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Mr L is a 60 year old male (progressive bilateral lower extremity oedema…

- - - - Heart failure
        
        Left-sided
        
        Right sided
        
        Pulmonary hypertension
        
        dyspnea, orthopnea, paroxysmal nocturnal dyspnea, chest pain, fatigue, peripheral edema, palpitations, and syncope.prominent P2, right sided S4, right ventricular (RV) heave or pulmonary artery (PA) tap, murmur of pulmonary regurgitation, or tricuspid regurgitation.
        
        Rapid onset: days-weeks. known heart disease. exertional dyspnea, orthopnea. peripheral pitting edema, weight gain, jugular venous distension, hepatojugular reflux, hepatomegaly, and crackles on lung auscultation.
      - Restrictive pericarditis
      - Restrictive cardiomyopathy
      - Atherosclerosis
        
        Decreased pulses or differential blood pressure
    - - Cirrhosis (normal JVP)
        
        ascites, jaundice, splenomegaly, stigmata of CLD (spider angiomata, caput medusa, palmar erythema, pitting lower extremity edema)
    - - Nephrotic syndrome
        
        Normal JVP. lower limb, periorbital edema
      - Chronic kidney disease (not on dialysis)
        
        Elevated JVP. Edema, hematuria, pruritus, fatigue, nausea, and sleep disturbance. With progression of renal dysfunction, several nonspecific symptoms may develop including ecchymosis, vomiting, anorexia, hyposmia, foot and leg edema, pallor, altered taste, and seizures
        
        DM most common cause
        
        Diabetic nephropathy
        
        polydipsia, polyuria, polyphagia, weight loss or gain, dizziness, sweating, headaches, vision loss / changes, and slowly healing skin lesions.
      - Dialysis
        
        non-compliance to fluid restriction, missed dialysis
    - - Lower extremities
      - Mild, pitting edema. Daytime fatigue (excessive), snoring, obesity
    - - Medication-induced edema
        
        Weeks after starting medication. resolves within days of stopping. Lower extremities
        
        Soft, pitting edema
    - - Inflammatory bowel disease
        
        Hypoalbuminemia
        
        Bloody diarrhea, abdominal pain
      - Malabsorption
    - - Thyroid (normal JVP)
        
        Normal albumin
        
        Non-pitting (from hyaluronic acid deposition)
        
        Hypothyroidism
        
        Myxoedema
        
        More common in females
        
        Graves' disease
        
        Pretibial myoedema
        
        More prevalent in individuals over the age of 60, but occurs commonly between 20 and 50 years of age. More likely to occur in women
        
        Non-pitting
  - - - Middle-older age. lower extremities, bilateral in later stages. (develop more slowly than HF). Aching swollen leg worse at end of day
      - Best: stasis dermatitis- browning of skin on inner side of ankle & loss of skin hair. Soft, pitting edema with reddish-hued skin, predilection for medial ankle/calf. Varicose veins. Associated signs: venous ulceration over medial malleolus, weeping erosions
    - - Fevers, chills, and malaise often precede. erythema, pain, warmth, and swelling. extremities and the face are common sites. Lymphadenopathy.
    - - following lymphatic obstruction from trauma/surgery. Upper/lower extremities
      - PE: early: dough-like skin, non-pitting. Late: thickened, hyperkeratotic skin. Associated signs: swelling of dorsum of foot with squared off digits, painless heaviness in extremity. Kaposi-Stemmer sign – The inability to pinch a fold of skin on the dorsum of the foot at the base of the second toe is a sign of lymphedema.
      - Secondary causes: tumor (lymphoma, prostate Ca, renal Ca), surgery
    - - begins around/after puberty. Lower extremities (thighs, legs, buttocks, spares feet, ankles, upper torso)
      - Nonpitting edema. Medial thigh and tibial tenderness, fat pad anterior to lateral malleoli
    - - Unilateral. following trauma/others events. upper/lower extremities, contralateral limb at risk regardless of trauma.
      - Soft tisue edema distal to affeced limb.burning, stabbing, and throbbing, as well as pain in response to nonpainful stimuli (allodynia) and pain out of proportion to stimulus (hyperalgesia). tenderness, swelling, changes in skin color and temperature of a body part / extremity, abnormal sudomotor activity, limb hair changes, atrophy, or focal osteoporosis