Oedema Examination - Patient Management

Oedema

·        Include in exam of appropriate system

·        Need to retain 3 – 4 litres before pitting begins

·        Exam:

o  Where is it? Distribution

o  Is it pitting

o  Other signs of inflammation

·        Mechanisms:

o  ↓colloid osmotic pressure

o  ↑hydrostatic pressure

o  ↓permeability of wall

·        Localised Cause:

o  Inflammatory (e.g. infection, allergy - cytokine mediated) ® pain/heat/redness/swelling

o  Trauma

o  Venous occlusion by tumour or lymph nodes

o  Thrombis (e.g. DVT)

·        Generalised Cause:

o  Is it bilateral?  Usually worse in the evenings

o  Heart Failure:

§  Mechanism: ↑preload ® ↑venous pressure, ↓renal perfusion ® ↑renin ® ↑Na/H20

§  History: check SOB, orthopnea, PND

§  Signs/Tests: CXR, ECG, Echo

o  Liver:

§  Mechanism: liver failure/malnutrition ® ↓colloid pressure ® ↓renal flow ® ↑retention

§  History: check alcohol, cholestasis, hepatitis, bleeding, bruising

§  Signs/Tests: portal hypertension, enlarged liver, jaundice, bloods (Liver Function, INR)

o  Renal:

§  Mechanism: nephrotic syndrome ® ↓colloid pressure (have to loose 3.5 g protein a day to be nephrotic. NB nephritis is inflammation)

§  History: check change in urination, nocturia (due to diuresis), diabetes

§  Signs/tests: ↑BP, urine test, 24 hr urine, dipstick, urea/creatinine

o  Drugs (eg vasodilators, like calcium channel blockers) can cause ankle oedema

o  Gastrointestinal: Malabsorption ® hypoalbuminaemia

·        Non-pitting lower limb oedema

o  Lymphoedema (eg malignant invasion of lymphatics, allergy) doesn‟t pit – push for 10 seconds

o  Hypothyroidism