Oedema

Definition

An abnormal accumulation of fluid beneath the skin or in a cavity of the body. Hypoalbuminaemia, also on this page, is a low albumin.

Epidemiology

Differential Diagnosis

• Heart failure (right-sided or congestive, but not left-sided)
• Hypoalbuminaemia
  • Liver - alcoholic liver disease, cirrhosis
  • GI - ulcerative colitis
  • Kidney - nephrotic syndrome, renal failure
• Inflammation - this is an acute phase reaction. It can be due to any inflammatory process including infection.
• Pre-eclampsia
• Venous stasis
• Lymphoedema

Clinical and Associated Features

• Heart failure - hopefully, you'll get a whole bunch of symptoms. Bilateral oedema in the lower leg. In right heart failure, there will also be a raised JVP. In congestive heart failure, you will get all sorts of crazy: pulmonary oedema (bilateral crackles in the lung bases), orthopnoea, paroxysmal nocturnal dyspnoea, pulse abnormalities (tachycardia, pulsus alternans, reduced volume), hepatomegaly, ascites.

This is a spider naevus. Not an actual spider. That'd be weird.

• Liver
  • Alcoholic liver disease: how bad the symptoms are depends on how severe the disease is. Jaundice, tender hepatomegaly, fever, nausea, diarrhoea, vomiting, spider naevi, ascites, hepatic encephalopathy, arterial bruit over liver. May show signs of alcoholism.
  • Liver cirrhosis: tiredness, itch (in PBC), fever, weight loss, ankle oedema, ascites, jaundice, hepatomegaly, splenomegaly, finger clubbing, leuconychia (white nails), palmar erythema (red palms), easy bruising, spider naevi, parotitis (parotid gland inflammation), gynaecomastia and reduced body hair (in men), erratic menstruation and breast atrophy (in women).
• Kidney
  • Nephrotic syndrome - heavy proteinuria, hypoalbuminaemia, generalised oedema. Oedema - periorbital, genital, affected by gravity; transudative ascites; pleural effusions; abdominal discomfort, hypovolaemia, peritonitis; diarrhoea and vomiting; can present in kids
  • Chronic kidney disease (fka chronic renal failure) - GI - nausea, vomiting, diarrhoea and anorexia; CVS - hypertension, peripheral vascular disease, heart failure and uraemic pericarditis; NS: coma, confusion, fits and peripheral neuropathy; anaemia and easy bruising (due to platelet abnormalities).
• Pre-eclampsia - they'll be pregnant
• Venous stasis - mainly due to peripheral vascular disease
• Ulcerative colitis - alternating constipation and diarrhoea, weight loss, tiredness, (probably finger clubbing)
• Lymphoedema - you'll get oedema. This is due to an obstruction, often cancer.