Oedema

Oedema

1 - Pitting oedema: 

Fluid can either be squeezed out of the veins (increased hydrostatic
pressure, eg DVT, right heart failure) or diffuse out because of reduced oncotic pressure (low plasma proteins, eg cirrhosis, nephrotic syndrome, protein losing enteropathy) leading to an osmotic gradient with the tissues .
The cause of oedema is still not completely understood.

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2 - Periorbital oedema: 

Oedema around the face has a very different differential;The eyelid skin is very thin so periorbital oedema is usually the first sign—think of allergies (contact dermatitis, eg from eye make-up, stings), angioedema (can be hereditary), infection ( orbital cellulitis can be life threatening, refer to hospital immediately if concerned, other infections include EBV and sinusitis); if there is proptosis  think Graves’ disease, connective tissue diseases (eg dermatomyositis, SLE, sarcoid, amyloid); and many others. Assess for systemic disease before putting it down to allergies.

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3 - Non-pitting oedema: 

ie non-indentable, is lymphoedema due to poor lymphatic drainage. Can be due to radiotherapy, malignant infiltration, infection, filariasis orrarely primary lymphoedema ( Milroy’s syndrome ).