Physician Liu Zhengjie of family medicine said that patients with edema may experience heavier weight at night than during the day, decreased urination, nocturia, inability to wear shoes, and swollen eyelids when waking up in the morning.

(Provided by Beirong Hsinchu Branch)

[Reporter Liao Xueru/Hsinchu Report] 78-year-old Grandma Liu has a history of high blood pressure and diabetes. Recently, she is prone to fatigue, and her knee pain has become severe. Although the pain has been relieved by taking painkillers, pitting edema has begun to appear in the lower limbs of both feet. Grandma is worried Taking too many painkillers will affect kidney function, so I went to the doctor for an examination. The doctor found out that my grandmother recently had dyspnea after exercise and paroxysmal nocturnal dyspnea. Auscultation found wet gong sounds in the lower lung lobes. After further examination, The diagnosis was related symptoms caused by heart failure. After treatment, grandma's spirit gradually recovered, and she no longer panted when walking.

Liu Zhengjie, a family physician at Taipei Veterans General Hospital Hsinchu Branch, said that when edema occurs in the lower extremities, many people intuit that it is related to the kidneys. Therefore, outpatients often ask: "My feet will swell at night, is it because the kidneys are not good?" In fact, There are many possible causes of clinical edema. The common causes of lower extremity edema are:

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1. Chronic venous insufficiency

Venous insufficiency is usually due to venous valve insufficiency, blood reflux and stasis leading to venous hypertension, causing water in the blood vessels to leak into the interstitial space and cause edema.

The most common cause of venous insufficiency is deep vein thrombosis and damage to venous valves.

The prevalence of venous insufficiency in the general population is about 25-30%, and it is the most common cause of edema in people over 50 years old.

2. Deep vein thrombosis

Due to venous thrombosis, venous return is blocked, and hydrostatic pressure increases, causing edema.

Typical symptoms are acute unilateral lower extremity swelling, pain, and red skin; but sometimes only mild symptoms.

Deep vein thrombosis is more likely to occur in cancer patients, patients with immobilized limbs after surgery or injury, patients who are immobilized, or patients with abnormally elevated blood coagulation.

3. Lymphedema

Swelling is caused by the accumulation of protein-rich fluid in the interstitium due to impaired lymphatic drainage.

Lymphedema is mostly secondary, including cancer (lymphoma, prostate cancer, ovarian cancer) that blocks lymphatic circulation, abdominal/pelvic surgery or radiation therapy, infection (filariasis or bacterial infection), etc. cause.

Primary lymphedema is a rare genetic disease.

Long-term lymphatic stasis can cause fibrosis of the subcutaneous tissue, thickening and darkening of the skin, and formation of elephantiasis.

In people with lymphedema, the skin on the instep is particularly swollen and cannot be pinched, which is called the Stemmer's sign.

Lymphedema can occur unilaterally or bilaterally, depending on the cause.

The skin of chronic lymphedema is not sunken after pressing, but early lymphedema may be soft and can be sunken by pressing, sometimes it is not easy to distinguish from venous edema.

4. Heart failure

The effective volume of blood vessels is insufficient due to poor heart function (due to the lack of blood pumped into the blood vessels by the heart), which makes the kidneys think that the renal blood vessels lack water and activate the sympathetic nerves and the renin-angiotensin-aldosterone system (renin-angiotensin-aldosterone- Aldosterone system, RAAS) to recycle water and salt, but the recovered water accumulates in the venous system, causing venous pressure and capillary pressure to rise, resulting in edema.

5. Nephrotic syndrome/renal failure

Nephrotic syndrome can occur in patients with acute glomerulonephritis, diabetic glomerulosclerosis, and allergic reactions. The edema is mainly caused by the loss of protein through the kidneys, which lowers the plasma osmotic pressure.

Other acute and chronic renal failures may also cause edema due to the inability of the kidneys to excrete sodium ions and water.

6. Liver cirrhosis/liver failure

Decreased plasma osmolarity due to portal hypertension and decreased albumin production allows extravasation of water into the interstitial space.

In addition, the reduction of effective intravascular volume in patients with liver cirrhosis can also stimulate the renin-angiotensin-aldosterone system to cause the accumulation of salt and water.

7. Drugs

The drugs that most often cause edema are calcium ion channel blockers, and 10-50% of users experience edema.

Non-steroidal anti-inflammatory drugs are also drugs that are more likely to cause edema, with an incidence of about 5%.

Other drugs that may cause edema include hormones, blood sugar-lowering drugs, and antidepressants.

If it is found that the edema is caused by drugs, the dose should be reduced or other drugs should be used. The effect of diuretic treatment is not good.

8. Myxedema

Occurs more often in hypothyroidism, but may also occur in hyperthyroidism.

This kind of edema is not sunken by compression and often occurs in the front of the tibia.

Liu Zhengjie pointed out that edema is defined as swelling caused by the accumulation of body fluid in the interstitial tissue. A variety of clinical conditions are related to the occurrence of edema, commonly including heart failure, liver cirrhosis, nephrotic syndrome, and abnormal venous return, followed by malnutrition , drugs, and lymphedema.

If you are worried about edema, you can try to press around the tibia of the calf first. The skin of normal people has a certain degree of elasticity. It will sag when pressed with your fingers, and it will return to its original appearance when you let go. But if you have edema, press with your hands to swell Release the part after 5 seconds, and the skin will continue to appear sunken. Especially in the early stage of edema patients, they may experience heavier weight at night than daytime, decreased urination, nocturia, inability to wear shoes, and swollen eyelids when getting up in the morning. If the above symptoms occur It is recommended to seek medical advice in order to prescribe the right medicine at the right time.

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keywords

• edema

• heart failure

• kidney failure

• Lymphedema

• Venous thrombosis

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