Limb Swelling

Question 1

What are the causes of oedema?

Answer 1

• Low plasma oncotic pressure: Low albumin states:
  
  • Increased loss- nephrotic syndrome
  • Reduced synthesis: CLD
  • Malabsorption: IBD, Coeliac disease
  • Malnutrition: Kwashiorkor
• Increased hydrostatic pressure
  
  • DVT
  • Venous insufficiency
  • HF
  • Increased intravascular volume- e.g. RF, x/ss IV fluid
  • Pregnancy, pelvic tumour
• Increased capillary permeability
  
  • Local- infection/inflammation (soft tissue)
  • Systemic- severe sepsis
  • Drugs e.g. CCB
  • Acute allergy
• Lymphatic obstruction (lymphoedema)
  
  • NB this is non-pitting
  • Malignant infiltration
  • Congenital- Milroy’s disease
  • Radiation
  • Elephantiasis (lymphatic filariasis)

Question 2

What causes non-pitting oedema?

Answer 2

• Lymphoedema
• Fat (obese patient)

Question 3

What are some common causes of pitting oedema?

Answer 3

• Heart failure
• Hypoproteinaemia
• DVT
• Ruptured Baker’s cyst (NB cannot distinguish from DVT on exam)