Bilateral leg swelling: Difference between revisions
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==Background== | ==Background== | ||
*Definition: existence of the excess fluid in the lower extremity resulting in swelling of the feet and extending upward | *Most common cause is bilaeral pedal edema | ||
**Definition: existence of the excess fluid in the lower extremity resulting in swelling of the feet and extending upward | |||
**Further classified as pitting (depress-able) and non-pitting | **Further classified as pitting (depress-able) and non-pitting | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:PedalEdema.jpg|thumb|Pitting pedal edema]] | [[File:PedalEdema.jpg|thumb|Pitting pedal edema]] | ||
* | *Bilateral lower extremity swelling | ||
**Pitting = edema | |||
**Non-pitting ("woody") = consider [[pretibial myxedema]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Bilateral pedal edema DDX}} | {{Bilateral pedal edema DDX}} | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*CBC | *CBC | ||
*Chem 7 | *Chem 7 | ||
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*[[UA]] (nephrotic) | *[[UA]] (nephrotic) | ||
*Consider [[BNP]] | *Consider [[BNP]] | ||
===Diagnosis=== | |||
*Idiopathic edema is a diagnosis of exclusion, must first rule out CHF, cirrhosis, renal failure, nephrotic syndrome, chronic venous insufficiency, and medication-induced edema<ref>Kay A, Davis CL. Idiopathic Edema. American Journal of Kidney Disease. 1999; 34(3): 405-408.</ref> | |||
==Management== | ==Management== | ||
Latest revision as of 17:14, 11 March 2021
Background
- Most common cause is bilaeral pedal edema
- Definition: existence of the excess fluid in the lower extremity resulting in swelling of the feet and extending upward
- Further classified as pitting (depress-able) and non-pitting
Causes of pedal edema
- Increased hydrostatic pressure
- Decreased oncotic pressure
- Increased capillary permeability
- Lymphatic obstruction
Clinical Features
- Bilateral lower extremity swelling
- Pitting = edema
- Non-pitting ("woody") = consider pretibial myxedema
Differential Diagnosis
Bilateral leg swelling
- Pedal edema
- Gravitational
- Venous insufficiency
- Thrombophlebitis
- Drugs
- CHF
- Lymphedema
- Renal failure
- Liver failure
- Pregnancy
- Heat edema
- Idiopathic
- Other
Evaluation
Workup
Diagnosis
- Idiopathic edema is a diagnosis of exclusion, must first rule out CHF, cirrhosis, renal failure, nephrotic syndrome, chronic venous insufficiency, and medication-induced edema[1]
Management
- Treatment is based on addressing underlying disease process
- Idiopathic pedal edema need not to be treated with diuretics
Disposition
- If no respiratory symptoms, most patients may be safely discharged home
- Patients should be followed up in medical clinic for further investigation and care
See Also
External Links
References
- ↑ Kay A, Davis CL. Idiopathic Edema. American Journal of Kidney Disease. 1999; 34(3): 405-408.