Please enable JavaScript.

Coggle requires JavaScript to display documents.

BD TLEAD 16 (Bilateral Lower Limb Edema) (Bilateral Predominance…

- - - - Congestive Heart Failure
        
        Symptoms of exertional dyspnea, orthopnea, examine for cardiomegaly for 3rd and 4th heart sounds & crackles. Check for hx of cardiac disease (e.g. IHD, old MIs). If there is worsening of edema and/or progressive dyspnoea, look for an acute precipitant (e.g. new ischaemia, arrhythmia, or noncompliance to fluid restriction). Displaced apex beat.
      - Renal (ESRF or Nephritic syndrome)
        
        In the known ESRF patient, chronic leg swelling suggests insufficient dialysis requiring titration of dry weight. If there is acute worsening of leg edema, look for a cause (e.g. missed dialysis, noncompliance to fluid restriction) and any complications (e.g. electrolytes).
        In the patient without known renal dx, CKD will be
        apparent from serum creatinine.
    - - Renal (Nephrotic syndrome)
        
        Malaise, nausea, dyspnea, edema; leukonychia
      - Hepatic Cirrhosis
        
        known cirrhotic with jaundice, marked ascites, portal hypertension (signs e.g. splenomegaly, caput medusae)
      - Gastrointestinal
        
        a protein-losing enteropathy (e.g. inflammatory bowel dx, celiac dx) or malnutrition can lead to hypoalbuminaemia and hence edema.
      - Thyroid
        
        edema of thyroid disease is uniquely non-pitting, as it arises not from excess interstitial water, but from hyaluronic acid deposition in the interstitium. This can be seen in hypothyroidism (myxoedema) and Graves disease (pretibial myxoedema). [Tremors, exopthalmos]