What are the main causes of anasarca. How is anasarca different from typical edema. What are the key symptoms of anasarca. How is anasarca diagnosed and treated. Can anasarca be managed with home remedies.

Understanding Anasarca: A Comprehensive Overview

Anasarca is a severe medical condition characterized by generalized swelling throughout the entire body. Unlike localized edema that affects specific areas, anasarca involves excessive fluid retention in body tissues from head to toe. This condition, also known as extreme generalized edema or massive edema, often indicates a serious underlying health issue or organ dysfunction.

Is anasarca a disease in itself? No, anasarca is not a standalone disease but rather a symptom of an underlying condition. It represents a more severe and widespread form of edema, significantly impacting mobility and overall well-being.

Distinguishing Anasarca from Typical Edema

How does anasarca differ from typical edema? While typical edema often results from minor issues like excessive salt intake or medication side effects and usually affects localized areas such as feet or hands, anasarca is far more extensive. In anasarca, the swelling is so severe that it can significantly impair movement and affect the entire body.

Common Causes of Anasarca: From Organ Dysfunction to Systemic Issues

Anasarca can stem from various underlying conditions. Understanding these causes is crucial for proper diagnosis and treatment. Here are some of the primary factors that can lead to anasarca:

• Kidney disease
• Liver cirrhosis
• Severe malnutrition
• Allergic reactions
• Capillary leak syndrome
• Excessive intravenous fluid administration
• Medication side effects

Kidney Disease and Anasarca

How does kidney disease contribute to anasarca? When kidneys fail to function properly, they cannot effectively remove excess fluid from the body. This impairment in fluid regulation leads to fluid accumulation in tissues, resulting in anasarca.

Liver Cirrhosis and Fluid Retention

What role does liver cirrhosis play in anasarca development? Liver cirrhosis alters hormone production, which in turn affects the body’s fluid regulation. As liver function deteriorates, it can cause fluid to leak into tissues, contributing to anasarca.

Malnutrition and Anasarca

Can malnutrition cause anasarca? Yes, severe protein deficiency in the diet can lead to fluid accumulation in tissues. When this deficiency becomes extreme, it can result in anasarca, highlighting the importance of proper nutrition in maintaining fluid balance.

Allergic Reactions and Generalized Edema

How can allergic reactions lead to anasarca? Severe allergic reactions can cause widespread fluid retention throughout the body. In extreme cases, this systemic response can develop into anasarca, emphasizing the potential severity of allergic reactions.

Recognizing the Symptoms of Anasarca

Identifying anasarca early is crucial for timely intervention. The primary symptom is widespread swelling, but there are several other indicators to be aware of:

• Generalized swelling from head to toe
• Skin dimpling when pressed (pitting edema)
• Blood pressure fluctuations
• Irregular heart rate
• Signs of organ system failure, particularly in the kidneys and liver

In severe cases, anasarca can lead to significant discomfort and immobility. Patients may struggle to move their limbs or walk, and facial swelling can impair vision by making it difficult to open the eyes fully.

Recognizing Emergency Situations

When does anasarca become a medical emergency? If you experience chest pain, shortness of breath, or difficulty breathing along with anasarca symptoms, seek immediate medical attention. These could indicate pulmonary edema, a life-threatening condition where fluid accumulates in the lungs.

Diagnostic Approaches for Anasarca

Proper diagnosis of anasarca involves a comprehensive evaluation to identify the underlying cause. Healthcare providers typically employ a combination of physical examination, medical history review, and various diagnostic tests.

Key Diagnostic Tests for Anasarca

What tests are commonly used to diagnose anasarca? Diagnostic procedures may include:

• Blood tests to assess liver, heart, and kidney function
• CT scans of the chest cavity
• Echocardiogram to evaluate heart anatomy and function
• Stress tests for heart function assessment
• Allergy tests to identify potential triggers

These tests help healthcare providers determine the root cause of anasarca, enabling them to develop an appropriate treatment plan.

Treatment Strategies for Anasarca

Treating anasarca effectively requires addressing the underlying condition while managing the symptoms. The approach may vary depending on the cause and severity of the condition.

Medication-Based Treatments

What medications are commonly used to treat anasarca? Diuretics, such as furosemide, are often prescribed to help the body expel excess fluid through urine. These medications can significantly reduce swelling and alleviate symptoms.

Treating Underlying Conditions

Why is treating the underlying condition crucial in anasarca management? Addressing the root cause, whether it’s kidney disease, liver cirrhosis, or another factor, is essential for long-term management and prevention of recurrence.

Home Care and Lifestyle Modifications for Anasarca Management

In addition to medical treatments, certain home care strategies can help manage anasarca symptoms and improve overall well-being.

Dietary Adjustments

How can dietary changes help manage anasarca? Limiting salt intake is crucial in managing fluid retention. A low-sodium diet can help reduce swelling and prevent fluid accumulation.

Physical Activity and Positioning

Can physical activity help with anasarca? Gentle exercise and proper positioning can help improve circulation and reduce fluid buildup. Elevating affected limbs when resting can also aid in fluid drainage.

Compression Garments

How do compression garments help in anasarca management? Wearing compression stockings or sleeves can help prevent fluid accumulation in the limbs and improve circulation.

Potential Complications and Long-Term Outlook of Anasarca

While anasarca itself is a serious condition, it can also lead to various complications if left untreated or poorly managed.

Skin Complications

What skin issues can arise from anasarca? Prolonged fluid retention can lead to skin stretching, increasing the risk of skin breakdown, infections, and ulcers.

Mobility Issues

How does anasarca affect mobility? Severe swelling can significantly impair movement, leading to reduced physical activity and potentially contributing to muscle weakness and joint problems.

Organ Stress

Can anasarca affect internal organs? Yes, the excess fluid can put additional stress on various organs, potentially exacerbating existing health issues or contributing to new complications.

Prognosis and Recovery

What factors influence the prognosis of anasarca? The long-term outlook for individuals with anasarca largely depends on the underlying cause and the effectiveness of treatment. Timely intervention and proper management of the root condition can significantly improve outcomes.

Preventive Measures and Risk Reduction for Anasarca

While not all cases of anasarca can be prevented, certain strategies can help reduce the risk or manage the condition effectively in those prone to fluid retention.

Regular Health Check-ups

Why are regular health check-ups important in preventing anasarca? Regular medical evaluations can help detect early signs of conditions that may lead to anasarca, such as kidney or liver disease, allowing for timely intervention.

Lifestyle Modifications

What lifestyle changes can help prevent anasarca? Maintaining a healthy diet, staying physically active, and managing underlying health conditions can all contribute to reducing the risk of developing anasarca.

Medication Management

How does proper medication management help in preventing anasarca? For individuals taking medications that may contribute to fluid retention, working closely with healthcare providers to monitor and adjust dosages can help prevent or manage anasarca.

In conclusion, anasarca represents a severe form of generalized edema that requires prompt medical attention and comprehensive management. Understanding its causes, recognizing symptoms early, and adhering to treatment plans are crucial steps in managing this condition effectively. While anasarca can be a challenging condition to navigate, with proper care and attention to underlying health issues, many individuals can experience significant improvement and better quality of life.

What is Anasarca: Causes, Symptoms, and Treatment

Written by WebMD Editorial Contributors

• Definition of Anasarca
• Causes of Anasarca
• Symptoms of Anasarca
• Diagnosis of Anasarca
• Treatment of Anasarca

Anasarca is a medical condition that leads to general swelling of the whole body. It happens when your body tissues retain too much fluid due to several reasons. It differs from other types of edema that affect one or two parts of the body. The condition is also known as extreme generalized edema or massive edema. When it happens, it’s usually as a result of a severe underlying condition or organ damage.

Anasarca is not a disease in itself but a symptom of an underlying condition. It differs from typical edema, and when it happens, your whole body will be affected. Under normal circumstances, when any part of the body swells, it’s usually due to eating too much salty food, injury, or a minor side effect of medication. This typical kind of swelling affects the feet, hands, or legs. With anasarca, the edema is so bad that it may inhibit movement.

Anasarca is usually a result of abnormalities in blood vessels, blockage in the lymphatic vessels, and water retention in the whole body. The condition happens due to several reasons. Here are some of the most common.

• Kidney disease. When your kidneys no longer function as they should, they can’t remove fluids from the body adequately. This retention of fluid causes anasarca.
• Liver cirrhosis. Cirrhosis happens when your liver fails to function. Liver disease causes changes in hormones that, in turn, affect the regulation of fluids in the body. Liver failure is responsible for fluid leakage into the tissues.
• Malnutrition. Protein deficiency in your diet can lead to fluid accumulation in the tissues. When the deficiency is extreme, it can lead to anasarca.
• Allergic reaction. Your whole body might retain fluid because of an allergic reaction. When the reaction is severe, anasarca can develop.
• Capillary leak syndrome. This is a less common cause of anasarca. It happens when protein and fluid leak out of the blood vessels into the body tissues. Research on why this happens is still very scarce, but scientists believe it’s because of inflammation and injury to blood vessels. They’ve found that this happens due to some medications and toxins. One case study shows that capillary leak syndrome can also happen because of certain cancer medications like gemcitabine. In another study, anasarca happened because of a snakebite.
• Excessive administration ofintravenous fluids. Hospitals will often administer intravenous fluids to treat various conditions, including infection, dehydration, and shock. If your body is unable to adapt to these fluids, you may develop severe edema.
• Side Effect of Medication. Various medications, including specific cancer treatments, can cause anasarca. The other common types that might cause the condition include blood pressure drugs like amlodipine. Steroid medications are also responsible for the condition. Discontinuing such drugs will often resolve anasarca symptoms.

The first symptom of anasarca is a swollen body, from your head to your toes. You may also experience:

• Dimples on the skin after you press a finger onto it for several seconds
• High or low blood pressure
• A slow or fast heart rate
• Organ system failure, especially the kidneys and liver‌

In extreme cases of anasarca, you will experience a lot of discomfort. You may also become immobile, unable to move your limbs or walk. The swelling on your face may also impair vision because it makes it hard to open your eyes.‌

Severe cases of anasarca can be an emergency. If, in addition to the above symptoms, you experience chest pain, shortness of breath, or difficulty breathing, seek immediate medical treatment. These could be signs of pulmonary edema, which causes a buildup of fluid in the lungs. This condition is life-threatening.

If you develop symptoms of anasarca, see your doctor immediately for diagnosis and treatment. A physical examination and assessment of your medical history will be necessary for the diagnosis. Your doctor may also run various other tests to determine the underlying condition causing the anasarca, including:

• A series of blood tests to check your liver, heart, and kidney functions, as well as your hemoglobin levels
• A CT scan to check the chest cavity
• A heart ultrasound or echocardiogram to establish any anomalies in the anatomy and function of the heart
• A stress test to monitor the heart function
• Allergy tests

For your doctor to give you the correct treatment, they must identify the underlying condition and treat it. Severe cases of anasarca require diuretics that help the body expel the excess fluid in the urine. One diuretic that’s commonly prescribed is furosemide.

In addition to medications, these home-care tips can also help in treating anasarca:

• Limit salt intake to reduce the swelling associated with anasarca.
• Gently massage your body in the direction of the heart.
• Exercise to pump out excess fluid, back to the heart. Talk to your doctor first if you have a heart problem.
• Increase your protein and fiber intake.

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Anasarca – StatPearls – NCBI Bookshelf

Continuing Education Activity

Anasarca is a medical condition in which there is a severe generalized accumulation of fluid or edema in the interstitial space. This accumulation of fluid occurs when capillary filtration exceeds the amount of fluid removed via lymphatic drainage or a change in the oncotic pressure from low protein states. It is caused by a variety of clinical conditions including heart failure, renal failure, liver failure, or conditions involving the lymphatic system. This activity reviews the causes, pathophysiology, presentation of anasarca and stresses the importance of the interprofessional team in its management.

Objectives:

• Identify the etiology of anasarca.

• Review the presentation of a patient with anasarca.

• Summarize the treatment and management options available for anasarca

• Explain interprofessional team strategies for improving care coordination and outcomes in patients with anasarca.

Access free multiple choice questions on this topic.

Introduction

Anasarca and edema both are defined as an increase, swelling, or expansion of interstitial fluid volume. This accumulation of fluid in the interstitial space occurs as the capillary filtration exceeds the amount of fluid take out by lymphatic drainage. When edema is massive and generalized, it is called anasarca and it can be caused by a variety of clinical conditions like heart failure, renal failure, liver failure, or problems with the lymphatic system. In this article, we will refer to the term anasarca when referring to instances of the severe form of edema as not every patient with edema has anasarca. The manifestation of anasarca in patients can vary, but it usually becomes clinically apparent as the interstitial volume exceeds 2.5 -3.0 liters.[1][2][3]

Etiology

The most common causes of anasarca include heart failure, cirrhosis, conditions cause a low albumin state, renal dieases like nephrotic syndrome, and pregnancy. Other causes of anasarca are venous obstruction, burns, trauma, malignancy etc.

Epidemiology

The epidemiology of anasarca is not well studied as it is a common complaint among the patients with various different medical conditions. Anasarca is noted in higher frequency in patients with organ dysfunction as well in post-operative patients. In a study of 241 patients who underwent major abdominal surgery, around 29% of patients developed postoperative anasarca. [4]

Pathophysiology

Anasarca develops as a response to an elevation in capillary hydraulic pressure, increased capillary permeability, a lower plasma oncotic pressure, or a combination of these changes. Anasarca also can be secondary to lymphatic obstruction leading to retained fluid in the interstitial space. The following are the clinical conditions for the various mechanisms described.[5][6]

• An elevation in capillary hydraulic pressure

  • Heart failure, kidney disease, early cirrhosis, pregnancy, drugs (i.e. amlodipine)

  • Venous obstruction or insufficiency states like DVT, hepatic venous congestion 

• Increased capillary permeability

  • Burns, trauma, sepsis, allergic reactions, malignant ascites

• Lymphatic obstruction

  • Malignancy, Post lymph node dissection

• Hypoalbuminemia

  • Nephrotic syndrome, liver disease, malnutrition

As a first step, when the fluid moves from the vascular space to the interstitium, it reduces the plasma volume. This reduces tissue perfusion which then causes retention of sodium and water by the kidneys which leads to a cascade of effects worsening fluid retention. Some of the excess fluid gained will be retained in the intravascular compartment. However, the alteration in capillary hemodynamics results in most of the retained fluid entering the interstitium and, eventually, becoming apparent as edema or anasarca.

History and Physical

The history should include the underlying comorbidities, the timing of the development of the edema and anasarca, positional changes, whether it is unilateral or bilateral, and medication history. Chronic accumulation of more generalized edema is caused by the onset or exacerbation of systemic conditions such as congestive heart failure (CHF), renal disease, or hepatic disease. Dependent edema caused by venous insufficiency is more likely to improve with elevation and deteriorate with dependency. Edema associated with decreased plasma oncotic pressure (e. g., malabsorption, liver failure, nephrotic syndrome) does not change with dependency.

The physical examination can aid in establishing the diagnosis. The exam should be focused on identifying the pattern of edema – peripheral vs. pulmonary edema, pitting vs. non-pitting edema, and the presence of jugular venous distension. Below are the exam findings of common clinical conditions that can cause anasarca.

Patients with pulmonary edema complain primarily of dyspnea that can be worsened at rest and upon exertion as well as orthopnea, cough, and chest pain. Common physical examination findings can reveal pulmonary findings like crackles or rhonchi, cardiac findings indicating volume overload, or heart failure like an S3 gallop. Peripheral edema is usually detected by the presence of pitting after pressure is applied to the edematous region. Pitting reflects the movement of the excess interstitial water in response to pressure. It is usually seen in dependent areas like the lower extremities in ambulatory patients and over the sacrum in patients who are bed-bound. Scrotal edema can also be seen in males when the edema is more severe like cases of anasarca. Non-pitting edema more commonly suggests lymphatic obstruction or hypothyroidism. Acute onset of unexplained unilateral leg edema should raise the possibility of deep vein thrombosis (DVT). Cirrhotic patients from any cause can develop ascites and then edema in the lower extremities because of an increase in venous pressure below the diseased liver. The presence of other signs of portal hypertension, such as distended abdominal wall veins and splenomegaly, also is suggestive of a primary hepatic disease. 

The cause of edema and anasarca sometimes can be determined by noting changes in skin temperature, color, and texture. Acute DVT and cellulitis may produce increased warmth over the affected area. The deposition of hemosiderin or chronic venous insufficiency often causes the skin to have a brawny, reddish hue and commonly involves the medial malleolus. As venous insufficiency progresses, it can result in lipodermatosclerosis which is associated with marked sclerotic and hyperpigmented tissue and characterized by fibrosis and hemosiderin deposition that can lead to venous ulcers over the medial malleolus. The ulcers may progress to deep, weeping erosions. Myxedema from hypothyroidism presents with a generalized, dry, thick skin with nonpitting periorbital edema and yellow to orange skin discoloration over the knees, elbows, palms, and soles. Pretibial myxedema occurs in patients with thyroid disease and is characterized by bilateral, asymmetric, nonpitting, scaly thickening, and induration of the skin. These ulcers may be violaceous or slightly pigmented (yellow-brown) and often have an orange-peel appearance. The most frequent location of pretibial myxedema is over the lower legs, especially the pretibial areas or the dorsum of the foot.

Evaluation

The initial evaluation should include basic blood and urine samples. A complete blood count (CBC), comprehensive metabolic panel (CMP), and a urinalysis (UA) can all give an initial broad overview of potential pathologies leading to the cause of the anasarca. The CMP can help assess renal function, albumin level, and liver function (AST and ALT). Dipstick testing principally detects albumin and would need an additional protein sulfosalicylic acid precipitation test (SAS) to detect globulins and Bence-Jones proteins. A urine protein/creatinine ratio or 24-hr urine for protein can obviate the need for SAS testing. The finding of a markedly positive dipstick for protein in combination with hypoalbuminemia and clinical edema is virtually diagnostic of a nephrotic syndrome. Additional testing through measuring a brain natriuretic peptide (BNP) can give clues like underlying CHF. Chest radiography is helpful in cardiac enlargement, pulmonary edema, and pleural effusions.

If warranted, a cardiac echo can evaluate the ventricular function, assess for the presence of a pericardial effusion, and aid in the diagnosis of cardiac disease. Echocardiography can also be used to evaluate pulmonary arterial pressures for patients with known or suspected obstructive sleep apnea and lower extremity edema. Venous ultrasonography is the imaging of choice in the evaluation of suspected DVT. Duplex ultrasonography also can be used to confirm a chronic venous insufficiency. The most commonly used radiographic technique in patients with renal dysfunction or proteinuria is the use of renal ultrasonography. Ultrasonography allows the clinician to characterize kidney size and assess for cystic renal disease and hydronephrosis.[7][8]

Magnetic resonance angiography with venography of the lower extremity and pelvis can be used to evaluate for intrinsic or extrinsic pelvic or thigh DVT. Left iliac vein compression by the right iliac artery (May-Thurner syndrome) should be suspected in women who are 18 and 30 years of age and present with edema of the left lower extremity. Lymphoscintigraphy is the method of choice for evaluating lymphedema when the diagnosis cannot be made clinically.  MRI may aid in the diagnosis of musculoskeletal etiologies like a gastrocnemius tear or popliteal cyst. T1-weighted magnetic resonance lymphangiography can visualize the lymphatic channels when lymphedema is suspected.

Treatment / Management

Management of anasarca should be guided by the treatment of the underlying etiology but generally includes diuresis. Pulmonary edema is one of the few forms of generalized edema that is life-threatening and requires immediate therapy. In all other edematous states, removal of the excess fluid can proceed more slowly as it is not acutely life-threatening to the patient. In patients with generalized edema due to heart failure, nephrotic syndrome, or primary sodium retention, the edema fluid can be mobilized rapidly with help of loop or thiazide diuretics. In patients with anasarca, removing 2 to 3 liters or more of edema fluid in 24 hours can ordinarily be accomplished without a clinically significant reduction in plasma volume.

In patients with localized edema due to venous or lymphatic obstruction or malignant ascites, diuretic therapy can lead to volume depletion. Diuretic therapy in generalized edematous states and anasarca is usually begun with a loop diuretic, such as furosemide or bumetanide. In patients with cirrhosis and ascites, the two mainstays of treatment include sodium restriction and oral diuretics. The dietary sodium restriction would be less than 2000 mg/day [88 mmol/day] and diuretic therapy should be a combination of spironolactone and a loop diuretic like furosemide. The addition of spironolactone is preferred in the initial diuretic regimen as it helps to prevent hypokalemia. As hypokalemia predisposes to increased production of ammonia. The recommended initial dose is spironolactone 100-200 mg/d with furosemide at 20-40 mg/d. The diuretic dosage can be monitored with a random “spot” urine sodium concentration. Diuretics should be increased until the urine sodium concentration is greater than the potassium concentration. [9] Higher doses of diuretics may be required in patients with nephrotic syndrome, up to 1 mg/kg/day of furosemide and 2 mg/kg/day of spironolactone.[10][11] Some cases of idiopathic edema are diuretic-induced, and the initial approach in patients with idiopathic edema who are already on diuretics is to stop the diuretics for at least 2 to 3 weeks and encourage sodium restriction in diet.

The mainstays of therapy for lower-extremity edema due to venous insufficiency are mechanical therapies, including leg elevation and compression stockings with 20 to 30 mmHg for mild edema and 30 to 40 mmHg for severe edema complicated by ulceration. Compression therapy is contraindicated in patients with peripheral arterial disease. Local skin and wound care of venous ulcers is essential in preventing secondary cellulitis and dermatitis. Eczematous (stasis) dermatitis, characterized by dry, inflamed, scaling skin overlying superficial varicose veins, often occurs in patients with chronic venous insufficiency. Treatment includes daily hydration with emollients and short courses of topical steroid creams for severely inflamed skin. Primary lymphedema treatment involves complex decongestive physiotherapy, including manual lymphatic massage and multilayer bandages. The first goal is the improvement of fluid resorption and continues until achieving the maximum therapeutic response. The maintenance phase of treatment includes compression stockings at 30 to 40 mmHg. Pneumatic compression devices can be used to augment standard therapies. Surgical debulking or bypass procedures are limited to severe refractory cases. Diuretics are not demonstrated to be effective in the treatment of lymphedema.

Differential Diagnosis

• Autoimmune conditions like juvenile dermatomyositis [12]

• Congestive heart failure from any cause

• Hematological disorders like acute myeloid leukemia or rare causes like TAFRO [13]

• Kidney disease from any cause like:

  • Acute or Chronic kidney disease

  • IgA nephropathy

  • Membranoproliferative glomerulonephritis

  • Nephrotic syndrome

• Liver cirrhosis from any cause like alcohol abuse or hepatitis

• Lymphedema

• Medications: amlodipine [14]

Prognosis

Prognosis of anasarca depends on the underlying etiology. Reversible causes may carry favorable outcomes, whereas irreversible etiologies and malignancies have a poor prognosis.  However in most of the situations, by the time anasarca has developed, the underlying problem has progressed beyond cure.

Complications

If left untreated, common complications include, but are not limited to skin ulcerations, skin infections, pulmonary edema, congestive heart failure, and even death.

Enhancing Healthcare Team Outcomes

Anasarca is a serious condition leading to generalized accumulation of fluid in the body. Because there are many causes of anasarca, it is best managed by an interprofessional team of healthcare workers. The nurse practitioner, physician assistant  and primary care giver should refer these patients to an internist because in many cases, admission is required to determine the diagnosis. A team approach for management is necessary with support of nurses and pharmacists. The outcomes of patients with anasarca is guarded, for those with failing organs, the mortality rates are very high. Even benign causes can require long-term admission and recovery is a very slow process.

Review Questions

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References

1.

Wang CS, Greenbaum LA. Nephrotic Syndrome. Pediatr Clin North Am. 2019 Feb;66(1):73-85. [PubMed: 30454752]

2.

Bonney KM, Luthringer DJ, Kim SA, Garg NJ, Engman DM. Pathology and Pathogenesis of Chagas Heart Disease. Annu Rev Pathol. 2019 Jan 24;14:421-447. [PMC free article: PMC7373119] [PubMed: 30355152]

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Wang G, Cao WG, Zhao TL. Fluid management in extensive liposuction: A retrospective review of 83 consecutive patients. Medicine (Baltimore). 2018 Oct;97(41):e12655. [PMC free article: PMC6203531] [PubMed: 30313055]

4.

Meena SP, Sairam MV, Puranik AK, Badkur M, Sharma N, Lodha M, Rohda MS, Kothari N. Risk Factors and Patient Outcomes Associated With Immediate Post-operative Anasarca Following Major Abdominal Surgeries: A Prospective Observational Study From 2019 to 2021. Cureus. 2021 Dec;13(12):e20631. [PMC free article: PMC8696563] [PubMed: 34963874]

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Klanderman RB, Bosboom JJ, Migdady Y, Veelo DP, Geerts BF, Murphy MF, Vlaar APJ. Transfusion-associated circulatory overload-a systematic review of diagnostic biomarkers. Transfusion. 2019 Feb;59(2):795-805. [PMC free article: PMC7379706] [PubMed: 30488959]

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Gradalski T. Edema of Advanced Cancer: Prevalence, Etiology, and Conservative Management-A Single Hospice Cross-Sectional Study. J Pain Symptom Manage. 2019 Feb;57(2):311-318. [PubMed: 30453053]

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Sharma R, Sharma S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 10, 2023. Physiology, Blood Volume. [PubMed: 30252333]

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Dopp H, Maagh P, Meissner A. [Heart Failure Despite Low BNP-Level: Paradoxon or Pathfinder? – – A Case of Pericarditis constrictiva]. Dtsch Med Wochenschr. 2018 May;143(10):731-734. [PubMed: 29727888]

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Runyon BA., AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013 Apr;57(4):1651-3. [PubMed: 23463403]

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Tapia C, Bashir K. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 5, 2022. Nephrotic Syndrome. [PubMed: 29262216]

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Kodner C. Diagnosis and Management of Nephrotic Syndrome in Adults. Am Fam Physician. 2016 Mar 15;93(6):479-85. [PubMed: 26977832]

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Zedan M, El-Ayouty M, Abdel-Hady H, Shouman B, El-Assmy M, Fouda A. Anasarca: not a nephrotic syndrome but dermatomyositis. Eur J Pediatr. 2008 Jul;167(7):831-4. [PubMed: 18414893]

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Nara M, Komatsuda A, Itoh F, Kaga H, Saitoh M, Togashi M, Kameoka Y, Wakui H, Takahashi N. Two Cases of Thrombocytopenia, Anasarca, Fever, Reticulin Fibrosis/Renal Failure, and Organomegaly (TAFRO) Syndrome with High Serum Procalcitonin Levels, Including the First Case Complicated with Adrenal Hemorrhaging. Intern Med. 2017;56(10):1247-1252. [PMC free article: PMC5491826] [PubMed: 28502946]

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Sener D, Halil M, Yavuz BB, Cankurtaran M, Arioğul S. Anasarca edema with amlodipine treatment. Ann Pharmacother. 2005 Apr;39(4):761-3. [PubMed: 15728328]

Disclosure: Sri Rama Surya Tez Kattula declares no relevant financial relationships with ineligible companies.

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Just swelling or extra fat? How to understand what actually causes weight gain

• Health

Most often we swell in the morning. Some problem areas are both on the face and on the body. Why they appear, how to properly get rid of edema, the beautician explains.

January 31, 20221

Source:

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When we sleep a lot (or, on the contrary, too little), eat salty, fatty or too high-calorie food in the evening, then in the morning, most likely, an unpleasant surprise will await us: a swollen face. For everyone, this effect manifests itself in different ways. Someone notices that only the area under the eyes swells – in such cases, patches are often used to eliminate swelling. For someone, the swelling “spreads” all over the face and disappears only after a few hours. They save themselves from it in different ways: they wipe the skin with ice cubes, take a contrast shower, make refreshing sheet masks. And sometimes the edema pours out not only on the face, but also on the whole body.

Dermatovenereologist, cosmetologist Irina Orlova told Doctor Peter about why edema appears, how not to confuse them with extra pounds and when it is time to see a doctor.

About the causes of edema

“Edema on the face and body appears due to impaired venous or lymphatic outflow. In fact, this is a whole cascade of reactions, as a result of which fluid accumulates, metabolic and trophic processes are disrupted, ”explains the expert.

There are many reasons for the formation of edema, this is generally a common medical problem. Most often they appear due to malnutrition, excessive consumption of salty foods, lack of protein in the body or, conversely, its excess.

In addition, there are edema associated with weakness of the vascular wall.

“In this case, we observe perspiration — this is the process of “leakage” of blood plasma through the walls of blood vessels, when their permeability increases. Edema is often confused with excess weight, this fact is quite logical: after all, when we swell, we visually increase in volume, ”says Irina Orlova.

See also

Edema and excess weight

Distinguishing permanent edema from extra pounds is not at all difficult. It is enough to perform a few simple steps, says the beautician.

“Swelling has certain symptoms. So, the skin becomes pasty In this case, when pressing with a finger, a hole remains on the skin, which then slowly, slowly recovers. Skin turgor is reduced, respectively, due to the accumulation of fluid in the tissue, it becomes less elastic.

If we are talking about swelling on the body, then in the places where the cuff or tight elastic band fits, a clear mark remains on the skin, which then also recovers for a long time. Plus, , the skin becomes paler , especially in places where there is some kind of pressure, ”explained Irina Orlova.

“Age” swelling

The older you get, the more likely it is that both your face and body will swell in the morning. This unpleasant fact also has an explanation.

“With age, the likelihood of edema increases. Doctors distinguish a separate morphotype of age-related changes – deformation-edematous , where the mechanisms of aging are based on a violation of the inflow and outflow of fluid through the vessels and tissues of the face. Edema that appears on the body is most often due to a lack of physical activity – and, as a result, a weak vascular wall. After all, various exercises strengthen not only the muscles of the body, as is commonly believed, but also the muscle layer in the vessels, ”says the cosmetologist .

The process of edema appearance looks like this: muscle fibers pass through the vessel wall, which pump blood and lymph. If they are weakened, skin tone is noticeably reduced. As a result, the body cannot cope with the pumping of the required volume of blood, fluid leaks into the tissues and edema develops.

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How to deal with them

When a patient comes to a beautician with complaints of edema, the specialist, first of all, needs to determine the cause of their appearance, and only then prescribe any procedures.

“To do this, I will ask how often and after what edema appears, I will collect all the necessary anamnesis. In some cases, it may be necessary to consult a general practitioner or endocrinologist. If there are no medical and physiological reasons for the formation of edema, we recommend reconsidering nutrition, lifestyle, and physical activity,” says Irina Orlova.

Cosmetic procedures can help get rid of edema. They are able to influence the microvasculature, thereby improving the functioning of blood vessels.

“So, if a woman complains about constant swelling on her face, we carry out course procedures: lymphatic drainage massage, microcurrent therapy, plasma lifting. You can also do injection procedures, for example, for the skin around the eyes. For the body, courses of lymphatic drainage massage, microcurrents and Endosphere therapy are also effective, ”the cosmetologist concluded.

By the way

There are cases when swelling on the face appears quite unexpectedly. They may not go away for several days or even weeks. Why is this happening? Endocrinologist Ekaterina Yang listed the diseases, a symptom of which may be a swollen face.

Text author:Sofya Khromova

Regional Dermatovenerological Dispensary, Lipetsk

Swelling in the morning of the upper and especially lower eyelids on the face, in the evening it is difficult to fasten boots, and shoes, perfectly dressed in the morning, begin to unbearably squeeze the legs, appear on the skin deep imprints from the gum of socks . …

Edema can be caused by many diseases How often do we have to deal with such phenomena! But these symptoms are not always safe, because these are the first signs of edematous syndrome. Edema, especially obvious, is always a manifestation of the disease of any internal organ or blood vessels. They will not go away on their own, and if you do not pay attention to them, then serious health problems may subsequently arise.
So where do you start? First you need to find out the reason why the legs and / or face began to swell. There are many diseases and conditions that are accompanied by edema, so differential diagnosis should be carried out by a specialist – a doctor.

Major diseases accompanied by edema

1. Varicose disease of the lower extremities.
2. Kidney diseases (pyelonephritis, glomerulonephritis, etc.).
3. Heart diseases (ischemic heart disease, malformations, cardiomyopathies, etc.).
4. Diseases of the liver (cirrhosis).
5. Allergy.
6. Diseases of the endocrine system.
7. Violations of the outflow of lymph, the so-called elephantiasis.

Varicose disease

One of the causes of swelling of the legs is varicose disease of the lower extremities Varicose disease of the lower extremities is one of the main reasons why the legs swell. Most common in women. Normally, veins are involved in blood circulation, their walls have a certain “strength” – a tone, due to which blood returns back to the heart against hydrostatic pressure, to the height of human growth. The valves inside the veins also keep the blood from going down. With varicose veins, the walls have somewhat weaker walls, and under certain conditions (for example, long standing work, pregnancy, etc.) they cannot withstand pressure and expand, taking the form of “bags”, knots, bundles. The return of blood decreases, it stagnates in the veins, and its liquid part goes into the tissues – swelling occurs. The longer a person spends on their feet, the stronger the swelling. They occur mainly on the legs and are accompanied by heaviness, pain in the legs (or one leg). Edema increases in the evening, go away or decrease overnight. If varicose veins have existed for some time, the color and moisture of the skin changes, spots may appear, and hair may fall out. Dilated veins do not always show through the skin. There is a lesion of deep veins that are not visible.
Varicose veins are dangerous due to the addition of thrombophlebitis – inflammation of a vein with the formation of a thrombus inside it – a blood clot. Thrombi can break away from the wall of the vein and be carried by blood flow into the lungs – there they clog the vessel and a lung infarction is obtained. It is better not to allow this and to be treated (or operated) on time by an angiosurgeon (vascular surgeon).

Edema in kidney disease

Edema in kidney disease is possible even on the hands Edema in kidney disease may first appear on the face, especially the eyelids, and then on the ankles, shins and even higher: arms, abdomen. Moreover, they appear in the morning, by the end of the day they intensify on their feet. The skin is not changed, warm, maybe a little pale. Their occurrence is associated with the difficulty of excreting salts and water by sick kidneys (excess water remains in the body), as well as protein losses through the kidneys (protein normally retains water in the bloodstream, prevents it from seeping through the vascular wall into the tissue). Quite often, edema is the first symptom of kidney disease, since both pyelonephritis and glomerulonephritis can flow latently (latently) for several years.

Edema in heart disease

Arterial hypertension and ischemic disease (angina pectoris) are the scourge of our time. Their prevalence is enormous. And then there are heart defects, cardiomyopathy … Any disease that damages the heart muscle (myocardium) causes a decrease in the contractility of the heart, weakens it and after a while contributes to the appearance of heart failure. Those. a situation arises in which it becomes difficult for the heart to pump the entire volume of blood and part of it remains, so to speak, on the periphery (more often in the lower extremities). Its liquid part seeps into the tissues – edema appears. Usually, with heart failure, kidney function is also impaired (reversibly), they do not remove excess fluid and salts, which increases swelling.
Edema in heart failure increases over several days and weeks, the skin is usually pale, cool, sometimes with a bluish edema. Accompanying them are symptoms such as weakness, palpitations during exercise, shortness of breath, changes in pressure, there may be pain and interruptions in the work of the heart (uneven pulse).

Edema in liver diseases

Liver diseases are characterized by swelling of the abdomen By themselves, liver diseases (hepatitis, hepatosis) do not lead to the appearance of edema. Edema appears at the stage of complications, if the disease turns into cirrhosis. With cirrhosis, water is also retained in the body, besides, the suffering liver does not produce enough protein, the so-called oncotic blood pressure drops, the fluid is not retained in the bloodstream.
Feet, shins, thighs, stomach can swell (especially characteristic!). They are accompanied by yellowness of the skin and eyes, bruises on the skin, weakness, heaviness in the right side, weight loss, sometimes a significant increase in the liver.

Allergic edema

They have a rather characteristic picture and are usually accompanied by skin redness, itching and often a rash. At the same time, the skin on the face, neck swells, in severe cases, skin edema spreads to the entire body. At the same time, hoarseness of the voice, nasal congestion, and lacrimation are also possible. These symptoms occur after contact with an allergen: a certain food product (citrus fruits, fish, etc.), medicine, aerosols, etc.

Endocrine diseases

Dense edema myxedema manifests itself in hypothyroidism First of all, it is a pathology of the thyroid gland with insufficiency of its function – hypothyroidism. It can be of different origin: autoimmune, postoperative, as a result of iodine deficiency in food, etc., but regardless of the cause, the thyroid gland produces few hormones. One of the manifestations of hypothyroidism is dense edema – myxedema. Myxedema is most noticeable on the face, but it spreads to the whole body. In addition to edema, there are other symptoms: slowness, drowsiness, memory loss, chilliness, slowing of the pulse, menstrual irregularities, lower body temperature, etc. The thyroid gland can be both enlarged and reduced.

Lymphostasis

Also causes edema. They can appear in principle on any part of the body (face, mammary gland, arm), but more often still on the lower extremities (or on one leg). In addition to veins and arteries, a person has lymphatic vessels in the body, in particular, through them, the exchange and outflow of fluid from tissues is carried out. If this outflow is disturbed, the lymph gradually stagnates more and more, the affected part of the body increases significantly in volume, its contours are deformed, and mobility is hindered. Edema is persistent, does not go away after rest. An early characteristic symptom of lymphostasis is the inability to fold the skin over the affected area when the swelling is still small.

Let’s summarize

The conditions listed here are far from a complete list of those diseases that may be the causes of edema. It is important to remember that edema is just a symptom of the ill health of a particular organ, and there is no single recipe for curing them. Diseases of the kidneys, liver, heart, thyroid gland, blood vessels are treated differently, and even the treatment of the same disease in two different people may differ.
Therefore, if you suddenly have swelling – do not rely on the advice of “experienced” people – go to the clinic, laboratory and take the simplest set of tests:
• Complete blood count,
• Complete urinalysis,
• Biochemistry: total protein, urea, creatinine, ALAT, ASAT, bilirubin, blood sugar, cholesterol;
• Ultrasound of internal organs.