Methods of dealing with Edema


  1. Methods of dealing with Edema
  2. Causes of Edema
  3. How to deal with Edema
  4. Differential diagnosis and treatment

Furosemide for EdemaKnown diuretics such as FUROSEMIDE, indapamide, and their analogs, efficiently and quickly remove the swelling (Edema).

But it is not recommended to use these medications alone, as undesirable side reactions may occur if the intake or dosage regimen is disturbed.

Widespread are plant diuretics, which have a milder effect, compared with drugs.

These include:

- Cowberry leaves;

- Kidney tea;

- Bearberry leaves;

- Birch buds and leaves;

- Grass of horsetail.

Some food products have pronounced diuretic properties, berries and vegetables, for example, cranberries, beets, oats, cucumbers, watermelon tomatoes, asparagus, etc.

Remember, the main rule of preventing swelling is less sweets, carbohydrates and salty foods, more fruits and vegetables that have a diuretic effect. If the swelling does not subside - then it's not at all in the diet.

Causes of edema

Causes of edemaThe appearance of edema due to various factors:

- Diseases of the liver, kidneys and heart;

- Unbalanced diets, which do not allow obtaining from the products all vital substances;

- For women - before and during menstruation;

- Change in diet (increase in salt food and carbohydrates, decrease in the amount of clean water).

If you are indulging in a salty before going to bed, then you can rest assured that in the morning it will "settle" on some part of the body. This is due to the ability of sodium, which is part of the common salt, to retain water in the body. Often, diuretics help with edema - their action is based on the removal of sodium salts from the tissues.

In addition to salt, carbohydrates possess the ability to retain water. Therefore, an excessive amount of flour, eaten in the evening, can lead to morning swelling of the face.

How to deal with edema

How to deal with edemaTo remove swelling (edema), you need to find out the reason for its appearance. In some cases, only an exception to the daily diet of certain foods will help, and serious illnesses will need to be treated medically or surgically.

1. Adjust the power supply.

If you are a lover of coffee, sweet or spicy, edema will become your constant companions. After all, these products not only delay the liquid in the body, but also cause thirst, forcing to drink water in large quantities. To combat puffiness in this case, you must abandon the sweet, salty and use less fluid in the evening and before bedtime. To make the dish more salty you can use lemon juice - and tasty, and useful.

2. Disturbance of blood circulation.

When the blood stagnates, excess fluid from it through the walls of the vessels gets into the tissues. The result is edema. Most often they are exposed to calves and ankles. Strengthen the vessels will help periodic walks, fitness classes and small workouts during the working day. Use underwear with compression effect, it will help to normalize the circulation in the legs.

3. Premenstrual syndrome.

The fluid accumulates in the body in the second half of the cycle, especially before the onset of menstruation. The result - swelling of the legs and hands, mammary glands and even the face. With the onset of menstruation, weight comes back to normal. To reduce puffiness, limit eating of sweet, spicy and salty foods. Give preference to complex carbohydrates, in large quantities present in legumes, cereals and potatoes.

4. Kidney disease.

Problems with the kidneys often affect the appearance - the face becomes pale, there are strong swelling. If you press the finger swelling, then the trace from it will not disappear immediately and will last for several minutes. Treatment of kidney diseases should be carried out strictly under the supervision of a doctor, and sometimes in a hospital. Therefore, if you suspect a kidney problem, do not delay the visit to the doctor - this will help to avoid serious complications.

5. Cardiovascular diseases.

Edema, arising from heart diseases, are localized first in the ankle region, gradually spreading to the hips and sometimes the stomach. Puffiness is not the first symptom of heart problems - at first there is shortness of breath, swelling of the veins on the neck and a bluish shade of fingers and lips.

Treatment of cardiovascular diseases at home is strictly contraindicated! In this case, only a cardiologist can help. After the course of treatment, you not only get rid of edema, but also improve the condition of the body as a whole.

Part II

Edema syndrome. Differential diagnosis and treatment

Swelling of limbs are a common complaint of patients (four of the most common reasons for seeking medical attention).
This is due to the fact that the swelling clearly visible, patients are considered as a manifestation of the disease and of concern to the cosmetic point of view, especially in women. For these reasons, as soon as the patients notice swelling, they immediately seek medical help.

Patients with edema syndrome encountered in clinical practice, doctors of different specialties. presence of edema is often interpreted as a sign of the patient's venous system pathology. This is due to a natural fear of doctors miss venous thrombosis or severe chronic venous failure, which potentially could lead to disability or even death of the patient. Meanwhile, the causes of edema syndrome are very diverse, and incorrect assessment of the clinical situation may lead to serious errors in the therapeutic strategy.

That is why it is important to correct the differential diagnosis of edema of the lower extremities. Swelling represent an increase in the size of a particular part of the body caused by excessive accumulation of interstitial fluid. They may be the result of increasing capillary permeability barriers venous outflow blood or lymph or accumulation of fluid in tissues as a result of reduction of plasma oncotic pressure.

The development of edema syndrome may be as a consequence of vascular diseases and locomotor system of the lower extremities, as well as a manifestation of a number of internal diseases.

These diseases and pathological conditions familiar precinct physicians and specialized hospitals:

1) Chronic heart failure;

2) Renal failure, nephrotic or accompanied by acute nephritic syndrome (glomerulonephritis, renal amyloidosis, diabetic glomerulosclerosis, nephropathy pregnant, rheumatoid arthritis, systemic lupus erythematosus, lymphocytic leukemia, Hodgkin's disease);

3) Increased venous pressure failure of venous valves, varicose veins, acute venous thrombosis and its consequences, external compression of the veins as a result of tumor growth;

4) Hypoproteinemia due to:

- Insufficient protein intake (hunger, malnutrition);

- Digestive disorders (exocrine pancreatic insufficiency);

- Lack of protein digestion (resection of a large part of the small intestine, the defeat of the small intestine wall, gluten enteropathy);

- Violation of the synthesis of albumin (liver diseases);

- Nephrotic syndrome;

- Protein loss (exudative enteropathy);

5) Violation of lymphatic drainage:

- Elephantiasis with recurrent erysipelas;

- Obstruction of the lymph filarial (filariasis);

- Traumatic lymphostasis;

- Post-traumatic lymphedema combining lymphatic and venous obstruction;

6) Allergic reactions (angioedema);

7) Swelling in diseases of large joints (deforming osteoarthritis, infectious arthritis, reactive arthritis);

8) Increase of hydrostatic pressure in the intake of certain drugs (eg, nifedipine);

9) Mixed edema.

The algorithm of differential diagnosis in detecting peripheral edema

When collecting medical history of a patient with peripheral edema most valuable information can be obtained through the following eight questions:

1. When the swelling first appeared?

Communication with the time factor is particularly valuable when deep vein thrombosis (acute occurrence of edema), whereas when lymphoedema important hallmark clinical feature is the age of the patient. Idiopathic lymphoedema (women meet 9 times more often than men) usually begin before the age of 40 years; typical for their occurrence is considered to be the period of menarche, and obstructive lymphoedema almost always appear after 40 years.

2. Do you have pain in the affected limb?

Acute pain is evidence of thrombophlebitis, inflammatory lymph edema or musculoskeletal pathology. The pain should be distinguished from pain on palpation, since, despite the fact that both symptoms are present in all of the above conditions, tenderness and pain in the absence of peace is usually seen when the fat edema - hyperlipidemia.

3. Does the swelling decrease during the night?

Edema in chronic venous insufficiency (CVI), and orthostatic edema decrease at an elevated position limbs at night. Common swelling can be moved to other parts of the body that depends on the position in the bed (e.g., back) to the patient the illusion that they are reduced; lymph edema when picked limbs decay slowly and often not until the end.

4. Do you have shortness of breath appears during normal physical exertion or adopting a horizontal position?

An affirmative answer to this question is definitely evidence for heart disease.

5. Have you had any infections or kidney albuminuria?

The presence of these key anamnesis evidence for edema of renal origin.

6. Have you ever had hepatitis or jaundice?

Patients with chronic liver disease, the severity of which is sufficient for the appearance of edema, usually have one or both of these anamnestic sign. When collecting history should ask questions about alcohol consumption.

7. Does your appetite changed, body weight and bowel operation?

Changing any of these indicators can alert the physician about the possibility of rare but serious edema associated with impaired absorption of food or income.

8. Do you take any medicines, tablets or capsules?

The medicines, promoting fluid retention, are: sex hormones drugs (estrogen, progesterone, testosterone), antihypertensive drugs (alkaloids Rauwolfia apressin, methyldopa, badrenoblokatorov, clonidine, calcium channel blockers of the dihydropyridine series), non-steroidal anti-inflammatory drugs (phenylbutazone, naproxen ibuprofen, indomethacin), antidepressants (monoamine oxidase inhibitors).

In a study of patients with peripheral edema should be clarified:

1) The rate of edema (swelling of acute or chronic);

2) Whether the acute swelling of bilateral or unilateral. If acute and unilateral edema, the first thing should be excluded DVT leg;

3) If chronic unilateral swelling, then there is a pit on pressure in the swelling?

Do not leave the hole only lymph edema, they are located, usually on the back of the feet, do not disappear in the raised position of the limbs. Level lymph blockade visualized using lymphography. If chronic edema, unilateral and leaves a hole, likely edema of venous origin.

To confirm this hypothesis, conduct a physical exam, which can be found at:

- Varicose veins;

- Characteristic skin changes (induration, dermatitis, ulcers);

- Loss of muscle tone and decreased reflexes in the paralyzed limbs, associated with a reduction in vascular tone;

- Becker cyst as a cause compression of the popliteal vein with the development phlebostasia palpation of the popliteal fossa.

In chronic bilateral edema should be excluded:

- Chronic heart failure;

- CVI;

- Pulmonary hypertension;

- Chronic renal failure;

- Portal hypertension;

- Side effects of drugs.

In a study of patients with chronic bilateral edema of the lower extremities should pay attention to the following symptoms:

1) The presence of jaundice, "drumsticks", telangiectasias, gynecomastia can be a manifestation of cirrhosis of the liver;

2) Increase in blood pressure may be associated with impaired renal function;

3) Wheezing in lung auscultation may be symptoms of bronchial obstruction associated with right ventricular failure;

4) Cyanosis, noises in the heart can indicate chronic heart failure as a cause of edema.

Screened laboratory examination of the patient with peripheral edema in outpatient settings should include:

1) Urinalysis (to detect proteinuria). If a positive result is performed daily proteinuria test to clarify the presence of nephrotic syndrome;

2) Serum creatinine is elevated in kidney function;

3) Reduced serum albumin at a syndrome of hepatic insufficiency (in parallel with the decrease of prothrombin), nephrotic syndrome (in parallel with the presence of proteinuria).

Instrumental examinations that help in the diagnosis of CVI are Doppler ultrasound (Doppler ultrasound) and ultrasound (US) scanning of the lower limbs. If you suspect a cyst Becker necessary to conduct ultrasound study of the knee joint.

According to the testimony to clarify the causes of edema outpatient therapist can be assigned:

1) Chest X-ray, which can detect a change of heart contours in chronic heart failure, the presence of pleural exudate with severe hepatic and renal failure;

2) Electrocardiography, allowing to identify the signs of hypertrophy of the right atrium and right ventricle with pulmonary hypertension;

3) Echocardiography revealed signs of pulmonary hypertension, systolic or diastolic dysfunction in patients with chronic heart failure.

Indications to the direction on the consultation of experts are:

- Nephrotic syndrome (nephrologist consultation);

- CVI, suspected lymphostasis, venous thrombosis and thrombophlebitis (Consultation vascular surgeon);

- Cirrhosis of the liver (gastroenterologist consultation).
Cardiac edema as a manifestation of heart failure

In patients with chronic heart failure are identified heart disease (malformations, atherosclerotic cardio, myocardial infarction, cardiac aneurysm, congestive cardiomyopathy, etc.).

Determined expansion of borders of the heart to some extent, hepatomegaly.

Often marked arrhythmias, especially atrial fibrillation. Characteristic position orthopnea, oliguria, nocturia, congestion in the lungs, swelling of the neck veins.

The development of edema is usually preceded by a shortness of breath. Swelling grow slowly, usually spread from the bottom up. They are symmetrical, there is little shift. Taken into account the dependence of the expressed edema of the position of the body: the appearance on the legs of the walking and waist in bedridden patients. Edema is usually stronger in the evening.

They are characterized by testovatoy consistency with pressure remains long pit disappearing. The skin over the area of edema cold, cyanotic. With long-term existence of edema occur trophic changes in the skin, cracks, dermatitis. In severe cases (anasarca) external swelling combined with ascites, hydrothorax, most - right-sided, at least - with hydropericarditis.

Edema associated with kidney disease

Gipoonkoticheskie swelling can occur when hypoproteinemia (less than 50 g / l). Particular importance is albumin deficiency (less than 25 g / l), having a much greater osmotic activity than globulins.

Edema in nephrotic syndrome appear primarily in the places with the most loose subcutaneous tissue: on the face (especially the eyelids), on the anterior abdominal wall, in the genital area. Shortness of breath is not typical. No swelling, depending on body position.

Gradually the swelling can reach the degree of hydrops. Often they are accompanied by ascites, rarely - hydrothorax. Oliguria is optional. Characterized by high proteinuria (daily - more than 3 grams), hypoproteinemia, Dysproteinemia, hyperlipidemia, often - an abundance of cylinders in the urine (granular, fatty, waxy) and fat degenerated renal epithelium. When obscure reason of nephrotic syndrome is a kidney biopsy.

Nephritic edema often observed in acute or chronic glomerulonephritis (without nephrotic syndrome) occur due to the reduction of sodium filtration charge and increase the permeability of the capillary wall.

Characterized by rapid development of edema (a few days). Thus they may sometimes appear earlier than changes in urine. Edema expressed moderately, are located in areas with the most loose fiber (eyelids, face), stronger - in the morning, quite soft and mobile. The skin over the swelling area of warm, pale. Trophic changes are not typical. swelling often associated with oliguria, hypertension. Almost always there is a urinary syndrome (mild proteinuria, hematuria, cylindruria). Laboratory signs of nephrotic syndrome are absent.

Edema in liver diseases

Swelling caused by hypoalbuminemia in liver disease may manifest itself in the advanced stages of severe liver disease (chronic hepatitis, cirrhosis) in patients with severe violation albumin synthesizing function of the liver. Most ascitic syndrome (often in conjunction with right hydrothorax) dominates in liver diseases.

Edematous syndrome in diseases of the joints

In diseases of the joints edema syndrome has a very specific pattern. Unlike all the other extremity edema options "joint" has a local character. He appears in the affected joint area is not common in the distal direction or the other.

The demonstration clearly edema associated with the appearance of other symptoms - pain in the joints, is greatly enhanced by its flexion and extension, limitation of active and passive movements. Many patients say the so-called starting problems - joint stiffness in the morning after a night's rest, passing after 10-20 minutes of movement.

edema regression observed as inflammation relief, the next episode of the acute edema syndrome reappears. Some patients with knee OA may be swelling or leg and pastoznost nadlodyzhechnoy area. The mechanism of occurrence of symptoms associated with vascular compression of the medial lymph collector in severe swelling of the subcutaneous tissue in the knee area.

Edema in pregnant women

In normal pregnancy swelling of the ankles in the later stages are quite often. The development of hydrocephalus pregnant women is associated with impaired vodnosolevogo metabolism and blood circulation in the capillaries of the system and as a result of the changed precapillaries neuroendocrine regulation.

Usually hydrops pregnant detected after the 30th week of pregnancy, at least - before. Attention is drawn to a greater increase in body weight (1.2 kg per week, while during normal pregnancy, it is 300-400 g per week). Initially, edema appear on the feet and legs, then raised above. Even with large edema and ascites, hydrothorax not observed. The general condition is satisfactory. In contrast, no change nephropathy pregnancy urine (in no particular proteinuria) and hypertension. Prognosis is generally favorable. In rare cases, a transition nephropathy in pregnant women.

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