• Venous insufficiency

Causes by Organ System

Cardiovascular	Aorta-pulmonary artery fistula, aortic coarctation, capillary leak syndromes, deep vein thrombosis, dilated cardiomyopathy, heart failure, hypertensive heart disease, ischemic heart disease, mitral valve disease, rheumatic fever, single ventricular heart, tricuspid atresia, tricuspid valve diseases, Uhl anomaly, varicose veins, venous stenosis, venous thrombosis.
Chemical/Poisoning	Anthrax, epidemic dropsy, St. Anthony's fire.
Dental	No underlying causes
Dermatologic	Erythroderma
Drug Side Effect	Aldesleukin, alitretinoin, alpha1 blockers, amlodipine, androgens, apomorphine hydrochloride, aromatase inhibitors,aspirin, azficel-T, bicalutamide,calcium channel blockers, carbenoxolone, cefaclor, cetrorelix, chlordiazepoxide,cisplatin, conivaptan, cidofovir, conjugated estrogens, crizotinib, danazol , deserpidine, desmopressin, desogestrel and ethinyl estradiol, dexamethasone,diazoxide, dihydropyridine calcium channel blockers , diltiazem, docetaxel, estramustine, estrogens,ethynodiol diacetate and ethinyl estradiol, felbamate, felodipine ,fludrocortisone,flurbiprofen, fungemia, gabapentin, gallium nitrate, gestrinone, glucocorticoids, glufosinate, gold salts, hydralazine, hydrocortisone,hydroxyprogesterone caproate, imatinib mesylate, indomethacin, insulins, interleukin 11, isradipine, lenalidomide, lidocaine (cream), lidocaine (ointment), mefenamic acid, methysergide, minoxidil, nabilone,nifedipine, nilutamide, nitrendipine, nondihydropyridine calcium channel blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), oxandrolone,oxaprozin, palifermin, pegaspargase, penciclovir, pergolide, phenylbutazone ,pimavanserin,pinacidil,pioglitazone, pramipexole, prednisolone, pregabalin, progestins, reserpine, rofecoxib, ropinirole, sargramostim, siltuximab, sinecatechins, sodium phenylbutyrate, streptozocin, sympatholytics, tamoxifen, temsirolimus, terconazole, testosterone, thiazolidinediones, tiagabine, tolmetin, vasodilators, Von Willebrand factor.
Ear Nose Throat	Recurring airway infection
Endocrine	Cushing disease, diabetes mellitus,hepatorenal tyrosinemia, hypothyroidism, thyroid disorders
Environmental	Anthrax, Boston ivy poisoning, burns
Gastroenterologic	Cirrhosis , early hepatic cirrhosis, eosinophilic gastroenteritis, eosinophilic enteropathy, pattern II, gastritis, familial giant hypertrophic, hepatic cirrhosis, hepatic failure, hepatic venous obstruction, hepatitis, liver disease, liver failure, malabsorption syndrome, Ménétrier's disease, primary biliary cirrhosis, protein losing enteropathy, Waldmann disease, Whipple's disease
Genetic	Aagenaes syndrome, amnion rupture sequence, Andersen disease, aplasia cutis congenital - intestinal lymphangiectasia, C1 esterase inhibitor deficiency, cardiomyopathy - hearing loss, type T-RNA lysine gene mutation, combined oxidative phosphorylation deficiency 5, cystic fibrosis, dextrocardia-bronchiectasis-sinusitis, distichiasis , ectodermal dysplasia - arthrogryposis - diabetes mellitus, encephalopathy progressive - optic atrophy, estrogen dependent hereditary angioedema, fructose-1-phosphate aldolase deficiency, hereditary, Goldberg syndrome, hemolytic disease of the newborn, ichthyosis congenita, Jacobs syndrome, microcephaly - microphthalmos - blindness, Milroy's disease, monosomy 3p14 p11, multiple joint dislocations - metaphyseal dysplasia, Neu-laxova syndrome, Noonan syndrome, Opitz-Reynolds-Fitzgerald syndrome, pulmonary lymphangiectasia, congenital, Schneckenbecken dysplasia, single ventricular heart, tricuspid atresia, Turner syndrome, type IV glycogen storage disease, tyrosinemia, Uhl anomaly, X chromosome, duplication xq13 1 q21 1, X chromosome, monosomy xp22 pter, X chromosome, monosomy xq28, X chromosome, trisomy 26-28, X chromosome, trisomy xp3, X chromosome, trisomy xpter xq13, X chromosome, trisomy xq, X chromosome, trisomy xq25.
Hematologic	Essential mixed cryoglobulinemia, hereditary angioedema.
Iatrogenic	No underlying causes
Infectious Disease	Acanthocheilonemiasis, Chagas disease, intestinal capillariasis, Junin virus, lymphadenitis, lymphatic filariasis, Plasmodium malariae, Plasmodium ovale, sleeping sickness (east african), sleeping sickness (west african), trichinosis, west african trypanosomiasis.
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Proximal spinal muscular atrophy, spinal muscular atrophy, type II
Nutritional/Metabolic	, excessive dieting,Kwashiorkor, malnutrition, nutritional deficiency, sodium overload, thiamine deficiency, vitamin E deficiency, water overload.
Obstetric/Gynecologic	Eclampsia, Ovarian hyperstimulation syndrome, pre-eclampsia, pregnancy and premenstrual edema,pregnancy
Oncologic	Angioimmunoblastic t-cell lymphoma,bronchogenic carcinoma, carcinoid tumours and carcinoid syndrome, classical hodgkin disease, [Letterer-siwe disease]], malignant ascites, mixed cellularity hodgkin's disease, nodal enlargement due to malignancy, nodular sclerosing hodgkin's lymphoma
Ophthalmologic	Distichiasis , nevus of ota retinitis pigmentosa, obal syndrome
Overdose/Toxicity	Ginseng overuse
Psychiatric	Refeeding edema
Pulmonary	Acute pulmonary edema, adult respiratory distress syndrome, hemangiomatosis, familial pulmonary capillary, lymphangiomatosis, pulmonary, pulmonary lymphangiectasia, congenital.
Renal/Electrolyte	Acute glomerulonephritis, acute renal failure, chronic kidney disease, glomerular disease, hypernatremia, hypoproteinaemia, lipoprotein glomerulopathy, membranoproliferative glomerulonephritis, mesangiocapillary glomerulonephritis type 1, mesangiocapillary glomerulonephritis type III, nephritis, nephrosis, idiopathic form, familiar, nephrotic syndrome, non-diarrheal (d-) HUS syndrome, post-streptococcal glomerulonephritis, renal disease, renal failure.
Rheumatology/Immunology/Allergy	Acute infantile hemorrhagic oedema, allergic reaction, anaphylaxis, autoimmune disease (juvenile idiopathic arthritis & Crohn's disease), eosinophilia-myalgia syndrome, Goodpasture's syndrome, inherited hemolytic-uremic syndrome, Kawasaki disease, polyarteritis nodosa.
Sexual	No underlying causes
Trauma	Leg injury, trauma.
Urologic	No underlying causes
Miscellaneous	Acute altitude sickness, bone marrow failure , cachexia, eosinophilic enteropathy, pattern II, granulomatous lymphangitis, hypernatremia, hypoproteinaemia, idiopathic edema, when diuretic induced, inflammation or sepsis, Irons-Bhan syndrome, lymph node dissection, lymphedema praecox, POEMS syndrome, protein deficiency, rheumatic fever, Tang Hsi Ryu syndrome, Yellow nail syndrome.

Causes in Alphabetical Order

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Organ-Specific Edema

Edema of specific organs (cerebral edema, pulmonary edema, macular edema, pedal edema) may also occur, each with different specific causes to peripheral edema, but all based on the same principles. Ascites is effectively edema within the peritoneal cavity, as pleural effusions are effectively edema in the pleural cavity. Causes of edema which are generalized to the whole body can cause edema in multiple organs and peripherally. For example, severe heart failure can cause peripheral edema, pulmonary edema, pleural effusions and ascites.

Common and usually harmless appearances of cutaneous edema are observed with mosquito bites and skin contact with certain plants (urticaria).

Edema may be found in the eyes after corrective surgery or procedures of that nature.

External links

• Medline Encyclopedia - Swelling