Edema is the medical term for swelling.

It is a general

response of the body to injury or inflammation. Edema can be isolated to a small area or affect the entire body.
Edema results whenever small blood vessels become

"leaky" and release fluid into nearby tissues. The extra fluid accumulates, causing the tissue to swell

 Swelling caused by edema commonly occurs in the

hands, arms, ankles, legs and feet. It is usually linked to the venous or lymphatic systems. Edema was formerly known as dropsy or hydropsy. Edema may be generalized or local. It can appear suddenly, but usually develops subtly - the patient may first gain weight, or wake up with puffy eyes. Many patients wait until symptoms are well advanced before seeking medical help.

CAUSES OF EDEMA
Causes of Edema
Edema is a normal response of the body to inflammation or

injury. For example, a twisted ankle, a bee sting, or a skin infection will all result in edema in the involved area. In some cases, such as in an infection, this may be beneficial. Increased fluid from the blood vessels allows more infection-fighting white blood cells to enter the affected area. Edema can also result from medical conditions or problems in the balance of substances normally present in blood. Some of the causes of edema include:

 Low albumin (hypoalbuminemia): Albumin and other

proteins in the blood act like sponges to keep fluid in the blood vessels. Low albumin may contribute to edema, but isn't usually the sole cause. Allergic reactions: Edema is a usual component of most allergic reactions. In response to the allergic exposure, the body allows nearby blood vessels to leak fluid into the affected area. Obstruction of flow: If the drainage of fluid from a body part is blocked, fluid can back up. A blood clot in the deep veins of the leg can result in leg edema. A tumor blocking lymph or blood flow will cause edema in the affected area.

 Critical illness: Burns, life-threatening infections, or

other critical illnesses can cause a whole-body reaction that allows fluid to leak into tissues almost everywhere. Widespread edema throughout the body can result. Edema and heart disease (congestive heart failure): When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. If fluid buildup occurs rapidly, fluid in the lungs (pulmonary edema) can develop. Edema and liver disease: Severe liver disease (cirrhosis) results in an increase in fluid retention. Cirrhosis also leads to low levels of albumin and other proteins in the blood. Fluid leaks into the abdomen (called ascites), and can also produce leg edema.

 Edema and kidney disease: A kidney condition called

nephrotic syndrome can result in severe leg edema, and sometimes whole-body edema (anasarca).

Edema and pregnancy: Due to an increase in blood volume

during pregnancy and pressure from the growing womb, mild leg edema is common during pregnancy. However, serious complications of pregnancy such as deep vein thrombosis and preeclampsia can also cause edema.
caused by head trauma, low blood sodium (hyponatremia), high altitude, brain tumors, or an obstruction to fluid drainage (hydrocephalus). Headaches, confusion, and unconsciousness or coma can be symptoms of cerebral edema.

Cerebral edema (brain edema): Swelling in the brain can be

OTHER COMMON CAUSES OF EDEMA

Edema is most commonly caused by:
Physical inactivity - edema is more prevalent among

people who do not exercise at all, and walk very little.

Standing or sitting still for long - if you stand or sit

still for a long time there is a much higher chance of swelling. Surgery - there is usually some swelling after a surgical procedure.

 Burns - the skin reacts to a burn by retaining fluid,

causing localized swelling.

Pregnancy - during pregnancy the woman releases

hormones which encourage the body to retain fluids. Pregnant women tend to retain much more sodium and water than women who are not pregnant. When a woman is pregnant her face will typically swell, as will her hands, lower limbs and feet.

 Menstruation and pre-menstruation - hormone

levels fluctuate during the menstrual cycle. During the days before menstrual bleeding there will be a reduction in the levels of the hormone progesterone, which may cause fluid retention.

Menopause - around the period of the menopause as well as after

it, hormone fluctuations can cause fluid retention. Hormone replacement therapy after the menopause can also cause edema.

Certain medications - such as vasodilators

vessels), calciumchannel blockers, NSAIDs drugs), estrogens, severalchemotherapy drugs, and some diabetes drugs, such cause edema

CLASIFICATION
Cutaneous edema is referred to as "pitting" when, after

pressure is applied to a small area, the indentation persist Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedemas for some time after the release of the pressure

PITTING EDEMA

NON PITTING EDEMA

MECHANISM
Six factors can contribute to the formation of edema:
increased hydrostatic pressure; reduced oncotic pressure within blood vessels; increased tissue oncotic pressure; increased blood vessel wall permeability e.g. inflammation; obstruction of fluid clearance via the lymphatic system; changes in the water retaining properties of the tissues

themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.

There are many types of edema. The most common ones are:
Peripheral edema - in the feet (pedal edema), ankles,

legs, hands and arms.

Cerebral edema - in and around the brain (cerebral

edema).
Eye edema - in and around the eyes, e.g. macular

edema, corneal edema, periorbital edema (puffiness around the eys. Macular edema is a serious complication of diabetic retinopathy

SYMPTOMS OF EDEMA
Symptoms will mainly depend on the underlying

cause. The following refer to generalized edema: Swelling of the skin. Skin may be stretched and shiny. The skin may retain a dimple after being pressed for about ten seconds. Puffiness of the ankles, face or eyes. Aching body parts.

 Stiff joints.
Weight gain. Weight loss.

Hand and neck veins are fuller.

Raised pulse rate. Hypertension - raised blood pressure

DIAGNOSIS
The patient will be asked questions about his/her:
Medical history. Current state of health.

How long the signs and symptoms have existed.

How permanent or intermittent the signs and

symptoms are. Whether the patient has had edema before.

 The physician will also carry out a physical exam.

If there are indications that there may be an underlying medical condition causing the edema the doctor may order some tests, these may include: A chest X-ray Blood tests Urine tests Liver function

TREATMENT
In order to treat the edema the doctor has to diagnose the

condition that is causing it first.

Diuretics

These are drugs that raise the rate of urination, providing a means of forced dieresis. Diuresis is the increased production of urine by the kidney. There are several types of diuretics - they increase the excretion of water from the body in various different ways. Diuretics are not suitable if the patient is pregnant, or has chronic venous insufficiency

SELF CARE TECHNIQUES

Cut down salt consumption.

If the patient is overweight, to lose weight.

Do regular exercise. Raise the legs several times per day to improve

circulation.

 Wear supporting stockings. DO NOT sit/stand still for too long.

Get up and walk about regularly when travelling by car,

train, boat or plane.

Avoid extremes of temperature, such as hot baths, showers,

and saunas. Dress warmly if it is cold.

Massage - if the affected area is stroked firmly in the direction of

the heart it may help move the fluid. It is important that the hand movements do not cause pain. A qualified masseuse or physical therapist will know how to do this more effectively.

COMPLICATIONS OF EDEMA
Edema is usually caused by an underlying disease or

condition. If that condition is not treated, the health consequences could be serious. Untreated edema can cause: Painful swelling. The pain can gradually get worse. Walking difficulty. Stiffness. Awkward gait.

Skin can become stretched, itchy The swollen area is more likely to become infected.
Scarring may occur between the layers of tissue. Poor blood circulation. Arteries, veins, and joints may lose their elasticity. Ulcerations of the skin.

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