Edema syndrome

Edema syndrome is an excessive accumulation of fluid in the body's tissues and serous cavities, accompanied by an increase in tissue volume or a decrease in the serous cavity with a change in the physical properties (turgor, elasticity) and function of tissues and organs.

Differentiation of edemas due to systemic pathological conditions from those due to local disorders can vary in complexity from a simple and straightforward clinical task to a very difficult and complex diagnostic problem. Edemas may result from increased capillary permeability, obstruction of venous blood or lymphatic drainage; fluid may accumulate in tissues due to decreased oncotic pressure in the blood plasma.

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What causes edema syndrome?

Edema syndrome is an important symptom of many diseases of organs and the regulatory system and, by its appearance, often serves for differential diagnostics of diseases that caused edema syndrome. A distinction is made between local (local) edema syndrome, associated with a violation of the fluid balance in a limited area of the body or organ, and general edema syndrome, as a manifestation of a positive fluid balance in the entire body. According to the disease that caused the development of edema, a distinction is made between: cardiac, renal, portal (ascites), lymphostatic, angioneurotic, etc.

Pulmonary edema, cerebral edema and swelling, laryngeal edema, hydrothorax, hydropericardium, etc. are distinguished as separate forms, posing a threat to life or complications, since edemas are easily susceptible to infection.

The predominant localization and nature of edema have specific features in various diseases, which are used for their differential diagnosis.

1. Heart disease
2. Kidney diseases
3. Liver diseases
4. Hypoproteinemia
5. Venous edema
6. Lymphatic edema
7. Traumatic
8. Endocrine
   • Myxedema.
   • Fatty edema syndrome.
9. Neurogenic edema syndrome
   • Idiopathic edema syndrome (Parchon's disease).
   • Hypothalamic edema syndrome.
   • Trofedema Mezha.
   • Complex regional pain (reflex sympathetic dystrophy).
10. Iatrogenic (medicinal)
    • Hormones (corgacosteroids, female sex hormones).
    • Antihypertensive drugs (rauvolfia alkaloid, apressin, methyldopa, beta-blockers, clonidine, calcium channel blockers).
    • Anti-inflammatory drugs (butadion, naproxen, ibuprofen, indomethacin).
    • Other drugs (MAO inhibitors, midantan).

Heart disease

In cardiac edema, there is usually a history of heart disease or cardiac symptoms: dyspnea, orthopnea, palpitations, chest pain. Edema in cardiac failure develops gradually, usually after preceding dyspnea. Simultaneous swelling of the jugular veins and congestive enlargement of the liver are signs of right ventricular failure. Cardiac edema is localized symmetrically, mainly on the ankles and shins in ambulatory patients and in the tissues of the lumbar and sacral regions in bedridden patients. In severe cases, ascites and hydrothorax are observed. Nocturia is often detected.

Kidney diseases

This type of edema is characterized by gradual (nephrosis) or rapid (glomerulonephritis) development of edema, often against the background of chronic glomerulonephritis, diabetes, amyloidosis, lupus erythematosus, nephropathy of pregnancy, syphilis, renal vein thrombosis, and some poisonings. Edema is localized not only on the face, especially in the eyelid area (facial swelling is more pronounced in the morning), but also on the legs, lower back, genitals, and anterior abdominal wall. Ascites often develops. Dyspnea, as a rule, does not occur. Acute glomerulonephritis is characterized by an increase in blood pressure and the possible development of pulmonary edema. Changes in urine tests are observed. With long-term kidney disease, hemorrhages or exudates in the fundus may be observed. Tomography and ultrasound reveal a change in the size of the kidneys. A study of kidney function is indicated

Liver diseases

Liver diseases usually cause edema in the late stages of postnecrotic and portal cirrhosis. They manifest themselves mainly as ascites, which is often more pronounced than edema in the legs. During examination, clinical and laboratory signs of the underlying disease are revealed. Most often, there is previous alcoholism, hepatitis or jaundice, as well as symptoms of chronic liver failure: arterial spider hemangiomas ("stars"), liver palms (erythema), gynecomastia and developed venous collaterals on the anterior abdominal wall. Ascites and splenomegaly are considered characteristic signs.

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Hypoproteinemia

Edema associated with malnutrition develops with general starvation (cachectic edema) or with a sharp lack of protein in the diet, as well as with diseases accompanied by protein loss through the intestines, severe vitamin deficiencies (beriberi) and in alcoholics. Other symptoms of nutritional deficiency are usually present: cheilosis, red tongue, weight loss. In edema caused by intestinal diseases, the anamnesis often includes indications of intestinal pain or profuse diarrhea. Edema is usually small, localized mainly on the shins and feet, and puffiness of the face is often found.

How does edema syndrome manifest itself?

Clinically, general edema syndrome becomes visible when the body retains more than 2-4 liters of water, local edema syndrome is detected with a smaller accumulation of fluid. Peripheral edema syndrome is accompanied by an increase in the volume of a limb or body part, swelling of the skin and subcutaneous tissue, and a decrease in their elasticity. Palpation reveals a doughy consistency of the skin, pressing with a finger leaves a pit that quickly disappears, which distinguishes them from false edema, for example, with myxedema it is pressed with difficulty, the pit is retained from several minutes to several hours, and with scleroderma, local obesity, the pit does not form at all. The skin is pale or cyanotic, can crack with the flow of swollen serous fluid or lymph through the cracks during the formation of ulcers, against the background of myxedema.

Venous edema syndrome

Depending on the cause, venous edema can be either acute or chronic. Acute deep vein thrombosis is typically accompanied by pain and tenderness upon palpation over the affected vein. With thrombosis of larger veins, an increase in the superficial venous pattern is also usually observed. If chronic venous insufficiency is caused by varicose veins or insufficiency (postphlebitic) of the deep veins, then symptoms of chronic venous stasis are added to orthostatic edema: congestive pigmentation and trophic ulcers.

Lymphatic edema syndrome

This type of edema is classified as local edema; it is usually painful, prone to progression, and accompanied by symptoms of chronic venous congestion. On palpation, the edema area is dense, the skin is thickened ("pig skin" or orange peel), when the limb is raised, the swelling subsides more slowly than with venous edema. There are idiopathic and inflammatory forms of edema (the most common cause of the latter is dermatophytosis), as well as obstructive (as a result of surgical intervention, scarring due to radiation damage or a neoplastic process in the lymph nodes), leading to lymphostasis. Long-term lymphatic edema leads to the accumulation of protein in tissues with subsequent proliferation of collagen fibers and deformation of the organ - elephantiasis.

Traumatic edema syndrome

Swelling after mechanical trauma also refers to local edema; they are accompanied by pain and tenderness upon palpation and are observed in the area of the previous injury (bruise, fracture, etc.)

Endocrine edema syndrome

1. Thyroid insufficiency (hypothyroidism) in addition to other symptoms is manifested by myxedema - generalized swelling of the skin. The skin is pale, sometimes with a yellowish tint, dry, flaky, dense. Mucous edema of the subcutaneous tissue is pronounced, especially on the face, shoulders and shins. When pressing, there is no pit in the skin (pseudoedema). There are concomitant symptoms of hypothyroidism (decreased metabolism, bradycardia, depression, decreased attention, hypersomnia, muffled voice, etc.) and a decreased content of thyroid hormones in the blood.
2. Fatty edema. This type of edema occurs in women and is manifested by noticeable symmetrical obesity of the legs. The usual complaint presented to the physician is "swollen legs", which in fact occurs and increases in the orthostatic position. They usually increase before the onset of menstruation, when bathing in warm water, during prolonged sitting, or uncontrolled use of salt. The area of edema is soft, with a depression when pressed, there are no symptoms of chronic venous congestion; the long-term existence of these edemas allows us to exclude deep vein thrombosis. In a patient with fatty edema, the feet and toes do not change, while in other types of lower limb edema they swell. Diagnostic difficulties arise with concomitant varicose veins, but the symmetry of the lesion and the typical location of fat deposits, as well as the normal shape of the feet and toes, should help in establishing the correct diagnosis.

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Neurogenic edema syndrome

1. Idiopathic edema syndrome (Parchon's disease) is a clinical symptom observed mainly in women aged 30-60 years and characterized by a decrease in the amount of urine, lack of thirst and the occurrence of edema not associated with pathology of the heart, liver and kidneys. Sometimes there are symptoms of organic brain and mild hypothalamic insufficiency: a tendency to obesity, emotional (demonstrative) and vegetative-vascular disorders, residual neurological microsymptoms. A provoking factor is often mental trauma. Edema increases with prolonged standing. In addition to edema of the lower extremities, patients may note an increase in the abdomen and mammary glands. Patients often complain of swelling of the face and hands in the morning, which subsides with movement. A study of the hormonal profile can reveal an increased content of aldosterone, an imbalance of sex hormones, a change in renin activity.
2. Hypothalamic edema can develop with involvement (not necessarily direct and immediate) of the hypothalamus in one or another pathological process (infarction, tumor, hemorrhage, meningitis, trauma) and cause a symptom of inadequate secretion of antidiuretic hormone (usually transient) with hyponatremia and water retention in the body.

Symptoms of water intoxication with fluid retention are also characteristic of Schwartz-Barter disease, caused by increased secretion of an ADH-like substance in bronchogenic carcinomas and other non-endocrine tumors. The ADH content in the posterior pituitary gland is normal.

3. Trophedema Mezha (Mezha's edema) is a very rare disease of unknown etiology, manifested by limited swelling of the skin, which quickly increases and lasts from several hours to several days, then regresses, but does not completely pass, leaving residual swelling. Later, relapses of edema are observed in the same place. The edema is dense; finger pressure does not leave a depression. Skin compaction after relapses becomes more pronounced. The edema gradually organizes. The affected part of the skin loses its usual normal shape. Optional symptoms: increased body temperature during edema, chills, headache, confusion.

Along with swelling of the face or limbs, pulmonary or laryngeal edema, tongue edema may sometimes be observed. Edema of the gastrointestinal tract, labyrinth, and optic nerve has also been described. Such edema is also part of the Melkersson-Rosenthal symptoms.

4. Complex regional pain (reflex sympathetic dystrophy) at a certain stage of its development may be accompanied by swelling of the painful part of the limb. The main complaint of the patient is burning vegetative pain. Trauma and prolonged immobilization are the main risk factors for the development of edema syndrome. Allodynia and trophic disorders (including in bone tissue) are characteristic.

Iatrogenic edema syndrome

Among the drugs that can lead to edema, the most frequently noted are hormones (corticosteroids and female sex hormones), antihypertensive drugs (rauvolfia alkaloids, apressin, methyldopa, beta-blockers, clonidine, calcium channel blockers), anti-inflammatory drugs (butadion, naproxen, ibuprofen, indomethacin), MAO inhibitors, midantan (the latter drug sometimes leads to effusion in the pleural cavity).

Cardiac edema syndrome

They develop gradually with left ventricular failure, after previous dyspnea, are located on the ankles and shins, are symmetrical, in bedridden patients and on the back. The skin is quite elastic, pale or cyanotic, the edema is easily pressed through, but with prolonged edema the skin can become rough. With right ventricular failure, which is determined by the simultaneous enlargement of the liver and swelling of the jugular veins, simultaneously with edema in the legs, ascites, hydrothorax (usually on the right), rarely hydropericardium can form. There may be pulmonary edema with previous dyspnea.

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Nephritic edema syndrome

Develops in the earliest stages of acute glomerulonephritis. Edema is localized mainly on the face, upper and lower extremities. The skin is pale, dense, normal temperature. Rarely, hydrothorax, hydropericardium develop, there may be pulmonary edema, but without previous dyspnea.

Nephrotic edema syndrome

It develops with subacute chronic glomerulonephritis, renal amyloidosis, nephropathy of pregnancy, some poisonings, especially alcohol, lupus erythematosus, syphilis, and renal vein thrombosis.

Edemas are predominantly on the face, more in the eyelid area and under the eyes, increase in the morning, in addition, they can be on the legs, genitals, lower back, anterior abdominal wall. The skin is dry, soft, pale, sometimes shiny. Edemas are loose, easily pressed and shifted when changing body position. Ascites often occurs, there may be hydrothorax, but they are small in volume and not pronounced, there is no shortness of breath.

Cachexic edema syndrome

It develops during prolonged starvation or insufficient protein intake, as well as during diseases accompanied by a large loss of protein (gastroenteritis, ulcerative colitis, intestinal fistulas, alcoholism, etc.).

Edema syndrome is usually small, localized on the feet and shins, the face is characterized by puffiness, although the patients themselves are exhausted. The skin is of a doughy consistency, dry.

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Edema syndrome of pregnancy

As a manifestation of toxicosis, they occur after the 25th-30th week of pregnancy, at earlier stages they are a manifestation of heart failure or develop due to exacerbation of renal pathology. At first, edema is localized on the legs, then expands to the genitals, the anterior abdominal wall, the lower back, and the face. The skin is soft, moist. Edema is easily pressed through. Ascites and hydrothorax occur very rarely.

Idiopathic edema syndrome

They develop in women prone to obesity, vegetative disorders; in the initial period of menopause. At the same time, there are no other systemic diseases and metabolic disorders. Edema occurs in the morning, on the face, more under the eyes in the form of swollen bags, on the fingers. Edema is soft, quickly disappears after a regular light massage.

In hot weather, with orthostatic insufficiency (prolonged standing, sitting), edema syndrome can manifest itself in the form of swelling in the legs, the skin is often cyanotic, its elasticity is preserved, and there is often hyperesthesia.

The peculiarity is Quincke's edema, allergic and non-allergic edema syndrome, when it is a hereditary disease.

Characterized by sudden development of general or local edema of the subcutaneous tissue and mucous membranes of the larynx; brain and spinal cord, abdominal organs. Edema syndrome develops very quickly, the patient feels distension, but itching is not typical. Edema of the larynx can cause asphyxia.

Considering that edematous syndrome is a manifestation of the insufficiency of some main organ or system involved in homeostasis, when general edema is detected, the patient should be referred or consulted by a specialist of the corresponding profile. Another matter is localized edema, which is mostly a manifestation of surgical pathology, injuries. Doctors consider these issues in each specific case according to nosology or in combination with other diseases.

A special place is occupied by edematous syndrome in gas gangrene. Its peculiarity is a large volume (2-4 liters of fluid go into effusion per day), rapid increase and spread in the proximal direction, leading to compression of venous and arterial trunks. Such rapidly progressing edematous syndrome is pathognomonic for anaerobic clostridial infection. It is detected by taking a thread tied around a segment of the limb, it cuts into the skin after 20-30 minutes. This technique was described by ancient doctors, but it does not have an author's name. The technique itself is unreliable, since the same edema can be caused by other types of infection, especially when the inflammation occurs in the form of phlegmon, trauma, especially with damage to blood vessels. A distinctive feature is the specific appearance of the skin of the edematous limb in the form of landcart-like spots of an unusual color: bronze, blue, greenish. Non-clostridial anaerobic edemas do not give such a specific picture. But in both cases, patients should be urgently hospitalized or transferred to specialized purulent-septic resuscitation departments that have the ability to perform hyperbaric oxygenation with high oxygen pressure (2-3 excess atmospheres - Yenisei-type pressure chambers).

Nephrotic syndrome

Nephrotic syndrome in children

How to recognize edema syndrome?

Serum protein electrophoresis, liver function tests, serum T4 and T3 levels, radioimmunological study of serum TSH levels, ECG, chest X-ray, echocardiography, chest CT, cardiac radioisotope angiography, Doppler ultrasound of veins, phlebography, renal tomography, abdominal CT, lymphangiography, consultation with a therapist and endocrinologist.