Cardiac, renal, liver disease and hypoproteinemia can cause generalized edema. Cardiac edema presents as pitting edema in the legs, ankles and feet that worsens at the end of the day. Renal edema in nephrotic syndrome causes severe generalized edema involving the face, legs and ascites with massive proteinuria and hypoalbuminemia. Liver cirrhosis causes edema in the legs and face due to decreased protein synthesis. Localized edemas include cellulitis, DVT, lymphedema and angioneurotic edema. Certain endocrine conditions like hypothyroidism and Cushing's disease can also cause edema.

1. CLINICAL FEATURES OF EDEMA

2. GENERALISED EDEMA-ANASARCA
Fluid accumulation in
tissues and body • Pericardial effusion
fluids • Constrictive
pericarditis
• Cardiac failure • Myxedema
• Renal disease • Idiopathic
• Liver disease • Epidemic dropsy
• Hypoproteinemia • Drugs

4. CARDIAC EDEMA
• Right sided heart failure-systemic congestion
and generalised edema
• Left sided heart failure-initially pulmonary
congestion and edema later generalised edema
• Pitting
• Dependent
Ambulant-maximal over ankles & feet(pedal)
-worse towards end of day
-clears up with recumbence
Bedridden-maximal over sacrum

5. • Legs face ascites
• Early-nocturnal polyuria (clears up at night)
• Later-established at all times
• Clears with Diuretic therapy
• Other signs of cardiac failure
-exertional dysnea
-engorged jugulars
-tender hepatomegaly

6. RENAL EDEMA
• Nephrotic ,Nephritic, Renal failure
• Nephrotic
-severe, generalised,dependent
-loose connective tissue, subcutaneous
tissue, visceral organs
-face(periorbital) legs ascites
(with scrotal swelling)
Other features -massive proteinuria
-hypoalbuminemia
-hypercholesterolemia

7. • Acute nephritic
-mild
-loose connective tissue-eyelids and
face ,ankles,genitalia
-moderate proteinuria
• Both
-more on waking up after sleep
-generalised,pitting

8. LIVER DISEASE
• Liver Cirrhosis
• Chronic liver disease
-decreased protein synthesis
-Ascites legs face

9. NUTRITIONAL EDEMA
• Protein losing enteropathy
• Starvation
• Dependent
• Hypoproteinemia Albumin<2.5g/dL

10. DRUG INDUCED EDEMA
• Nifedipine-ankle edema
• Corticosteroids
• Estrogen
• NSAIDs

11. ENDOCRINE
• Myxodema- hypothyroidism,
infiltrative edema due to
deposition of mucinous
material, nonpitting
• Pretibial myxodema-
Grave’s disease, swelling
over shins, nonpitting
• Cushing’s disease-
hyperaldosteronism

12. Pretibial myxodema

13. EPIDEMIC DROPSY
• Ingestion of edible oil contaminated with oil
from seeds of argemone mexicana
• Bilateral pitting edema of lower limbs
generalised edema
• Pigmentation of skin over edema
• Fever,diarrhoea,abdominal pain,malaise

14. IDIOPATHIC EDEMA
• Young menstruating women, not cyclical
• Periodic episodes of edema with pain and
discomfort
• Sitting and standing-abdomen and legs
• On lying down-face and eyelids
• Diurnal weight changes
• Has to be differentiated from cyclical edema

15. LOCALISED EDEMA
Redistribution of edema fluid, no accumulation
• Cellulitis
• DVT
• Lymphedema
• Angioneurotic
• Trauma
• Milroy’s edema
• Nifedipine

16. CELLULITIS,TRAUMA,COMPARTMENT
SYNDROME,DVT
• Localised
• Sudden onset
• Painful edema

17. ANGIONEUROTIC EDEMA
• Hypersensitivity
• Solid edema-involves deeper layers of skin
• Localised-Tongue,lips,face,eyelids
• Develops rapidly,pale or faint pink, itching
• Threatens life by suffocation
• ACE inhibitor induced
• Congenital-C1 esterase inhibitor deficiency

18. LYMPHADEMA
• Surgery, radiation, chemotherapy
• Filariasis
• Nonpitting edema
• localised

19. MILROY’S EDEMA
• Lymphedema at birth due to
congenital absence of
lymphatic tissue
• Autosomal dominant inheritance
• Unilateral limb edema progressive
both legs

21. REFEEDING EDEMA
• Edema occurring following
feeding after prolonged
starvation
• Increased salt intake
• Insulin release sodium
reabsorption

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