53. Oedema

Question 1

Leg swelling: causes

a) Bilateral
b) Unilateral

Answer 1

a) CCF, venous insufficiency, liver failure, nephrotic syndrome, hypoalbuminaemia (protein-losing enteropathy), myxoedema (hypothyroid), pregnancy
b) Trauma, cellulitis, DVT, lymphoedema

Question 2

Red flags for oedema

a) In a child
b) In anyone

Answer 2

a) Periorbital oedema (nephrotic syndrome)

b) - Change in medication (angio-oedema; allergy)
- Accompanying breathlessness
- Pain, hyperpigmentation, absent leg pulse
- Signs of sepsis
- High blood pressure

Question 3

Pitting vs. non-pitting oedema - causes

Answer 3

• Pitting: generally indicates extra fluid (water) - more common; caused by fluid overload or inflammation (e.g. CCF, cellulitis, DVT, etc.)
• Non-pitting: 2 main causes are lymphoedema and myxoedema (hypothyroidism)

Question 4

Examining patient with oedema.

a) Systems - findings to look for
b) Investigations

Answer 4

a) - Vitals: pyrexial (cellulitis), HR/BP (heart failure, thyroid)
- Chest - signs of heart failure
- Abdo - ascites
- Legs - pitting/non-pitting, DVT/cellulitis signs

b) - Bedside: ECG, urine dip, pregnancy test
- Bloods: FBC, CRP, UEs, LFTs, NTproBNP, TFTs, D-dimer
- Imaging: CXR, leg US, ECHO, abdominal USS/CT
- Special tests: ascitic tap?