Congestive Cardiac Failure
- The edema is found on the most dependent parts of the body as gravity plays an important part.
- In an ambulatory patient edema is in the feet, ankles and legs
- In the recumbent patient it is mainly over the sacrum, lumbar region and genitalia.
- Edema is most marked in the evening.
Left ventricular failure
Here accumulation of fluid in the lung comes much earlier than edema of the feet, resulting in
- Dyspnea
- Cough
- Basal rales.
Pericardial effusion
Here since there is obstruction to the flow of blood into the right atrium, edema of feet may occur, but no edema of lungs occurs because the heart is able to pump the little blood it receives into the lungs and general circulation. It is associated with raised JVP, hepatomegaly and ascites.
Acute nephritis
- Edema is generalized and not restricted to the dependent parts of the body.
- It is more noticeable in the early morning.
- The fluid accumulates initially in the loose connective tissues, hence it is most marked around the eyelids and face.
- The cause of edema is damage to the endothelial lining of the capillaries, disturbance of fluid and sodium excretion and later also due to hypoproteinemia.
Nephrosis
The swelling is generalized and massive due to hypoproteinemia following massive albuminuria.
Hepatic (Portal hypertension):
Here ascites occurs before edema of feet. This occurs due to hypoproteinemia and compression of the hepatic branches of the portal vein. Ascites leads to pressure on the venous circulation in the lower limbs leading to edema of the legs.
Inferior vena cava obstruction
This is characterized by bilateral nondependent painless pitting edema. Collateral dilated veins are usually present in the flanks with flow of blood from below upwards.
Myxedema
Here edema is non-pitting, associated with puffy face, weight gain, weakness, alopecia, hoarse voice, rough dry skin, constipation, anemia and menstrual disturbances.
6. Allergic (Angioneurotic edema):
This often resembles myxedema with swelling over the face and limbs. There is usually intense itching and bronchospasm.
7. Nutritional:
This is characterized by dependent edema with puffiness of face, pallor and cachexia.
8. Filariasis:
In filariasis, edema occurs due to destruction of the lymphatic filter action of the lymph glands with consequent blocking and dilation of the lymph vessels. Subsequently there is transudation of lymph, rich in proteins, into the tissues. Later connective tissues proliferate leading to elephantiasis. This is characterized by unilateral non-pitting edema with rough skin. There may be history of fever with rigors especially at night and initially pitting edema. Blood smear may show microfilaria.
9. Gout:
This commonly affects the big toe with marked pain, edema and deformity of the part involved. Tophi may be present. There may be history of renal colic or renal stones.
10. Venous Thrombosis:
This is characterized by unilateral painful pitting edema.
