Comprehensive Edema Overview and Treatment
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ritik patelComprehensive Edema Overview and Treatment
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ritik patelThis is a very comprehensive set of notes on Edema (Dropsy/Hydropsy).
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Notes on Edema (Dropsy/Hydropsy)
Definition
● It is a general response of a body to any injury or inflammation.
● It is an abnormal accumulation of fluid beneath the skin in one or more parts of the
body due to any injury or inflammation.
I. Classification of Edema
1. According to Area Involvement
● Localised edema: If a particular area of the body, like joints, is involved.
● Generalised edema: If the edema involves the whole limb.
2. According to Nature
● Pitting edema: When, after pressure is applied to a small area, the indentation persists
for some time after the release of pressure.
○ It occurs because of water retention.
○ Examples: Varicose veins, cirrhosis of the liver, lung disorders, liver disease, heart
valve problems.
○ It is associated with lymphoedema or lipoedema.
○ Example: Elephantiasis. In mastectomy, lymph around the axilla is removed and it
can cause swelling over the affected limb.
● Non-pitting edema: If, on giving pressure, the indentation does not persist.
3. Organ Specific Edema
● Cerebral edema: It is the accumulation of extracellular fluid in the brain.
○ It can occur in any type of internal trauma to the brain, reduced oxygen supply (high
altitude), or because of toxins.
○ It can cause drowsiness or loss of consciousness.
● Pulmonary edema: If the pressure in the blood vessels in the lungs increases because of
obstruction in the pulmonary vein.
○ It can also occur due to inhalation of toxic chemicals as well as high altitude.
● Edema in Liver Disease: Severe liver disease results in fluid retention.
○ It can also lead to low levels of albumin & other proteins in the fluid.
○ Example: Cirrhosis.
● Cardiac edema: When the heart weakens and pumps blood less effectively, fluid can
slowly accumulate, creating leg edema.
● Edema in Kidney Disease: It is also called nephrotic syndrome.
○ It can cause severe edema, and sometimes whole-body edema.
○ It is also seen along with facial edema.
● Edema & Pregnancy: Due to an increase in blood volume & pressure from the
growing embryo, it can cause mild leg edema.
● Allergic reactions: It is also one of the reasons for edema in response to allergic
exposure to certain noxious stimuli.
● Burn: Burn is also one of the reasons for developing edema.
● Myxedema: It is caused by increased deposits of connective tissue.
○ The condition is characterized by an increased tendency of tissue to hold water
within the extracellular space.
● Mosquito bite, bee sting, insect bite, skin contact with certain plants, skin
infections like dermatitis: All these produce cutaneous edema.
II. Factors Affecting Edema
There are various factors which contribute to the formation of edema:
1. Increased Hydrostatic pressure
2. Reduced oncotic pressure within blood vessels
3. Increased tissue oncotic pressure
4. Increased blood vessel wall permeability
5. Obstruction of fluid clearance via the lymphatic system
6. Changes in the water retaining property of the tissues themselves
III. Symptoms of Edema
● Edema symptoms depend upon the amount of edema & the body part affected.
● Edema in a small area from an infection or inflammation (such as a mosquito bite) affects
for a small period of time.
● In a large area on the other hand, edema can be large. It can affect the entire limb.
● In these conditions, swollen skin, intense pain, and limited movement are symptoms
of edema.
● Example: Pulmonary edema causes shortness of breath. Food allergy may cause
throat edema or tongue edema, which may interfere with breathing, causing a
life-threatening condition.
IV. Assessment of Edema
1. Girth Measurement
● a) Circumferential method: Measurement is taken over the skin at a certain part with
reference to bony prominences.
● b) Figure of eight method: It is a more reliable technique than the circumferential
method as it covers a bigger area.
○ The measurement is covered with a tension-controlled measuring tape.
○ It is used to measure the swelling around the ankle, foot, or hand.
○ It is usually easier to do and it has its own specific point across its consistency.
2. Pitting Edema Assessment
● Pressure is given (thumb of foot) from the tip of the hand over the dorsum, behind the
medial malleolus, or above the medial malleolus.
● Pit depth & the time needed for the skin to return to its original position (Recovery
time) are recorded.
● The grading of edema is determined by pit depth & recovery time from Grade 0 to 4 of
the scale, and it is used to grade the severity of edema.
Grade Description Pit Depth & Rebound Time
Grade 0 No clinical edema -
Grade 1 Slight pitting 2 mm depth & the rebound is
immediate.
Grade 2 Somewhat deeper pit Approx 4 mm depth & the
rebound is less than 15 sec.
Grade 3 Modified deep pit 6 mm depth with dependent
extremity affected. Full of
swollen fluid. It takes 30 sec to
rebound.
Grade 4 Very deep pit 8 mm depth & it takes more
than 30 sec to rebound.
V. Treatment of Edema
● Primarily, the treatment is to treat the underlying cause of the edema.
● It includes two types of management: medical management and physiotherapy
management.
1. Medical Management
● Antihistaminics
● Corticosteroids
● If the patient is having edema resulting from blockage in blood vessels (thrombosis or
embolism), it can be treated by anticoagulant drugs like ecasperin (likely a misspelling
of Aspirin or Enoxaparin/Heparin).
● If the blockage is from outside due to the abnormal growth of tissues, then it can be
treated by chemotherapy or radiotherapy.
● If the leg edema occurs which is connected with CHF (Congestive Heart Failure) or liver
disease, it can be treated by diuretics like furosemide, thiazide, etc.
2. Physiotherapy Management
● Elevation of limb above the heart level.
● Crab bandage application (compression bandaging): It should be applied distal to
proximal. Distally, the pressure should be more than the proximally aspect.
● Faradism under pressure: By placing electrodes under the crab bandage.
● Cryotherapy: It should be between 10 to 15 min but should not be less than 10 min.
● Massage techniques are also useful:
○ Effleurage
○ Friction
○ Kneading
● Exercise: Ankle pump exercise.
● Pneumatic compression therapy
● If the patient is having localized edema: Various types of different current are used
(including IFT).
● IFT and Ultrasound therapy are useful in the reduction of edema.
● If the patient is having chronic edema: Mobilization of the joint is performed to loosen
the edema, along with ultrasound therapy.
● If the patient is having chronic generalized edema: Salt-restricted diet is advised.
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Common questions
Powered by AIEdema can cause swollen skin, pain, and reduced range of motion, severely affecting mobility. Physiotherapy treatments such as exercises and ultrasound therapy can promote fluid drainage, reduce swelling, and restore function. Compression techniques and massages also aid in reducing fluid retention, improving mobility and functional recovery .
Various medical conditions can lead to edema, including heart valve problems, liver diseases like cirrhosis, lung disorders, cerebral and pulmonary conditions, nephrotic syndrome (kidney disease), congestive heart failure, allergic reactions, and conditions like Myxedema and chronic during pregnancy due to increased blood volume and pressure .
The primary factors contributing to edema formation include increased hydrostatic pressure, reduced oncotic pressure within blood vessels, increased tissue oncotic pressure, increased blood vessel wall permeability, obstruction of fluid clearance via the lymphatic system, and changes in the water-retaining property of the tissues themselves .
Edema can be classified based on area involvement (localized or generalized) and nature (pitting or non-pitting edema). Localized edema affects particular areas like joints, while generalized edema involves entire limbs. Pitting edema retains indentation after pressure due to water retention, associated with conditions like varicose veins and heart valve problems. Non-pitting edema does not retain indentation. It can also be classified by organ-specific differences, such as cerebral, pulmonary, and cardiac edema .
Oncotic pressure, primarily driven by plasma proteins like albumin, prevents fluid from leaking out of blood vessels. Reduced oncotic pressure leads to fluid retention and edema. This is significant in conditions like liver disease, which causes low albumin levels, reducing oncotic pressure, thereby contributing to edema development .
Physiotherapy for edema includes limb elevation above heart level to promote fluid return, compression bandaging to reduce edema through pressure gradients, cryotherapy to limit swelling, and massage techniques to enhance fluid movement. Exercises like ankle pumps increase circulation, while therapies like pneumatic compression, IFT, and ultrasound therapy help mobilize joints and decrease fluid retention .
The grading of pitting edema involves assessing pit depth and rebound time, ranging from Grade 0 to 4. Grade 0 indicates no clinical edema, Grade 1 shows slight pitting with immediate rebound, Grade 2 involves a 4 mm pit with rebound in under 15 seconds, Grade 3 features a 6 mm pit taking 30 seconds to rebound, and Grade 4 involves an 8 mm pit with rebound taking over 30 seconds .
Pulmonary edema occurs due to increased pressure in lung blood vessels because of pulmonary vein obstruction or toxic chemical inhalation, leading to shortness of breath. Cerebral edema is the extracellular accumulation of fluid in the brain caused by internal trauma, oxygen deprivation, or toxins, resulting in symptoms like drowsiness or loss of consciousness .
Edema assessment includes girth measurement and pitting edema assessment. Girth measurement uses the circumferential method, based on the skin measurement at anatomical landmarks, and the figure-of-eight method, which measures swelling around joints with tension-controlled tape. Pitting edema assessment involves applying pressure to determine pit depth and recovery time, with grading from 0 to 4 .
Edema treatment primarily addresses underlying causes, involving medical management such as antihistamines, corticosteroids, anticoagulant drugs, chemotherapy, and diuretics. Physiotherapy management includes limb elevation, compression bandaging, cryotherapy, massage techniques, exercises, and therapies like IFT and ultrasound. Treatments like chemotherapy are used if edema results from external obstructions like abnormal tissue growth .