leg edema Flashcards
why synthroid (levothyroxin for hypothyroidism) be an issue?
is it controlled?
if too high dose, induce hyperthyroidism
if too low: swelling
another med an issue for cramping
amlodipine: Ca2+ channel blocker
ddx
DVT
PAD
CHF
if start to see dark coloration around ankle implies blood leakage
venous inflammation
happens with allergies
may also have streaking
if skin turns white then black implies
arterial blockage
normal venous pressure
80mm Hg in deep veins
20-30mm Hg in superficial veins
cephalad venous blood flow
Biscuspid venous valves
Effective muscle contractions
Normal respirations
LE edema occurs in response to
Increased venous or lymphatic pressures
Decreased intravascular oncotic pressure
Increased capillary leak (mastectomy)
Local injury or infection
most common cause of LE edema
chronic venous insufficiency
LE edema ddx
DVT* (acute) Cellulitis* (acute) Lymphedema* (chronic) Heart failure* (chronic) Musculoskeletal disorder (baker cyst, gastrocnemius tear/rupture) Cirrhosis Nephrotic syndrome Medications (CCB, minoxidil, pioglitazone)* (chronic unless med change)
brawny fibrotic skin caused by
Chronic exposure of elevated venous pressures by postcapillary venues
-prone to getting ulcers
chronic exposure of elevated venous pressures causes
Leakage of fibrinogen and growth factors into interstitial space
Leukocyte aggregation and activation
Obliterations of cutaneous lymphatic network
LE cramping always check….
*K+ and Mg+ levels!!
LE cramping ddx
Arterial disease Hypokalemia Deconditioning Dehydration Medication
DVT: need to find cause
Malignancy, esp untreated
Recent limb immobilization or paralysis (ortho sx)
Bedridden >3 days due to surgery in past 4wk (month)
Localized tenderness along deep veins (homan sign)
Swelling of entire leg
Swelling of one calf >3cm
Ipsilateral pitting edema
Collateral superficial veins
Previous DVT
pregnancy, OCTs >35 yo
DVT ppx
heparin and lovenox
compression stockings
Bilateral involvement with improvement after awakening
Systemic (heart failure, cirrhosis)
heavy legs or itching
Chronic venous insufficiency
LE swelling or inflammation with recent DVT
Postphlebetic syndrome
dx testing
Ultrasound – arterial or venous depending on cause D-dimer (not typ. done outside ER) Ankle brachial pressure index Kidney function/urine analysis CT (if no clue what's going on)
what looking for in UA
proteinuria
RBC/WBC casts (nephritis)
*kidney etiology
in chronic liver cirrhosis
LFTs will not be elevated: “killed off” liver, will not put out enzymes
CT will find
muscle tears, etc
leg edema tx
Treat underlying cause
Compression stockings (for venous issues)
OMM (better for benign, venous causes, not arterial)
Aspirin and walking if PAD
compression stockings do what
force more blood thru clogged vessels-breaks it up
new vessels are formed
(less pain in end)
bring blood back to heart
Asians, Afr. Americans at higher risk for
compartment syndrome, etc if cellulitis not tx properly
have thin-walled vessels
don’t miss emboli, PAD
note absent pulses
life threatening leg edema
High risk for DVT
Compartment syndrome
Acute edema that impairs ability to function
