Peripheral oedema

Swelling of the ankles/legs (or sacrum if bed-bound) occurs when the rate of capillary filtration > rate of drainage.
• Increased capillary filtration occurs due to i venous pressure, hypoalbuminaemia, or local inflammation
• Decreased drainage occurs due to lymphatic obstruction
Consider whether swelling is acute or chronic, symmetrical or asymmetrical, localized, or generalized. Ask
about associated symptoms, e.g. breathlessness. Treat according to cause. Causes:
• Superficial thrombophlebitis
• Joint effusion/haemarthrosis
• Cellulitis
• Haematoma
• Baker’s cyst
• Arthritis
• Fracture
• Acute arterial ischaemia
• Dermatitis
Gravitational oedema, e.g due to immobility—common in the elderly—advise elevation of feet above waist level when sitting, support stockings (ideally apply stockings before getting out of bed), avoid standing still. Diuretics are not a long-term solution
• Heart failure
• Hypoproteinaemia, e.g. nephrotic syndrome
• Idiopathic oedema
• Reflex sympathetic dystrophy
• Post-thrombotic syndrome Chronic venous insufficiency/ venous obstruction
• Lipodermatosclerosis
• Lymphoedema—infection, tumour, trauma
• Congenital vascular abnormalities

dr.Dukagjin Zeqiraj Author

Hello! I am Dukagjin Zeqiraj from Kosovo. I have finished Medical Faculty in Prishtina ( capital city of Kosovo). Now I live in Pristina and I work in QKMF Podujeve (family medicine center). Tel: +38344311154