Edema

Synonyms in a broader sense

• Dropsy
• Water in the legs
• Ascites
• swollen legs
• Pleural effusion
• Ascitis
• Water retention

English

• edema
• ascites

Definition of edema

Under Edema one understands a fluid accumulation in the interstitial tissue (water retention). Interstitial tissue is understood to mean intermediate tissue, mostly connective tissue, which subdivides organs.

The consequences of the edema are e.g. Swelling of the legs. With strong expression it comes to Hydropsanasarca (Accumulation of water, extensive edema, especially of the subcutaneous tissue) and cave effusions with the result that the body water in the lungs (Pleural effusion) or in the stomach (Ascitis) accumulates.

Symptoms of edema

The symptoms of edema are mainly two characteristics.
On the one hand there is pain that can be explained by the reduced blood flow, on the other hand there is typical discoloration. Also read: Circulatory disorders

The discolorations are three-colored and have the following sequence:

• White discoloration (Narrowing of the finger arteries = vasoconstriction of the aa. Digitales)
• Blue discoloration (cyanosis = Lack of oxygen)
• Red discoloration (increased blood flow (reactive hyperemia) as a result of insufficient blood flow)

It is important here that the edema always occurs symmetrically, i.e. affects both hands, feet, etc.

Water in your feet is a particularly common symptom.
Typically worsened Smoke the symptoms, there nicotine the vessels narrowed.

Diagnosis of edema

When diagnosing edema, a distinction must be made between the different types of edema.
There are generalized edema in which the fluid accumulation in the tissue is usually low in protein. These edemas consist of so-called transudate, which is pressed through the inner lining of the blood vessels (endothelium) when the pressure is too high.The edema consists mainly of water.
There is also edema, which consists of an exudate. In inflammatory processes, this enters the tissue by opening the endothelial barriers and is rich in protein. So not only does water leave the vessel, but also protein-rich blood components that attract further water.

Pulmonary edema, for example, can be diagnosed both by auscultation (through the stethoscope) and by percussion (tapping). Through the stethoscope you can hear so-called coarse-bubble, moist rattling noises and when you tap your lungs you can hear a darker knocking sound compared to healthy lung tissue. Pulmonary edema usually occurs symmetrically.

In ascites, the knocking noise is also muffled and a fluctuation wave can be detected. A fluctuation wave occurs when you bump the patient's abdomen on one side and on the other side, with your placed hand, feel a wave moving through the abdomen.
It is best to carry out the examination in a quadruped position. In the ultrasound (sonography) the detection limit is 100ml.

Edema in the legs can be proven very easily by pressing the tissue with a finger. If edema is present, a dent remains in the tissue, which regresses after a while.

Recognize edema

Edema is water retention in the tissue and therefore also shows up in different regions of the body.
They have a wide variety of causes and underlying diseases, but often always show up in the same way. Smaller swellings are initially not noticed by the person affected and typical swelling of the legs in the evening after a long day at work or standing and walking are often considered normal.

However, if the edema persists and continues to increase, the patient will at some point experience an unprovoked increase in weight. The circumference can also be measured on the leg, which is also enlarged. Doctors also measure the condition of the edema in the hospital and also check the patient's fluid intake.
The skin is usually smooth, tense and shiny. The skin can also be marbled and feel colder. Since the water retention can also depress the supplying vessels of the tissue, edema also leads to a deteriorated blood flow. This may also cause a tingling sensation and a changed feeling.

A typical test for edema is pressing in the swelling with one or more fingers. If there is edema, the indented area of ​​skin remains for a short time and only slowly recedes. This is characteristic of swelling with water retention.

Read more about the topic here: Lymphedema.

Therapy edema

The therapy of generalized edema in general is the administration of Diuretics (e.g. Furosemide (Lasix®)), in traditional language "Water tablets" called.
Through this Diuretics the excess water in the tissue is about the Kidneys eliminated, so you have to go to the toilet frequently.
However, this therapy is only symptomatic, i.e. it in no way eliminates the cause of the water retention. Drinking large amounts of fluids should be avoided. The underlying disease must be treated, since edema is not a disease, but only a symptom.
The therapy of protein-rich edema is primarily in the Improvement of lymph drainage. This is where physical edema treatment comes into play. It consists of manual lymphatic drainage and compression treatment.
In the manual lymphatic drainage is tried by light stroking movements (special massage technique) to make the accumulated liquid flow away.
Not only is the drainage through the lymph vessels stimulated, but new lymph vessels are even formed. The firm tissue is loosened with the help of the compressions.

Of the Ascites (Ascites) also has its own therapy. When therapy with Diuretics (Water tablets) is not successful, the fluid in the abdomen can be drained by puncture. The fluid is drawn out of the abdomen using a needle.
Is there a Cirrhosis of the liver as the cause of ascitis, both the so-called peritoneovenous shunt and the TIPSS (transjugular intrahepatic portosystemic stent-shunt) represent.
A peritoneovenous (peritoneum = peritoneum, vein = vessel that transports the deoxygenated blood back to the heart) is a connection between the peritoneal cavity (abdominal cavity; this is where the fluid collects) and the central venous system.
This enables the ascites to flow back into the venous system. A TIPSS is a short circuit between the portal vein and the great main vein (Vena cava) of the body, which carries the blood directly to the heart. The disadvantage of both, however, is that about 40% of the shunt are closed after one year.

prophylaxis

To that Ascites To prevent, the underlying disease must be prevented. In addition, the prescribed Medication (e.g. diuretics) are taken regularly, as these are responsible for ensuring that the water decreases.
You should pay attention to the amount you drink (all liquids, including soup!) Per day, which should not exceed 1.5 liters.

Edema by location of occurrence

Read about this too Lymphedema of the arms

Edema on the legs

Edema is water retention that is particularly common in the legs with various underlying diseases.
One of the first signs of edema in one or both legs is swelling of the ankle, which can spread up to the hip. (e.g. water in the knee) The skin in the area of ​​the swelling can be dented and typically remains that way for a while and only slowly recedes.
In addition, the skin is often very smooth, tense and shiny. The skin may also be paler in color because the blood supply to the tissue is reduced by the accumulation of water in the tissue. Please refer: Water in the legs

Patients often experience weight gain and an increase in leg circumference.
Right heart failure means that the right heart is weak. As part of this disease, both legs typically swell. The swelling begins in the feet and ankles and can progress beyond the shins. The edema often develops during the day and is then particularly clearly visible in the evening. Patients then put their legs up and the swelling will subside overnight.
However, if the underlying disease progresses, the edema can persist permanently.

Another possible cause of edema in the legs is a blockage of a vessel (thrombosis in the leg) or a weakness of the venous valves. The edema usually only occurs in the affected leg. If the venous valve is weak, the veins are no longer able to carry the blood back to the heart. Due to gravity, the blood sinks into the legs and accumulates there.
Ultimately, this will force more fluid into the tissue. Accordingly, the swellings often arise in the feet and lower legs first. Furthermore, swelling can also arise from impaired lymphatic drainage. Lipedema is an increased accumulation of subcutaneous fat tissue, which is accompanied by an accumulation of water in the tissue.
Affected people have characteristic swellings from the pelvis to the ankles. One speaks of the image of the pillar legs, as the legs are often evenly swollen. The cause of edema in one or both legs should always be clarified by a doctor in order to subsequently treat the underlying disease. An initial diagnosis is usually made by the family doctor, who refers the patient to an internist.

Read more on the topic: Edema in the legs

Edema of the eyes

Puffy eyes are common in the morning and can have a variety of causes. In addition to poor sleep behavior, facial edema, which then also affects the eyes, can also occur during pregnancy.
Furthermore, water retention on the eye can also be caused by an existing angioedema. They are also known as Quincke's edema and are often associated with allergies.

The water retention mostly occurs on the upper eyelid, lips, cheeks and forehead and can cause a distorted overall picture. Often with angioedema there is also hives (Urticaria) in front. This is a skin disease that typically causes wheals from too much histamine, but it can also have physical triggers such as cold or warmth due to medication.

Read more on the topic: Angioedema.

Eyelid swellings usually resolve on their own. Cortisone ointments can also help them subside. At night it helps to sleep with your head up, so that the increased fluid can flow away better. However, if the edema persists for a long time, this should be clarified by a doctor. Because kidney or liver dysfunction that can be associated with a protein deficiency can also be the cause of edema in the eye.

More information can be found at: Edema of the eye

Edema on the abdomen

Edema on the abdomen manifests itself on the one hand with a significant increase in the circumference of the abdomen and, on the other hand, usually with an increase in weight.

There can be various causes here.

In women, edema in the abdomen often occurs during the monthly hormonal change and thus during menstruation. This is probably due to the excess of estrogen. Furthermore, a high-salt diet can also lead to edema. They often show up on the legs, but can also affect the stomach. Salt binds water and this then accumulates in the tissue. The swelling and weight gain usually recede again through a balancing intake of fluids.
As part of a Cirrhosis of the liver edema also occurs on the abdomen. This liver disease has a functional impairment of the liver. It does not produce enough proteins, the album in particular is deficient. As a result, too little water is retained in the vessels and, due to the pressure, it finally passes over into the tissue. Ascites is characteristic of cirrhosis. The increased fluid accumulates especially in the abdominal cavity. Finally, in medical terminology, one speaks of ascites. Since the increasing belly can also affect breathing, the fluid is usually drained through a puncture. A similar picture emerges in a state of hunger. The spherical, bloated belly is particularly typical of children. Due to a lack of nutrition, the body also lacks the important proteins such as albumin, which keep the water in the vessels. These symptoms do not only occur in starving people, even with extremely low-protein diets such as vegans, a bloated stomach, feet and also a swollen face can occur.

Edema in pregnancy

The development of edema during pregnancy affects about eighty percent of all pregnant women and is a completely normal problem.
In addition, it is also harmless in most cases. During pregnancy, the body goes through some changes, especially a major hormonal change. Accordingly, the progesterone should be responsible for the increased storage of water in the tissue.

In addition, there is a salt and protein deficiency. Both substances normally bind water and can thus remove excess water from the body. The edema often develops during the day from long periods of standing or walking, often without sufficient breaks. They then show up clearly in the evening and are even more pronounced on warmer days.
The accumulation of water occurs most frequently in the arms and legs, but can also affect the face and other regions of the body.
Edema is usually not a complication during pregnancy and can be treated very well with sufficient rest and raising the legs.

However, if the edema is caused by sudden pregnancy high blood pressure (hypertension), this can cause pregnancy poisoning (pre-eclampsia) speak. Preeclampsia is a typical condition that occurs during pregnancy and is associated with high blood pressure and significant loss of protein in the urine.
It often occurs from the 24th week of pregnancy and the patients suffer from edema. Preeclampsia in a pregnant woman should definitely be clarified by a doctor and monitored regularly. The blood pressure is measured regularly and the electrolyte balance is checked. After the birth, the high blood pressure usually subsides quickly and returns to normal after six weeks at the latest.
The other complaints such as edema also subside again afterwards. However, preeclampsia can suddenly develop into eclampsia. This complication is life-threatening and must be monitored in the hospital and treated immediately. Neurological disorders occur, which can ultimately lead to a seizure in the pregnant woman.
Acute kidney failure, thrombosis, bleeding, placental insufficiency and cerebral edema can also develop. Eclampsia is dangerous for both the mother and the unborn child.

Read more on the topic: Edema during pregnancy, lymphatic drainage during pregnancy