What causes edema fluid leakage through skin. How to manage grossly edematous legs. What are the consequences of severe leg edema. How to prevent complications of leaky legs. What dressings are effective for managing fluid leakage. How to reduce edema in lower limbs. What is the role of compression therapy in managing edema.

Understanding Edema and Fluid Leakage in the Lower Limbs

Edema occurs when an abnormal amount of fluid accumulates in the interstitial space between cells. Normally, about 85% of fluid filtered from capillaries into this space is reabsorbed, with the lymphatic system draining the remainder. However, when capillary blood pressure rises, increased fluid escapes the blood vessels, overwhelming the body’s ability to reabsorb it.

In severe cases, this can lead to gross swelling of the limbs and eventual fluid leakage through the skin, a condition often referred to as “leaky legs.” Understanding the underlying mechanisms is crucial for effective management.

What causes edema fluid to leak through the skin?

Edema fluid leaks through the skin when:

• The volume of interstitial fluid exceeds the limb’s capacity to retain it
• There is a breach in skin integrity
• An infection is present
• The lymphatic drainage system fails (lymphorrhea)
• Large wounds or certain skin conditions are present

The type of fluid that leaks can vary depending on the underlying cause. Transudate results from elevated capillary blood pressure, while lymphorrhea occurs due to lymphatic system failure.

Identifying the Underlying Causes of Lower Limb Edema

Effective management of edematous legs begins with identifying and addressing the root cause. The etiology of edema can provide crucial insights into the most appropriate treatment approach.

What are the common causes of lower limb edema?

Lower limb edema can result from various conditions:

1. Venous insufficiency
2. Lymphatic disorders
3. Congestive heart failure
4. Kidney disease
5. Liver disease
6. Medication side effects
7. Prolonged immobility
8. Hormonal changes

Unilateral edema often indicates venous or lymphatic issues, while bilateral edema may suggest systemic conditions like heart or kidney disease. Pitting edema, where pressure leaves an indentation in the skin, is commonly associated with congestive heart failure.

Consequences and Complications of Grossly Edematous Legs

Severe lower limb edema can have significant impacts on a patient’s quality of life and overall health. Understanding these consequences is crucial for developing comprehensive management strategies.

How does severe leg edema affect patients?

Gross edema in the legs can lead to:

• Reduced mobility due to the heavy, swollen limb
• Discomfort and pain
• Increased risk of skin breakdown and ulceration
• Higher susceptibility to infections
• Psychological distress and reduced quality of life
• Challenges with personal hygiene and clothing

When fluid leaks through the skin, patients may experience additional issues such as constant wetness, which can lead to maceration and further skin damage. The leaking fluid can also soil clothing and bedding, creating hygiene challenges and potential safety hazards if floors become slippery.

What are the main infection risks associated with leaky legs?

Patients with grossly edematous, leaking legs are at increased risk of developing infections, particularly:

1. Cellulitis: A bacterial skin infection characterized by redness, swelling, and warmth
2. Erysipelas: A more severe form of cellulitis that affects the upper layers of skin
3. Fungal infections: Particularly in warm, moist skin folds

Cellulitis and erysipelas can develop rapidly, causing acute inflammation, fever, and general malaise. While they often respond well to antibiotic or antifungal treatment, recurrence rates are significant. This underscores the importance of addressing the underlying cause of edema to prevent future infections.

Dressing Selection for Managing Fluid Leakage

Choosing the right dressing is crucial in managing fluid leakage from edematous legs. The ideal dressing should effectively absorb excess fluid, protect the skin, and promote healing.

Which dressings are most effective for managing fluid leakage in edematous legs?

Several types of dressings can be considered for managing leaky legs:

• Foam dressings: Highly absorbent and can conform to the leg’s contours
• Alginate dressings: Form a gel when in contact with fluid, providing a moist environment
• Hydrofiber dressings: Absorb large amounts of fluid and lock it away from the skin
• Composite dressings: Combine multiple layers for absorption and protection
• Super-absorbent dressings: Designed to handle very high levels of exudate

However, it’s important to note that in cases of gross edema, even highly absorbent dressings may become quickly saturated. Frequent dressing changes may be necessary, and combining dressing strategies with other interventions is often required for optimal management.

How should dressings be applied and changed in cases of severe fluid leakage?

When applying dressings to leaky legs:

1. Gently cleanse the skin with warm water or saline
2. Apply a skin protectant to the surrounding area to prevent maceration
3. Choose a dressing large enough to cover the entire affected area
4. Secure the dressing with appropriate bandaging, taking care not to apply too much pressure
5. Monitor the dressing closely and change it as soon as it becomes saturated
6. Consider using a secondary dressing or absorbent pads for additional protection

The frequency of dressing changes will depend on the volume of fluid leakage and the absorbency of the chosen dressing. In some cases, multiple daily changes may be necessary.

Compression Therapy in Edema Management

Compression therapy plays a vital role in managing lower limb edema, particularly when venous insufficiency is a contributing factor. By applying external pressure to the leg, compression therapy can help reduce fluid accumulation and improve circulation.

How does compression therapy help in managing edematous legs?

Compression therapy works by:

• Reducing capillary filtration
• Increasing the efficiency of the calf muscle pump
• Improving lymphatic drainage
• Reducing venous hypertension
• Helping to reshape the limb over time

However, it’s crucial to note that compression therapy should only be applied after a thorough assessment by a healthcare professional. In cases of arterial insufficiency or certain other conditions, compression may be contraindicated.

What types of compression therapy are available for edema management?

Several compression options can be considered:

1. Compression bandages: Multi-layer systems that provide sustained pressure
2. Compression stockings: Graduated pressure garments available in various strengths
3. Intermittent pneumatic compression: Devices that inflate and deflate to simulate muscle pumping
4. Adjustable compression wraps: Allow for easy application and adjustment

The choice of compression method will depend on factors such as the severity of edema, the patient’s mobility, and their ability to apply and remove compression devices independently.

Systemic Approaches to Edema Reduction

While local management of fluid leakage is important, addressing the underlying systemic causes of edema is crucial for long-term improvement. This often requires a multidisciplinary approach involving various healthcare specialists.

What systemic treatments can help reduce lower limb edema?

Systemic approaches to edema reduction may include:

• Diuretic medications to increase fluid excretion
• Treatment of underlying heart, kidney, or liver disease
• Management of venous insufficiency through procedures like sclerotherapy or vein ablation
• Lymphedema therapy, including manual lymphatic drainage
• Lifestyle modifications such as weight loss and increased physical activity
• Elevation of the affected limb when at rest
• Nutritional support to address any deficiencies contributing to edema

The specific treatment plan will depend on the identified cause of edema and may evolve as the patient’s condition changes. Regular reassessment is essential to ensure the effectiveness of the chosen interventions.

Preventing Complications and Promoting Skin Health

Maintaining skin integrity is a critical aspect of managing grossly edematous legs. The combination of excess fluid, potential skin breakdown, and increased infection risk necessitates a proactive approach to skin care.

How can skin health be maintained in patients with leaky legs?

To promote skin health and prevent complications:

1. Keep the skin clean and dry, using gentle cleansers and patting dry
2. Apply emollients to maintain skin hydration, avoiding areas of broken skin
3. Use barrier creams or films to protect skin from excess moisture
4. Regularly inspect the skin for signs of breakdown or infection
5. Encourage proper nutrition and hydration to support skin health
6. Implement regular repositioning to relieve pressure on edematous areas
7. Address any underlying conditions that may affect skin health, such as diabetes

Early intervention at the first sign of skin changes can prevent minor issues from developing into more serious complications. Patient education on self-care and when to seek medical attention is also crucial.

Holistic Patient Care and Quality of Life Considerations

Managing grossly edematous legs with fluid leakage extends beyond physical treatments. The condition can significantly impact a patient’s quality of life, affecting their mobility, self-esteem, and ability to engage in daily activities. A holistic approach to care is essential for optimal outcomes.

How can healthcare providers address the psychological and social impacts of leaky legs?

To provide comprehensive care:

• Offer emotional support and counseling to address anxiety or depression related to the condition
• Provide education on self-management techniques to empower patients
• Connect patients with support groups or peer mentors
• Work with occupational therapists to adapt living spaces and daily routines
• Collaborate with social workers to address any social or financial challenges
• Encourage family involvement in care planning and implementation
• Consider referral to pain management specialists if chronic pain is an issue

By addressing both the physical and psychosocial aspects of living with grossly edematous legs, healthcare providers can help patients maintain a better quality of life despite their condition.

Managing fluid leakage in grossly edematous legs presents significant challenges for both patients and healthcare providers. A multifaceted approach that combines appropriate dressing selection, compression therapy, systemic treatments, and holistic care is essential for effective management. By addressing the underlying causes of edema, preventing complications, and supporting patients’ overall well-being, it is possible to improve outcomes and quality of life for those affected by this condition. Ongoing research and advancements in treatment modalities continue to enhance our ability to manage this complex issue, offering hope for better solutions in the future.

The management of fluid leakage in grossly oedematous legs

There are no easy ways to manage gross oedema and the resulting fluid leakage. It is vital to treat the underlying cause and reduce the risk of complication

This article has been updated

The evidence in this article is no longer current. Click here to see an updated and expanded article

Abstract

VOL: 99, ISSUE: 21, PAGE NO: 54

Managing patients with grossly oedematous legs poses challenges because the condition is often accompanied by the leakage of considerable volumes of fluid, often known as ‘leaky legs’. Irene Anderson explains why leakage occurs, provides an overview of management strategies and opens the debate on how to manage the condition.

Author: Irene Anderson, BSc, RGN, DPSN, is senior lecturer, tissue viability, University of Hertfordshire, Hatfield.

Introduction

Oedema occurs when there is an abnormal amount of fluid in the interstitial space. Normally about 85 per cent of the fluid that is filtered out of capillaries into this space is reabsorbed; the rest is drained by the lymphatic system (Tortora and Grabowski, 2000). A rise in capillary blood pressure causes increased quantities of fluid to escape from capillaries. As a result, filtration of fluid into the tissues exceeds the reabsorption rate of fluid into the circulation, leading to oedema (Tortora and Grabowski, 2000) (Fig 1).

Oedema of one limb may be indicative of venous or lymphatic disease, while bilateral limb oedema may be a symptom of heart or kidney disease (Gorman et al, 2000). Pitting oedema may indicate congestive cardiac failure. In ischaemic conditions, the cause may be limb dependency as patients try to alleviate pain by hanging the limb out of the bed (Stubbing and Chesworth, 2001).

Oedema and fluid leakage

Problems can occur if the volume of interstitial fluid in the limb exceeds its capacity to retain it. This may be complicated if there is a breach in skin integrity or an infection. This can result in gross swelling, blistering and leakage of interstitial fluid on to the skin. 

Fluid that leaks from grossly oedematous legs will differ depending on the underlying cause. Transudate is excess fluid that is forced out as a result of elevated capillary blood pressure in the lower limb (Cutting and White, 2002). Fluid leakage resulting from failure of the lymphatic drainage system is called lymphorrhoea (Board and Harlow, 2002a). It is important to remember that fluid leakage can also be caused by a large wound or by some skin conditions that result in the formation of papules and vesicles (Moffatt and Harper, 1997).

Management of leaking interstitial fluid often centres on appropriate dressing selection. However, it is essential to take an interdisciplinary approach to managing patients to prevent complications, maintain skin integrity and promote independence.

Consequences of gross oedema

A grossly oedematous limb is physically heavy to lift, affects mobility and well-being, and has a high risk of infection. If it is leaking fluid, it will feel wet and quickly become cold. The fluid will soil clothing and bedlinen, and could pose a safety problem if flooring becomes slippery.

There is a risk of infections such as cellulitis or erysipelas, although the causative organism is rarely identified from skin swabbing (Regnard et al, 1997). Erysipelas can develop rapidly with acute onset of inflammation – it is characterised by a firm red margin and blistering. Cellulitis has a less rapid onset and ill-defined margins, and blistering is less likely to occur.

In both cases the patient will feel unwell and febrile, but will usually respond rapidly to antibiotic or antifungal treatment (Seal et al, 2000). The recurrence rate of erysipelas and cellulitis is significant (Dupuy et al, 1999) and management should focus on reducing the cause of oedema where possible.

It can be difficult to differentiate between varicose eczema and cellulitis. The former is characterised by scaling and crusting, while the latter generally by shiny, tight skin (Quartey-Papafio, 1999). However, in some cases cellulitis may be concurrent with varicose eczema, making distinction difficult. Topical antimicrobials may be indicated, but if the whole lower limb is affected it is crucial not to exceed the recommended dose. In the acute phase of cellulitis or erysipelas the patient may need hospital treatment.

Management of leaking fluid

Dressings

There is a range of dressings materials and devices for dealing with wound fluid (Anderson, 2002), although choice is limited when treating a grossly oedematous limb, owing to its size and leaking fluid. Dressings designed to deal with significant fluid volumes include foam, alginate, hydrofibre and composite dressings. However, dressings may quickly become saturated and thus extremely heavy, causing them to slip and pull on the skin.

Alginates and hydrofibre dressings are recommended for high exudate levels but would have to be used in sufficient quantity to cover the limb and require a secondary dressing. Low-adherent silicone materials could also be used but, again, these need to be used in sufficient quantity to cover the limb. Padding material, such as surgical pads or absorbent surgical dressings (for example Gamgee tissue), may be used as secondary dressings, but there is a risk of skin damage and discomfort owing to the weight of the wet dressing and cooling of the patient’s leg (Anderson, 2002).

There are anecdotal reports of absorbent disposable continence pads or nappies being used to absorb fluid but there is lack of evidence to support this practice. There may be a case for protecting bedding this way.

Barrier creams are often applied to leaking legs to protect skin from breakdown. This must be balanced against the possibility of blocking the absorptive action of the dressing material. This is particularly pertinent in the case of alginate and hydrofibre dressings that rely on direct contact with wound fluid (Anderson, 2000).

It is not advisable to use adhesive dressings on grossly oedematous legs because they may tear the very fragile taut skin and will require frequent changing.

Compression therapy, elevation and exercise

Because reabsorption of fluid occurs when pressure in the tissues exceeds pressure in the capillaries (Tortora and Grabowski, 2000) (Fig 1), the application of compression to the lower limb aids drainage of excess fluid back in to the capillaries by reducing the capillary pressure (Moffatt and Harper, 1997).

Graduated compression therapy can be applied using multilayer, short-stretch, intermittent compression bandages or compression hosiery. However, it can be difficult to apply these to grossly oedematous limbs because of distortion of limb shape. Pain may also govern the decision to apply compression therapy. It can be difficult to determine the status of arterial supply in the lower limb using a hand-held Doppler device because of the oedema. Compression should not be applied to limbs with significant arterial insufficiency.

If gross oedema is caused by lymphatic failure, the use of specialist therapeutic massage techniques to aid lymph drainage may help (Board and Harlow, 2002b).

Limb elevation is often recommended for dependent oedema. However, arterial insufficiency may make this undesirable because elevation will further reduce the blood supply to the lower limb (Moffatt and Harper, 1997). Great care must be taken when elevating limbs or applying compression therapy in patients with heart failure, as the increased volume of fluid return to the circulation may be catastrophic (Morison et al, 1997).

Exercise is important in managing oedema: muscle pump action assists reabsorption of fluid and drainage via the lymph system (Board and Harlow, 2002c).

Potassium permanganate

Potassium permanganate is a mild antiseptic with astringent properties. There is a debate about its role in managing exuding wounds (Hollinworth and Quick, 1995). It may be useful in the short term for treating extensively leaking legs, under supervision of a dermatologist. However, clinical experience would suggest it only offers brief respite.

Drug therapy

Pharmaceutical agents, such as diuretics, are used to control circulating fluid volumes in the body. It is important to use these appropriately and not merely to reduce dependent oedema (Khan, 2000).

Evaluating outcome

It is vital to record changes in limb volume, to assess the impact of clinical decisions. This may be as simple as measuring limb circumference. This is important if compression hosiery is being used – as fluid levels reduce, compression bandages will need to be reapplied more frequently. The patient may benefit psychologically from seeing the difference in limb size.

Interdisciplinary care Nurses play a vital role in assessing, monitoring and providing psychological support. The patient may need to be referred to a dermatologist, microbiologist and vascular consultant. Occupational therapists can provide aids for activities of daily living, while physiotherapists can offer exercises and help with mobility. There can be a role for the specialist nurse in lymphoedema, particularly if limb size does not reduce in the short term. Although this is a distinct condition, the specialist nurse’s experience can be utilised for patients suffering similar difficulties.

Conclusion

There are no easy ways to manage gross oedema and the resulting fluid leakage. It is vital to treat the underlying cause and reduce the risk of complication, such as infection and injury to wet, vulnerable skin.

Anderson, I. (2002) Practical issues in the management of highly exuding wounds. Professional Nurse; 18: 3, 145–148.

Board, J., Harlow, W. (2002a) Lymphoedema 2: classification, signs, symptoms and diagnosis. British Journal of Nursing; 11: 6, 389–395.

Board, J., Harlow, W. (2002b) Lymphoedema 3: the available treatments for lymphoedema. British Journal of Nursing; 11: 7, 438–450.

Board, J., Harlow, W. (2002c) Lymphoedema 1: components and function of the lymphatic system. British Journal of Nursing; 11: 5, 304–309.

Cutting, K.F., White, R. (2002) Avoidance and management of peri-wound maceration of the skin. Professional Nurse; 18: 1, 33–36.

Dupuy, A. et al (1999) Risk factors for erysipelas of the leg (cellulitis): case-control study. British Medical Journal; 318: 7198, 1591–1594.

Gorman, W.P. et al (2000) Swollen lower limb 1: general assessment and deep vein thrombosis. British Medical Journal; 320: 7247, 1453–1456.

Khan, M.G. (2000) Cardiac Drug Therapy. London: W.B Saunders.

Hollinworth, H., Quick, A. (1995) Using potassium permanganate for wound cleansing. Journal of Wound Care; 4: 2, 194.

Moffatt, C., Harper, P. (1997) Leg Ulcers. London: Churchill Livingstone.

Morison, M. et al (1997) Nursing Management of Chronic Wounds. London: Mosby.

Quartey-Papafio, C.M. (1999) Importance of distinguishing between cellulitis and varicose eczema of the leg. British Medical Journal; 318: 7199, 1672–1673.

Regnard, C. et al (1997) ABC of palliative care: mouth care, skin care and lymphoedema. British Medical Journal; 315: 7114, 1002–1005.

Seal, D.V. et al (2000) Skin and wound infection. London: Martin Dunitz.

Stubbing, N., Chesworth, J. (2001) Assessment of patients with vascular disease. In: Murray, S. (ed.) Vascular Disease: Nursing and Management. London: Whurr Publishers.

Tortora, G.J., Grabowski, S.R. (2000) Principles of Anatomy and Physiology. Chichester: Wiley and Sons.

Oedema | Fluid & Water Retention

Oedema is fluid retention. It used to be called dropsy. Oedema can be most easily seen around the ankles after you’ve been standing (peripheral oedema). After lying down for a while, your eyes may look puffy and swollen. In severe cases, oedema can also collect in your lungs and make you short of breath.

Mild oedema is common and usually harmless. It may be due to medication, allergies, or more serious underlying disease.

It is important to seek medical attention if you have oedema. Often no particular cause will be found. The most common causes are mentioned below.

What is oedema?

Oedema is a collection of fluid in the spaces between cells of the body. Fluid leaks out of damaged cells. The fluid cannot be simply drained with a needle and may not improve if you take ‘water pills’ (diuretics).

Types of oedema include:

• Idiopathic – no known cause.
• Localised – fluid retention in a particular part of the body. It is usually due to injury or an allergic reaction.
• Generalised – affects the whole body. It usually causes puffy ankles after standing and puffy eyes after lying down for a while. This may be due to an underlying heart condition.
• Cerebral oedema – fluid on the brain, usually due to infection (meningitis) or serious brain disease (stroke or brain tumour).
• Pulmonary oedema – fluid on the lungs, usually due to heart disease.
• Lymphoedema – a build-up of lymph fluid when lymph channels are damaged – eg, after breast cancer surgery.

What causes oedema?

Fluid retention (oedema) may be caused by many different conditions. Oedema may be due to having to spend a long time sitting or having to stay in bed (immobility). Varicose veins and pregnancy are also common causes of oedema. Oedema may also be caused by serious conditions such as heart failure, liver disease or kidney disease.

No known cause (idiopathic)

Idiopathic oedema is the term for fluid retention which it not caused by a known medical condition. It is most common in women and can sometimes worsen with age. Although there is no cure for idiopathic oedema, having a healthy diet which is low in salt can make a real difference.

Many people with fluid retention are overweight, and losing weight can make a big difference to improve the oedema. A gradual weight loss (rather than fasting and bingeing) is recommended. Support stockings and regular exercise are also beneficial. Avoiding long periods of standing can also help.

Heart failure

An excess collection of watery fluid in the lungs (pulmonary oedema) is often caused by heart failure. The fluid collects in the many air sacs (alveoli) of the lungs, making it difficult to breathe. When the heart is unable to pump blood to the body efficiently, the amount of blood staying in the veins that take blood through the lungs to the left side of the heart increases. As the pressure in these blood vessels increases, fluid is pushed into the alveoli in the lungs. This fluid reduces normal oxygen movement through the lungs, which can lead to shortness of breath.

Angio-oedema

Angio-oedema is a condition that can cause swelling of the deeper layers of the skin. These include the dermis and subcutaneous tissues. It also affects the tissues just under the lining of the airways, mouth and gut (the submucosal tissues).

In most cases there is no known cause and it is not clear why it occurs. This is called idiopathic angio-oedema. Although the cause is not clear, in up to half of cases there is a link to an autoimmune disorder. These include chronic urticaria, systemic lupus erythematosus (SLE), or having an underactive thyroid gland (thyroiditis, hypothyroidism). In some cases there are known triggers that can cause the release of histamine, which leads to tissue swelling of angio-oedema. These include allergic reactions and non-allergic reactions to medicines.

Other possible causes of oedema include anaemia, pregnancy and some kidney diseases. A blood clot in a leg (deep vein thrombosis) can make the leg (with the blood clot) swell.

The doctor will want to know when you first noticed the oedema, how long it lasted for and whether you have any other symptoms. It is important to mention if you’ve started any new medication. You will be given a physical examination of your lungs, heart and blood pressure as well as the part which is puffy. You will probably be asked for a urine sample and to have a blood test. You may need further tests on your heart, and a chest X-ray.

What treatments may be offered?

Treatment will depend on the likely cause of your fluid retention (oedema). Most cases will be managed by your GP but you may be referred for further investigation and treatment at a hospital. Treatments include:

How can I get rid of oedema fast?

There is no one-size-fits-all solution and no quick fix. Mild oedema (particularly of the legs and ankles) is often the result of excess weight and exercise, so addressing these issues will help. You may be surprised how quickly the extra fluid disappears once your weight reduces. However, persistent oedema needs assessment by a doctor to detect the underlying cause .

How can I treat itching?

Itching with oedema can be due to several causes.

• Mechanical stretching of the skin due to fluid retention can cause a local disturbance which results in itching. This usually settles once the oedema is treated.
• Angio-oedema is often treated with antihistamine tablets and steroid tablets.
• Varicose veins can cause a combination of oedema and an itchy rash known as varicose eczema. Make sure your legs are raised when you are sitting down, keep active, and use moisturising cream. Steroid ointments are occasionally prescribed if the rash becomes very itchy.

What should you do next?

You should call an ambulance if you experience severe shortness of breath or chest pain. Mild puffiness of your ankles that gets better when you lie down for a few hours, may not need any treatment. In all cases, you should see your GP to find out if there is an underlying cause.

Who is affected by oedema?

Women are more prone than men to fluid retention (oedema). Female hormones (progesterone) tend to cause fluid retention so some women notice puffy ankles just before a period. Oedema may occur for the first time at any age if you have an allergic reaction or become anaemic. Older people can develop oedema, as they sit for long periods of time. They are also more likely to have underlying heart or kidney conditions that may cause oedema.

For more information, see the separate leaflet called Swollen Legs.

How can I avoid oedema?

You will need to find the underlying cause of the fluid retention (oedema) and try to address it if possible. Idiopathic oedema has no specific cause and is very common. The best approach is to walk regularly, avoid becoming overweight and put feet up on a footstool when resting.

What is the outlook (prognosis)?

This depends on the underlying cause. Oedema can be dangerous if untreated, particularly if you get fluid retention in the lungs. However, providing the underlying condition is recognised and treated, the outlook is generally very good. Most oedema is due to standing too long on a hot day, especially if you are overweight.

Common Risk Factors and Complications

By the WoundSource Editors

Edema is the abnormal accumulation of excess fluid within tissue. The swelling associated with edema can be localized to a small area following an acute injury, it can affect an entire limb or a specific organ, or it can be generalized throughout the entire body. Edema is not a disease, but rather a symptom that can indicate general health status, side effects of medications, or serious underlying medical conditions.¹

Normally, fluid is exchanged in the body through intravascular (the vascular system and chambers of the heart) or extravascular (all other interstitial areas) compartments. This fluid movement is governed by a balance of hydrostatic and oncotic pressures. When the balance of these pressures is disrupted and the filtration capacity of the lymphatic system is overwhelmed, the result is edema.¹

Compression Garment Selection for Kidney Failure-Related Edema

Symptoms of Edema

Swelling is the most prevalent symptom of edema, with variations in location and type indicating different underlying issues. Peripheral edema affects the extremities and can be exacerbated by prolonged sitting or standing. Peripheral edema manifests differently by order of severity. In severe cases with pitting edema, finger pressure applied to the site of swelling will leave a depression lasting from 10 to 30 seconds. In non-pitting edema, finger pressure will not result in a lasting depression. Anasarca is general edema affecting the entire body. Abdominal edema is referred to as ascites and is an indication of peritoneal cavity fluid retention. The skin of areas affected with edema may appear shiny and taut with swelling.²

Common Risk Factors Associated With Edema
General health factors contributing to mild forms of edema include prolonged sitting or standing, skin injury, excessive sodium consumption, premenstrual hormonal changes, and pregnancy. None of these factors are indicative of significant health issues, and the edema in each of these cases is usually temporary.³

Edema can also be a side effect of several common medications. These include blood pressure medications, certain diabetes medications, estrogens, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and vasodilators. Most of these reactions are non-critical, but allergic reactions to medications can cause tongue or throat edema requiring emergency medical treatment.²

The most serious risk factors associated with edema are systemic diseases involving the heart, kidneys, liver, and lungs. ³

• Chronic lung diseases such as chronic bronchitis or emphysema resulting in pulmonary edema may contribute to shortness of breath and low blood oxygen levels.
• Chronic venous insufficiency caused by varicose veins and thrombophlebitis manifests in fluids accumulating in the feet and ankles.
• Cirrhosis of the liver can cause increased pressure in abdominal blood vessels manifesting as an abdominal bulge from excessive fluid collected in the abdominal cavity, or ascites.
• Congestive heart failure may result in pulmonary edema when the heart is unable to pump blood efficiently. Increased pressure in the veins that circulate blood through the lungs eventually pushes fluid into the alveoli, thereby reducing lung capacity.
• Kidney disease may result in periorbital edema (swelling around eyes) or swelling of legs secondary to fluid accumulation caused by declining levels of protein (albumin) in the blood.
• Lymphedema, a disease resulting from lymphatic system dysfunction, can cause swelling in the legs or arms. This edema is from tissue fibrosis produced by proteinaceous fluid buildup as a result of this dysfunction. It has various causes and can be treated and managed, but not cured.

Potential Complications of Unmanaged Edema
Although mild cases of edema may resolve on their own, unmanaged edema stemming from chronic, systemic causes can result in a range of complications. Edema left untreated can cause skin stretching to a point of pruritus and discomfort accompanied by painful swelling, stiffness, and difficulty walking. Swollen areas are at increased risk of skin ulcers and infection. Blood clots in deep veins, a condition known as deep vein thrombosis, are more likely when blood circulation is decreased as a result of edema.²

Common Edema Treatments and Interventions

Patients with edema or who are at risk of developing edema can reduce their risk or symptoms by taking the following precautions:⁴

• Reducing daily consumption of sodium
• Participating in regular exercise
• Avoiding exposure to extreme temperatures (hot baths, saunas, etc)
• Wearing compression stockings, sleeves, or gloves
• Using compression clothing during air travel
• Receiving specialized lymphatic decongestive therapy
• Protecting the affected area from injury and moisturizing the skin often
• Elevating the affected area above heart level throughout the day

Diagnosis and treatment of the underlying condition causing severe edema are necessary to implement a long-term plan for management. Severe or chronic edema may require treatment with diuretic medications to help increase the volume of fluid excreted by the kidneys.

References
1. Trayes KP, Studdiford JS, Pickle S, Tully A. Edema: diagnosis and management. Am Fam Physician. 2013;88(2):102–110. https://www.aafp.org/afp/2013/0715/p102.html. Accessed October 11, 2019
2. Mayo Foundation for Medical Education and Research. Edema. http://www.mayoclinic.com/health/edema/DS01035. Mayo Clinic; 2011. Accessed October 11, 2019.
3. Phelps KR. Edema. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990.
4. Bobkova I, Chebotareva N, Kozlovskaya L, Shilov E. Edema in renal diseases – current view on pathogenesis. Nephrology @ Point of Care. 2016;2(1):e47–e55. https://doi.org/10.5301/pocj.5000204. Accessed November 3, 2019.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

Symptoms, Causes, Diagnosis, and Treatment

Edema is the medical term used to describe swelling associated with injury, inflammation, or fluid overload. It can affect a small area, large area, or even the entire body. Edema is the result of the small blood vessels leaking fluid into tissues. When fluid builds up, tissue swells.

Verywell / JR Bee

Symptoms

There are various different types of edema, and each has different health risks that go along with it. The symptoms of each type of edema are dependent upon the type, location, and cause.

Peripheral

Peripheral edema is the most common type of edema and affects the feet, ankles, legs, arms, wrists, and hands. Symptoms usually include increased swelling, puffiness, pain in muscle tissues and joints, and difficulty moving. Skin symptoms include pain, swelling, tightness, and a shiny, stretchy appearance.

Additional symptoms of peripheral edema include:

• Skin that retains a dimple when pressed for a few seconds (pitting)
• Puffiness in ankles, hands and/or face
• Joint aches and stiffness
• Full hand and neck veins

Macular

Macular edema involves swelling in the macula, the part of the eye responsible for detailed and centralized vision. This type of edema will change central vision and how colors are perceived. Macular edema is often a complication of diabetic retinopathy, an eye disease that affects people with diabetes. 

Early on, macular edema does not cause symptoms. When symptoms are present, it is an indication of blood vessel leakage. Symptoms include blurry and wavy central vision, colors that appear faded, and problems with reading any type of writing and viewing information on a computer screen. Left untreated, macular edema will eventually cause vision loss.

Pulmonary

Pulmonary edema causes excess fluid to build up in the heart and/or lungs causing breathing problems. Often it is caused by congestive heart failure or a lung injury. Pulmonary edema is a very serious condition and can be a medical emergency. Left untreated, it could lead to respiratory failure and/or death.

Symptoms of pulmonary edema include shortness of breath, difficulty breathing (especially when lying down), waking up breathless, chest pain, wheezing, excessive sweating, general body weakness and fatigue, and coughing up blood.

Cerebral

Cerebral edema happens in the brain for any number of reasons, many of which are life-threatening. Symptoms of edema in the brain include headache, neck pain and/or stiffness, vision loss (partial or whole), dizziness, nausea, and vomiting.

Symptoms of severe cerebral edema may include confusion, mood/mental state changes, memory loss, difficulty speaking and finding the right words, changes in consciousness, especially unconsciousness, physical weakness, incontinence, and seizures.

Be sure to make an appointment to see a doctor for swelling, stretching, or pitting of skin.

Seek out immediate medical attention for shortness of breath, difficulty breathing, chest pain, confusion, mental health changes and changes in consciousness. 

Causes

There are many causes of edema. Causes are dependent on the type of edema.

Peripheral

Peripheral edema can result from sitting or standing in one place for too long. Fluid will get pulled into the legs and feet and cause swelling. In addition, other causes include medications (such as blood pressure drugs and pain medicines), too much salt in a person’s diet, and low protein levels in the blood (often due to malnutrition).

Other causes of peripheral edema include:

• Venous insufficiency, a condition that causes edema when the valves of the legs become weakened. This makes it harder for the veins to push blood to the heart. It also leads to varicose veins and fluid in the legs. Venous insufficiency affects 30% of the population.
• Certain diseases such as conditions of the lung, liver, kidney, or thyroid, in which salt retention can occur.
• Joints that swell and retain fluid caused by an arthritis condition.
• Being pregnant, as it puts pressure on the blood vessels of the lower part of the body.

Macular

There are many different conditions and risk factors that may lead macular edema, including age-related eye conditions, such as macular degeneration and cataracts, which may cause macular swelling that leads to blood vessels leaking fluid in the retina. Certain medications might also cause macular edema.

For example, hydroxychloroquine (an antimalarial drug) and Tamoxifen (a breast cancer treatment) are two medications that may affect the retina, but there are many others. It is a good idea to check with your doctor if any medications you are taking may affect your eye health, especially if you have other risk factors.

Other causes of macular edema include:

• Inherited and genetic disorders: Retinoschisis or retinitis pigmentosa are genetic conditions that cause problems with the retina resulting in central and peripheral (side) vision changes and loss.
• Inflammatory eye diseases: For example, uveitis—a condition that causes ongoing eye inflammation—can cause macular swelling.
• Eye tumors and eye injuries: Eye tumors (both benign and malignant) and eye injuries can lead to swelling of the macula.
• Diabetes: High sugar levels can damage blood vessels, which end up leaking in the macula.

Pulmonary

Pulmonary edema is often caused by a problem with the heart, usually in the left ventricle (one of the chambers) in the heart. Poor pumping of the left ventricle creates a buildup of fluid. Narrow arteries, heart valve problems, muscle damage, and high blood pressure can also weaken the left ventricle.

Respiratory problems, blood clots, inhaling toxins, and lung injuries can also lead to pulmonary edema.

Cerebral

Several factors can lead to brain swelling, with the most common being traumatic brain injuries, strokes, infections—both viral and bacterial, and brain tumors. Other causes include high altitude, drug use, carbon monoxide poisoning, and bites from poisonous animals (including reptiles).

Diagnosis

Diagnosing peripheral edema involves a simple physical exam. In peripheral edema, the skin of the swollen area is often stretched and shiny. Gently pushing on the swollen area for about 15 seconds will leave a dimple.

Other types of edema require a medical history, symptom history, and additional testing (such as blood work and imaging) in order for a doctor to determine if someone has edema, the type of edema, and treatment options.

Treatment

The only way to treat edema is to treat the cause of it.

Peripheral

Doctors may prescribe diuretic medications (water pills) to help push salt and extra fluid out of the body with urine output in peripheral edema.

To help reduce swelling at home if you have edema in the lower part of your body, try elevating legs with sitting or lying down. 

Wearing supportive stockings can put pressure on legs to reduce fluid collection in the legs and ankles. Avoid standing or sitting for long periods. Lastly, reduce the amount of salt in your diet.

Macular

Treatment for macular edema depends on the severity of the condition and the health of the patient. Treatment may include ocular steroid and non-steroid anti-inflammatory eye drops, ocular steroid injections, anti-inflammatory medications to be taken orally, and/or surgery to remove excess fluid from the eye.

Most people will experience significant vision improvements with treatment.

Pulmonary

Pulmonary edema can be a life-threatening condition. Therefore, it requires prompt treatment. Oxygen therapy is usually the first treatment doctors will use to manage symptoms, which may include a breathing tube or oxygen delivered through an oxygen mask.

Depending on the cause of pulmonary edema, additional treatments may be prescribed including medications to decrease fluid in the heart and lungs, to reduce blood pressure and control pulse, to take pressure off the heart, and/or to relieve anxiety and shortness of breath.

Cerebral

Treatment for brain swelling should be immediate as this is a life-threatening condition.

It is important to reduce swelling and restore blood flow and oxygen to the brain as soon as possible. 

Treatment options include medications to reduce swelling and blood clots. Further treatment may include:

• osmotherapy, or the use of osmotically active substances (substances that reduce fluid) to shift excess fluid in the brain.
• hyperventilation to cause more exhaling and lower the amount of carbon dioxide in the bloodstream. Controlling carbon dioxide will lower blood flow and reduce pressure and swelling.
• hypothermia, which involves lowering body temperature to reduce swelling in the brain.
• ventriculostomy, a surgical procedure where a small incision is made in the skull to drain fluid from the brain.
• a surgery in which part of the skull is removed to reduce pressure and swelling in the brain.

Complications

Untreated edema can lead to complications. For peripheral edema, this includes stiffness and problems with walking, stretched and itchy skin, scarring between layers of tissue, and skin ulcers.

Among the complications of pulmonary edema is respiratory failure. Heart attack or stroke is a risk of both pulmonary and cerebral edema.

Cerebral edema could also lead to neurological issues, and vision loss could result from macular edema. Additionally, aside from the complications unique to certain types of edema, there are overlapping conditions that could occur as a result of every type of edema.

Potential Complications of Edema

• Loss of elasticity in the joints, veins, and arteries
• Painful swelling
• Infection
• Poor blood circulation
• In severe cases, death related to untreated complications

The best way to prevent complications is to treat underlying conditions appropriately to keep them from getting worse.

A Word From Verywell

Edema can be caused by a serious medical condition or something simple. Regardless of the cause, treatment can help to relieve swelling and prevent complications. It is a good idea to see a doctor if you are unaware of the cause of edema or if there are symptoms more than just minor swelling and fluid buildup, especially if breathing or consciousness is affected or an injury has occurred.

Lymphoedema and limb swelling – Vascular Society

Swelling of the foot and/or leg can have a number of causes. If both legs are affected it may suggest a more generalised cause such as fluid retention in the body. Kidney, liver and heart function can influence this. It may also be a side effect of medications. A long period of immobility with the legs dependent (below heart level) can lead to a build up of fluid, since we rely on the movement of the muscles in the leg to move the blood and fluid up out of the legs towards the heart. In some illnesses the protein level in the blood stream drops and this causes fluid to move out into the tissues causing bilateral limb swelling. In some cases abnormal fat distribution leads to the appearance of limb swelling and it is mistaken for fluid.

When one limb is affected it can point to a more local problem in the leg being the cause of the swelling. There are a number of possibilities :

1. Venous insufficiency – poor return of fluid in the veins from the leg. (valve failure, DVT, varicose veins)
2. Infection – tissues are inflamed and accumulate fluid which leaks from the circulation.
3. Injury – after any injury the healing repsonse involves some element of swelling
4. Lymphatic failure – damaged, blocked, or absent lymph channels and glands.

Investigations are therefore required to establish which of the above problems is causing the leg swelling. From the vascular perspective, it is important to establish the function of the veins. Lymphoedema is different from venous oedema, and it may be clear that the swelling is lymphoedema from examination. Sometimes specific tests are needed to be more certain.

Treatment

This will be directed to the underlying cause. Compression with support stockings is often helpful. Vein treatments may be useful. Difficult lymphoedema may need more specilaised therapy.

LYMPHOEDEMA

What is lymphoedema?

We all have a small amount of fluid (lymph) in our body tissues. This fluid leaves our blood system to provide water and nourishment to the tissues. Most of this fluid is collected by a system of drainage tubes, similar to blood vessels, called the lymphatic system. Lymphoedema is swelling which is due to a build up of lymph in the limbs if the fluid is not draining out properly.

To start with, the swelling is often noticeable at the end of the day and goes down at night. However, unless the swelling is treated properly, the fluid becomes fixed in the leg permanently.

What causes lymphoedema?

The most common cause for lymphoedema is that you were born without enough lymphatics. If there are very few lymphatics then the swelling may start as a teenager or even earlier. This type of lymphoedema is called Milroy’s Disease. One leg is often worse than the other and sometimes only one leg is affected.

In less severe cases the lymphatics may be able to cope initially and only start to fail when you are older. This kind is sometimes called Lymphoedema Tarda.

Are there any other causes?

Lymphoedema can also be caused if the lymphatics of the arm and leg are damaged by surgery or radiotherapy for the treatment of cancer. Sometimes this is unavoidable if the cancer is to be cured. .

What are the effects of lymphoedema?

Apart from the uncomfortable and unsightly swelling, lymphoedema can cause problems, especially if it is not kept under control. There is an increased risk of infection under the skin (cellulitis) and repeated attacks of cellulitis lead to more lymphatic damage. This vicious circle may eventually lead to severe infections, ulcers and even amputation in extreme cases.

What is the treatment?

Lymphoedema cannot be cured but it can usually be controlled so that complications do not occur later. The mainstays of treatment are compression bandages or stockings, elevation of the limb and external pneumatic compression.

Elevation of the limb

Whenever the leg is elevated, fluid will tend to drain out of it. Put your legs up whenever you can and as high as you are able – the arm of a sofa is good. Elevate the end of your bed (6 inches or so) in order that your feet are a little higher than your head. You can use some old books for this.

Compression bandages or stockings

Compression is required to squeeze the fluid out of your legs when you are standing up. Bandages may be required at first, to remove the worst of the swelling, before stockings can be used. These stockings need to be specially fitted and are much stronger than ordinary “support tights”. If the swelling only affects the lower leg, then you can wear a below-knee stocking that is self-supporting, like a pop-sock. The usual strength of stocking used is a Class II, but sometimes a stronger Class III is required. If you have difficulty putting on your stockings, then you can buy a special stocking applicator.

External Pneumatic Compression (EPC)

Despite compression stockings, many people find that some swelling accumulates by the end of the day. The EPC device is a pneumatic boot that inflates and deflates to squeeze fluid out of the leg. EPC is normally used in the evening to get rid of any fluid that has built up despite compression stockings. If your doctor thinks you need EPC therapy, a trial of the device will normally be arranged so that you can decide whether it is worth buying one.

What about surgery?

Many operations have been tried to cure lymphoedema, but none have been very successful. Surgery to reduce the size of the lower leg, liposuction or surgical excision (Homan’s Reduction) may be suggested if your leg remains very swollen despite compression therapy.

How can I help myself?

Wear your compression stockings every day from morning to night.

Elevate your legs whenever possible.

Take plenty of exercise and don’t put on weight.

Keep the skin in good condition by using plenty of moisturising cream to prevent dryness.

For more information go to The Circulation Foundation;   NHS Choices or Foldi clinic

Leg Edema & Swelling Treatment

Managing Leg Swelling and Discoloration After Treatment

Long term management of swelling and discoloration may include the following

• Ongoing use of compression devices(stockings, lymphedema pump, wraps, etc)
• Leg elevation
• Routine exercise regimen
• Maintenance of BMI of <30
• Close monitoring and management of other medical conditions
• Reduced salt/sodium intake in the diet

During and after treatment, you need to find ways to manage your condition to reduce your risk of having your symptoms return. Those include:

• Getting regular exercise, even if it’s just walking
• Eat healthier foods, including fruits and vegetables
• Try and maintain a healthy weight for your body’s build
• Follow your doctor’s advice if you have conditions like diabetes
• Maintain healthy blood pressure and cholesterol levels
• Take all medication as prescribed
• Visit your doctor regularly

Prognosis

Once you begin treatment for leg discoloration or swelling due to vascular disease, what can you expect? Will you get better? Will your symptoms go away?

The treatment plan will be based on the degree of symptoms and the underlying disease process.  It is important to maintain compliance with recommended treatments to obtain maximum results. Swelling and discoloration can be chronic symptoms and may take several months to see optimal results.

In many cases of discoloration may be permanent to some degree.  Adherence to your treatment plan will help to make sure the reduction of discoloration is optimized.  Keeping the skin well moisturized to avoid cracking and open areas are advised.  You may be prescribed or recommended specific creams to assist with this.

Although you may not have complete resolution of the skin discoloration or swelling, compliance with treatment measures will assist in worsening of these symptoms and reduce the risk of progression to development of open wounds or ulcers

Your prognosis depends on how early your doctor diagnoses your condition, your immediate treatment needs, and how strictly you stick to your treatment plan. Treatment can reduce or eliminate your symptoms and help you manage your condition, which prolongs your quality of life and reduces your risk of serious complications.

However, many patients’ prognoses are worse with this type of vascular disease than coronary artery disease. One reason for that may have to do with patients suffering from certain kinds of vascular disease receiving less medication and overall treatment than patients with coronary artery disease.

That doesn’t mean you shouldn’t seek treatment. Without treatment, your prognosis is much worse.

Prevention

As with many conditions, prevention is the best cure. If you have any risk factors that you can address on your own, such as many of those listed above, your risk of developing the types of vascular disease that cause leg swelling and leg discoloration can fall dramatically.

Common Medications to Expect During Your Treatment Period

Patients may be prescribed diuretics or “fluid pills” to help reduce swelling.  While these medications will help to reduce the amount of fluid in the system and may reduce swelling, it is not an optimal long term treatment for underlying venous insufficiency or lymphedema.

Topical creams or ointments may be prescribed or recommended to treat dryness of the skin, skin discoloration or irritation of the skin.

The most common medication for leg discoloration and swelling due to a vascular disease involves blood thinners. One of the most significant vascular disease issues is clotting, and those clots can block entire blood vessels.

Also, high cholesterol and blood pressure contribute to vascular disease that results in edema and discoloration in your legs. Because of that, your doctor may also prescribe statins to lower your cholesterol levels and blood pressure medications, too.

What Happens If You Don’t Treat Prolonged Leg Discoloration or Swelling?

Untreated swelling and discoloration can lead to the progression of chronic skin changes which can put you at risk for cellulitis and/or open skin sores or ulcerations

If you have clots, they can break apart and travel to your lungs, heart, or brain, causing pulmonary embolisms, heart attacks, and strokes. Once any of these happen, your ability to mitigate your condition decreases dramatically.

You can also suffer tissue damage and death, resulting in gangrene. At this point, you’ll need amputation because the tissue death will only spread.

What to expect after treatment from CVM?

At the Center for Vascular Medicine, our mission is to help patients with their vascular diseases in a cost-effective and compassionate manner. We specialize in the diagnosis and treatment of venous and arterial diseases in the legs, feet, and pelvis. Our world-class providers are the most experienced in the specialty and work with patients to develop a treatment plan that is custom-tailored to their unique situation.

Typically, this process involves an initial consultation and ultrasound scan at one of our accredited facilities. After reviewing the results of your scan and obtaining a thorough medical history, our providers will discuss the results with you and help you decide on the next steps.

Our health care providers use several diagnostic tests to help determine what vascular diseases may be causing your symptoms. Our initial evaluations utilize ultrasound because this non-invasive imaging modality helps us verify our suspicions on whether your symptoms are caused by underlying vascular disease.

Edema: Types, Causes, Symptoms, and Treatment

Edema is another word for swelling. It is caused by excess fluid leaking from your capillaries (tiny blood vessels) into the surrounding tissue. When this extra fluid builds up, the tissue swells. The swollen site may be red, painful, inflamed, and warm or hot to the touch. Edema can happen anywhere in the body but is more common in the extremities: the arms, hands, legs, and feet. Sometimes taking medication can reduce edema, but in order to reduce edema stemming from a disease, the underlying disease must be treated.

Edema Symptoms and Causes

Edema has many different causes. It can stem from allergies, bug bites, eating too much salt, being pregnant or having premenstrual symptoms, or even from being in one position too long. These are usually minor cases and can be easily treated at home.

Taking medications such as those for high blood pressure, steroids, estrogens, and some diabetes medications can cause edema. In this case, talk to your doctor to find out if it is something that needs to be addressed.

If edema is caused by underlying diseases or serious allergies, it may be time to go to urgent care or the emergency room.

• Swollen legs, ankles, and feet can be from congestive heart failure and you need to contact your doctor.
• Swollen legs and abdomen can stem from cirrhosis of the liver and you should seek medical help.
• Swollen legs in conjunction with swollen eyes could be kidney disease or kidney damage and you should call your doctor or seek medical help if you believe this is the cause.
• Sudden swelling accompanied by pain in the calf can be due to a blood clot and you must seek immediate care.
• Allergies to an insect bite/sting leading to inflammation of the tongue and throat must seek immediate medical attention.
• Allergies to food leading to inflammation of the tongue and throat must seek immediate medical attention as well.

Types of Edema

• • Pedal edema- affects lower legs, ankles, and feet. Possible causes: pregnancy, being older
  • Peripheral edema/Lymphedema- affects the arms, legs, and feet. Possible causes: lymph nodes, kidneys or cancer treatment
  • Pulmonary edema- affects lungs, makes it hard to breathe, especially when lying down. Causes: fluid in the lungs
  • Cerebral edema- affects the brain. Causes: head trauma, blocked blood vessel, allergic reaction or tumor.

Edema Treatment

For mild cases of edema, where treatment at home is suggested, there are a few different solutions.

• Insect bites with mild redness and swelling, such as a mosquito bite or non-venomous spider bite, ice the area.
• A bee sting could be serious depending on whether the person is allergic to bees. Severe swelling or shortness of breath needs immediate medical attention and needs to be treated immediately.
• A broken bone warrants a trip to the emergency room,
• For an injury that has caused swelling, bruising, redness and pain, the best treatment is to do RICE Rest, Ice, Compression, and Elevation.
• If the edema is not caused by a broken bone, moving the affected part will help keep the fluid moving
• Massage the affected area, pushing the fluid towards the heart.
• Try to reduce the amount of salt in your diet as it can make edema worse.

If you have an insect bite or a small bruise, you can treat the minor swelling at home, if the edema is on a much larger scale, such as it affects your whole arm, you have trouble breathing, your head is swollen or it’s painful to walk, it may be time to visit Las Vegas Vein Center and let them help you reduce your swelling and get you back on your feet!

90,000 Pulmonary edema in cats – why it occurs and what are its symptoms, treatment, types of edema!

Pulmonary edema is the accumulation of fluid in the lung tissue or, in other words, “water in the lungs”.

How is this possible?

The lung consists of small thin-walled sacs – alveoli, entangled in a network of capillaries with blood. Between these capillaries and the air in the alveoli, gas exchange constantly takes place – the blood takes oxygen, and gives off carbon dioxide, which is then exhaled outside.But when the alveoli, instead of gas, are filled with fluid leaking from the blood vessels, then pulmonary edema occurs. The increase in fluid in the lung decreases its volume and elasticity. The result is a violation of gas exchange, oxygen starvation (hypoxia) of all body systems.

This is how it looks roughly:

Symptoms of pulmonary edema in cats and cats:

• anxiety
• shortness of breath, rapid breathing
• abdominal breathing (the cat “breathes its belly”) with an open mouth
• cyanosis, then there is cyanosis of the mucous membranes – the tongue and gums are blue (in a normal state – from poor pink to pink), sometimes blue skin is also noticeable
• first taking a pose with widely spaced limbs (an attempt to enlarge the chest), later – lying lateral position
• coughing up fluids (sometimes)
• wheezing in breathing

Edema, depending on the cause, is cardiogenic and non-cardiogenic.

Cardiogenic pulmonary edema

As the name implies, this pathology is caused by disturbances in the work of the heart and is characterized by high pressure in the vessels. Poor pumping function of the heart (for example, due to insufficiency of the mitral valve, etc.) leads to the accumulation and stagnation of blood in the vessels of the lungs, hence an increase in pressure and leakage of fluid from the blood capillaries into the alveoli.

Non-cardiogenic pulmonary edema

This type of edema is caused by any other (non-cardiac) causes and is characterized by an increase in the permeability of the walls of the pulmonary vessels.

The reasons for such edema may be:

• electric shock, craniocerebral trauma, convulsions (neurogenic edema)
• infectious and non-infectious diseases (inflammatory edema)
• gastrointestinal disorders, liver diseases, starvation, etc.
• poisoning with toxins – inhalation of carbon monoxide in a fire, snakebite, poisoning, uremia (severe intoxication as a result of renal failure), etc. (toxic edema)
• allergic reaction, anaphylactic shock
• sepsis
• neoplasms leading to blockage of lymphatic vessels
• vomit entering the airways (aspiration)

Diagnostics

The diagnosis of pulmonary edema is primarily based on chest X-ray cells.The picture is usually taken in two projections – frontal and lateral. With edema, the image shows a darkening of the pulmonary field, stagnation in large vessels. For cardiogenic edema, an increase in the cardiac shadow is characteristic, and with left-sided heart failure, an increase in the left half of the heart.

Listening with a stethoscope (auscultation) of the lungs can reveal wet wheezing, heart murmurs and arrhythmias.

Pulmonary edema is a life-threatening condition. It requires an immediate visit to the clinic!

Treatment of pulmonary edema in cats and cats

First of all, no stress (!), The cat should not worry, she needs peace.You can not try to force her to lay, feed or water. Take your pet to a doctor as soon as possible.

Treatment of pulmonary edema largely depends on the severity and cause of it. The main methods used are diuretics (diuretics) and oxygen therapy. Then, after stabilization of the condition, treatment of the disorders leading to edema is carried out.

To provide the animal with oxygen, it is placed in a special chamber or allowed to breathe oxygen using an oxygen bag and mask, sometimes artificial ventilation or surgery is used.

Simultaneously with the provision of first aid, the diagnosis of the underlying disease is carried out: an x-ray, general and biochemical blood tests and other studies are taken.

The state of pulmonary edema requires constant monitoring (listening, monitoring the work of the heart, blood composition, color of mucous membranes), the use of oxygen therapy and intensive decongestant therapy with diuretics, the use of painkillers, cardiac drugs, etc., if necessary.Therefore, it is more expedient to place a pet with a diagnosis of pulmonary edema in a veterinary clinic.

Unfortunately, the body of cats, like other animals living on land, is not adapted to do without oxygen, so its lack is life-threatening. If the cat has breathing problems, the visit to the doctor cannot be postponed! Often times, the animal needs emergency help counting down minutes!

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Why feet swell | UNIAN

Edema occurs due to the accumulation of fluid in the tissues.They can be caused not only by excessive stress on the legs, a large amount of fluid and heat, but also have more serious causes associated with diseases of the veins, heart, kidneys.

1. Heart failure

If the swelling in the legs is chronic, it may indicate heart failure. Swelling caused by heart problems is painless. In heart failure, a weakened heart muscle does not pump all of the blood, causing it to build up in the veins, causing them to dilate in the legs.The liquid component of the blood seeps into the tissue and causes swelling. In heart failure, the swelling spreads to both legs.

2. Phlebitis

Another cause of chronic edema is phlebitis, in which one or more veins are blocked by a blood clot called a thrombus. Most often, with phlebitis, one leg is affected by edema, less often two. The disease brings severe pain.

3. Varicose veins

Varicose veins are a violation of the outflow of blood, which leads to an increase in pressure first in large veins, then in small ones.High pressure in the capillaries promotes the release of fluid from the vessels into the tissue, from which edema occurs. With varicose veins, edema is often asymmetrical in both legs or is present in only one. With varicose veins, the swelling increases in the evening or after a long stay on the legs.

4. Renal pathology.

In kidney disease, edema extends to both legs and is not accompanied by pain. There may be puffiness on the face and hands, blue under the eyes, sometimes there is an increase in body temperature.This happens when there is a violation of the amount or composition of proteins in the body. If the kidneys are diseased, they secrete protein into the urine. When there is a loss of protein in the tissues, replenishment is due to fluid leaking from the blood vessels, which contains protein. In this case, edema occurs.

5. Disturbance of lymph flow

Disturbance of lymph flow in the skin and subcutaneous tissue leads to stagnation of lymph. This is due to a violation of water and protein metabolism in the body. In this case, severe edema occurs.This phenomenon is called “elephantiasis”.

6. Side effects of medications

Some medications can cause swelling of the legs. These include contraceptives containing female hormones – estrogens, some drugs that lower blood pressure, steroids used for a long time for diseases such as arthritis, cancer, asthma.

7. Wrong footwear

Incorrectly fitted footwear leads to the appearance of edema, which helps to limit the contraction of the calf muscles.You should not wear tight and tight shoes with too high heels or with completely flat soles.

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Severe facial edema | Medical clinic in St. Petersburg

Facial edema is a consequence of the retention of excess fluid in the body. In a normal state, he himself maintains the balance of fluid, removing excess.
If for some reason this does not happen, the tissues swell, causing the face to turn red and look swollen.Edema is not only an aesthetic defect, it can signal serious illness.

Often, edema manifests itself along with redness and peeling not only of the skin of the face, but also of the scalp, neck, as well as of the arms and legs, which requires immediate treatment.
Redness indicates an increased content of red blood cells: the blood becomes thick, there is a risk of thrombosis.

Procedures for the treatment of edema

Manual lymphatic drainage massage. Helps relieve puffiness by stimulating lymph flow.Excess fluid and waste products are eliminated from the body, and a red and swollen face becomes rosy and healthy as before.

Ultrasonic cleaning – Stimulates blood flow and lymph circulation, and this improves skin tone. In addition, the procedure allows medicinal preparations to penetrate deeper under the skin, relieve swelling, irritation and redness.

Nursing procedures. Masks and peels. we especially recommend alginate masks to help reduce swelling.

Causes of edema and redness of the skin of the face and body

• The main reason for the recurrent appearance of edema is excess fluid in the body.At the household level, this is due to an improper and unbalanced diet, including too much salty, smoked and spicy foods. But if, after switching to a healthy diet, your eyes and face still swell, it’s time to think about what to do with other possible disorders in the body.
• Kidney disease. The edema they cause is usually mild, watery, and prone to displacement. If there is severe swelling of the face in the morning, the cause must be sought in poor kidney function. Toward evening, under the influence of gravity, the swelling goes down below.
• Disorders of the heart. In this case, puffiness manifests itself, on the contrary, in the evening and has dense formations in itself. In addition to the face, swelling can also spread to the hands.
• Other internal diseases: liver, endocrine system, etc.
• Allergy. The immune system reacts to an allergen with a whole range of symptoms: in addition to swelling of the face and neck, a rash, redness of the skin, itching of the head, peeling, shortness of breath and headaches appear.
• Pregnancy.During this period, the body needs fluid, so you often feel thirsty. The body strenuously accumulates sodium, which retains water in the body. It has been established that weight gain during pregnancy is largely due to fluid. And a large amount of fluid leads to the appearance of edema.
• Overwork, regular lack of sleep.
• Alcohol abuse, like other causes, leads to redness and itching of the skin of the face, and treatment should be started without delay.

Professional treatment of facial edema

If the face swells strongly in the morning, if swelling and redness also appear around the nose, under the skin, on the arms, legs and other parts of the body, then the reasons should be sought in the general condition of the body and a possible latent disease: it is necessary to conduct a medical diagnosis.
In the “Ultraclinic” you can pass the necessary tests and get a conclusion. The swelling may go away after the underlying disease has been treated.

We can also provide you with advice on severe swelling of the face and neck along with a recommended treatment plan: how to properly care for your skin to get rid of an uncomfortable cosmetic defect, and how to treat redness and itching of the skin.
The choice of diet, daily regimen, cosmetics – we always approach the problem in a comprehensive manner.

What to do if the eyes and face become swollen, reddening of the skin around the nose, eyes and other areas occurs, and the cause cannot be eliminated? Cosmetology procedures will help to eliminate the defect.

How to remove swelling from the face and neck: home remedies

• To avoid swelling in the morning, try to eat 3-4 hours before bedtime, no later.
• Eat foods that help remove excess fluid: watermelons, apples, carrots, citrus fruits.
• To prevent liquid from retaining in the body, try to salt and season food less, give up canned food and smoked meats.

The structure of the human skin | Physiological perception of the bath | Bath theory

Air exposure to a person is carried out through the skin, the area of ​​which is 1.5-2 m2 (with an area of ​​heat exchange between the body and air on average 1 m2). The skin consists of three layers: the epidermis (the outer epidermal layer with a thickness of 0.03 mm on the eyelids to 1.5 mm on the soles), the dermis (the skin itself is 0.5-5 mm thick) and the hypodermis (subcutaneous adipose tissue), which may be absent altogether or, conversely, reach significant thicknesses up to 10 cm in obesity (Fig.47).

The epidermis is characterized by high mechanical and chemical resistance, impervious to aqueous solutions and to infectious agents. The outer layer of the epidermis – the stratum corneum – is aged and keratinized epithelial cells. The epidermis has the property of self-cleaning by constant exfoliation (exfoliation) of the surface of the stratum corneum. The exfoliated layer, which carries away impurities, is replaced by younger cells from deeper layers of the epidermis.An intercellular fluid circulates between the rows of cells in the epidermis, which nourishes the growing cells with protein substances. With a lack of intercellular fluid (when too little fluid comes from the dermis or the fluid evaporates too quickly from the stratum corneum), the skin becomes dry, flaky, irritable, painful, cracks form in the epidermis, itching appears, which disappears when using agents that lubricate the surface of the stratum corneum and prevent evaporation of moisture from the epidermis (the so-called “moisturizing agents”).A natural lubricant for the surface of the skin is sebum (an emulsion of fats in water), which is secreted by the sebaceous glands into the hair follicles (canals) so that the sebum lubricates the hair and the stratum corneum at the same time. At the same time, the secretion of sebum (up to 10-50 g per day) and sweat (with a dry residue of up to 5-20 g per day) contribute to the contamination of hair and skin.

The dermis consists of densely intertwined connective fibers and a few cells. The elasticity of the fibers gives the skin elasticity, and the strength of the fibers provides reliable mechanical fixation of internal organs and tissues.The dermis contains hair follicles, sweat glands, blood vessels, and nerve fibers. The hypodermis is a layer of connective tissue that softens various mechanical effects on the skin and, in addition, serves as a heat-insulating pad.

The vital activity of the dermis is provided by continuous metabolic processes using the cardiovascular system (circulatory and lymphatic). Blood enters the skin through arteries that branch into thousands of small arterioles.The latter, in turn, disintegrate into countless blood capillaries, the walls of which are highly permeable. Nutrients and oxygen pass through the walls of the blood capillaries into the tissue fluid and then into the cells. At the same time, the cells release carbon dioxide and waste products into the tissue fluid, and then into the blood capillaries. Contaminated blood, moving along the blood capillaries, enters the smallest veins (venules), then into ever larger veins and, finally, the right atrium.

However, part of the tissue fluid enters completely different capillaries, lymphatic, which are closed at one end (blind, deaf) tubes with high permeability of the walls. Connecting with each other, the lymphatic capillaries form the lymphocapillary network, from which the lymphatic vessels originate, which have valves that prevent the return flow of lymph. As a result of the contraction of the muscles of the body, lymph flows through the lymphatic vessels to the lymph nodes, where lymphocytes are formed, which give the body the properties of resistance to the effects of foreign (including infectious) agents (immunity), after which the lymph enters the vein.If the lymphatic system malfunctions, edema develops in the skin, which can be reduced due to artificial (forced) massage, as well as due to the active work of sweat glands, which empty the blood capillaries, which in turn “suck” tissue fluid from the dermis. Thus, a bath (as well as a hot bath and a hot shower) can be useful not only by cleansing the surface of the skin, but also by expanding the blood capillaries, accelerating metabolism and thereby saturating the tissue fluid with oxygen, as well as , which helps to remove excess tissue fluid by sweating and massage, and massage can increase immunity.

In the bath literature, sweat formation is usually considered simplified: in a normal state, sweat ducts are narrowed, but according to signals from thermoreceptors, the ducts (pores) open, which ensures the free flow of sweat. It is clear that if the mouths of the sweat ducts are clogged with sebum, then the flow of sweat is difficult. The movement of water (or aqueous solutions) through capillaries with evaporation at the open end of the capillary is called transpiration in plant physiology (from the Latin words trans – through and spiro – to breathe, exhale).In everyday life, evaporation of sweat from the skin is also called skin breathing, although this process has nothing to do with oxygen consumption. In bathing practice, the occurrence of sweat is associated exclusively with the need to cool the body by evaporation. At rest, a person secretes 0.5 liters of sweat per day, and during physical exertion, up to 2 liters per hour.

In fact, the processes of perspiration are much more complex. First, sweat is not produced by sweat ducts at all, but by very specific, local and non-moving sweat glands in the dermis.So, the idea that sweat in the bath, as the body warms up, flows out of deeper layers of the skin, and even from the muscles, that is common in everyday life in the bath, is fundamentally wrong.

Secondly, perspiration occurs continuously, but not by gravity, but due to rhythmic contractions of the muscles of the sweat duct, so that perspiration occurs even when a person is immersed in hot water. Sweat itself is formed in the sweat gland ball by ultrafiltration of blood coming from the network of arterioles that encircle the ball (Fig.48). Sweating is controlled (innervated) by the nerve plexuses, in particular, in the subcutaneous layer and in the dermis, and chemically under the influence of many substances. So, for example, adrenaline and acetylcholine excite, and atropine blocks the secretion of sweat. The sweat formed in the myoepithelial cells of the gland is squeezed out by cell contractions under pressure into the sweat duct, and then due to the contraction of the musculature of the duct on the skin.

Thirdly, sweat ducts in the area of ​​the mouth (pores) often do not come out to the surface of the skin, but are closed with a layer of keratinized epidermal cells, which, although loosened in the pore zone, significantly limit the release of seeping sweat, especially if the epidermis is contaminated sebum.The inability of sweat to come out causes itching, a type of pain that is especially manifested, naturally, when the sweat glands are excited (for example, when the body overheats), which makes a person itch. Therefore, so that the skin does not itch, it is necessary not only to wash the sebum, but also to scrape off the layer of keratinized cells at the mouths of the sweat ducts, having previously steamed them.

Fourth, sweat glands are common (eccrine) and specific (apocrine). Ordinary sweat glands (about 2 million)pcs.) are placed throughout the body (including the armpits), emit weak-smelling (or completely odorless) sweat, intended only for evaporation and moisturizing, containing, in addition to salts, only nitrogen metabolism products. Specific sweat glands are located in the armpits, inguinal and perianal areas, are associated with sexual function and secrete sweat with a large amount of protein substances, which decompose, smell and give a person a well-known “smell of sweat”. In European countries, “the smell of sweat” is considered “indecent”.At the same time, among many peoples of Asia and Africa, the smell of sweat is very much appreciated, it is considered spicy, attractive, exciting. So sweat is different. Sweat functions are not limited to cooling.

Human sweat contains on average 0.5% sodium chloride, 0.1% urea, as well as up to 1.5% of other complex (apparently lipid) organic substances, called slags in everyday life, which pass into sweat from the blood. Recall that the liquid part of blood (plasma), which makes up (55-65)% of all blood, contains up to 0.9% sodium chloride, up to 0.8% lipids, up to 0.03% potassium chloride, up to 0.01% salts calcium, up to 0.002% magnesium salts and up to 0.08% urea.Lymph is similar in composition to blood plasma. And although sweat is (98-99)% water, the evaporation rate of sweat can be much lower than the evaporation rate of water, since a film of fat-like (lipid) surfactants with a high boiling point “floats” on the surface of the sweat and, in addition, a lot of salt gradually accumulates on the skin, and it makes it difficult for sweat to evaporate. By washing off these substances, we give the skin “easy breathing”, since only slightly salted “fresh sweat” from a clean body can easily evaporate.

The largest number of low-odor eccrine sweat glands (up to 300 pcs / cm²) is located on the skin of the palms and feet. These glands are only designed to wet the skin to prevent slipping of the palms, provide a secure hold on objects and have nothing to do with thermoregulation. With emotional unrest, palms and feet sweat especially (since the days of monkeys, they are accustomed to instantly prepare their paws for jumping in trees). In case of fright, the released adrenaline causes instant, profuse “cold” sweat throughout the body.

Under heat stress, sweating on the palms does not increase, but completely different sweat “fields” are formed – around the nose, on the forehead, neck, wrists, on the legs below the knees, and especially on the back in the form of the famous rhombus (neck, shoulder blades, lower back). This means that in dry saunas, evaporative cooling of the body occurs through these “sweat fields” zones. But the lips do not have sweat glands at all and they heat up the most.

Sweat glands are also the main transport route for the possible penetration of liquid water-soluble substances into the body.So, the irritating effect of mustard plasters, turpentine, finalgon, pepper plaster is significantly enhanced on clean skin with cleansed sweat ducts mouths. Sweat ducts, especially those that do not go directly to the surface of the skin, but into the loosened channels in the stratum corneum (pos. 7 in Fig. 48), can retain foreign substances. So, after washing with soap, sweat ducts and loosened channels in the stratum corneum retain this soap (as well as odors, including the smell of a broom). It is easy to be convinced of this: after shampooing with soap, it is enough to steam in the steam room and immediately feel how the soap begins to “eat eyes” from the soap washed out from the sweat ducts.So sweating in the steam room after washing with soap and cleaning the ducts from soap can be very useful, contrary to popular beliefs that prohibit the use of soap before the steam room, supposedly to avoid drying out the skin, but in reality only because of the unpleasant sensations associated with eye irritation washed out soap.

Cosmetic preparations to prevent the smell of sweat – antiperspirants – also work on the principle of retention of chemicals by sweat ducts. Unlike deodorants (fragrances), which drown out the smell of sweat with their smell and deodorants (antiseptics), which slow down the decomposition of protein impurities in sweat, antiperspirants contain oxychlorides (hydrochlorides) of metals (aluminum, titanium, zirconium), which give gels (jellies) when reacted with water hydrates of metal oxides Me (OH) nClm + H₂O → Me (OH) m + n + HCl.Oxychlorides in an alcoholic solution first penetrate into the loosened channels of the stratum corneum, and then into the sweat ducts, and when moisture (sweat) appears, they turn into jellies that clog the mouths of the sweat ducts. This process, apparently, is to some extent harmful to health, but irreplaceable for representative purposes. In any case, when using antiperspirants, an especially thorough cleaning of the pores is required when washing the skin.

Sweat is formed from blood: in humans, all glands produce secretions from blood water, even milk ones.The heart pumps at rest 5-6 liters of blood per minute, and with significant physical exertion, 5-6 times more. The time for a complete blood circulation in the body is thus 1 minute at rest and 10 seconds with high physical and thermal stress. In this case, the speed of movement of blood in the capillaries at rest is (0.05-2.0) cm / sec, in the veins 10-20 cm / sec, and in the arteries 20-50 cm / sec. Such values ​​of fluid flows are hundreds of times higher than the values ​​of lymphatic and sweat flows.So, under normal conditions, at rest, a person secretes 0.5-0.7 liters of sweat per day, which corresponds to the cooling power due to the evaporation of sweat (13-18) W. In extreme conditions of high overheating and high physical exertion, the rate of sweat production reaches 2 liters per hour, which corresponds to a cooling capacity of 1200 W.

Blood flow provides continuous heat transfer inside the body, leveling the temperature field in the tissues. So, if the blood somewhere heats up by 1 ° C (for example, in the skin), and then gives off the received heat somewhere inside the body, then the corresponding heat flux inside the body will be 0.3 kW at rest and up to 1.5 kW with great physical exertion.The values ​​of this order should correspond to the physical stress in production and heat flows in the baths. An increase in blood flow during exercise (as well as overheating) is carried out first by expanding the arterioles, and then by increasing the heart rate (pulse). The expansion of blood vessels and sweat ducts occurs when the body temperature rises according to signals from the central (internal) thermometers of the nervous system located in the brain and spinal cord and washed by blood moving in the vessels.The expansion of the blood vessels of the skin leads to the overflow of blood into them from the internal blood vessels and, as a result, to a temporary decrease in blood pressure in the body.

Blood microvessels in the dermis do not have thermoreceptors. But in the dermis there is a dense network of nerve fibers ending in a wide variety of external (peripheral) receptors: pain, tactile, cold, heat. The most common type of skin receptors is free nerve endings, which perceive mainly pain associated with violations of the integrity of the skin (100-200 receptors per square centimeter of skin).Tactile receptors perceive mechanical stress – touch (20-30 pcs / cm²). Cold receptors (Krause flasks) react to skin cooling (12-15 pcs / cm²). Heat receptors (Ruffini corpuscles) react to heating of the skin and are very few in number, 1-2 pcs / cm²; in humans, there are only about 30 thousand heat receptors (skin thermoreceptors).

Note in conclusion that eccrine sweat glands are present only in humans, monkeys and ungulates (horses). Predators (cats, dogs) and rodents (mice) practically do not emit sweat to cool the body.

Source: Bath theory. Khoshev Yu.M. 2006

90,000 Medical terms – Turtles.ru – all about turtles and for turtles

The following are definitions of medical terms that appear on the site.

Abscess – Local purulent inflammation of a tissue or organ.
Anemia – A painful condition characterized by a decrease in the hemoglobin content in the blood, as well as a decrease in the total mass of blood in the body; anemia.
Arthritis – Inflammation of the joint or some of its elements.
Ascaris – Roundworm – a worm parasitizing in the intestines of humans and animals.

Veterinarian – specialist in the field of veterinary medicine.
Veterinary Science is a scientific discipline about animal diseases, their prevention and treatment.

Helminths – Parasitic worms – causative agents of human, animal and plant diseases.
Herpes – Damage to the skin and mucous membranes of the lips, eyes, etc.n. blistering rash.
Hypo … – The initial part of compound words, which brings meaning: decrease, decrease in relation to any norm (hypovitaminosis, hypodynamia, hypomotoricity, hypotension, hypofunction, etc.).
Hyper … – the initial part of compound words, adding meaning: exceeding any norm (hypercharge, hypersonic, hyperspace, hyperrealism, hypersecretion, hypertension, hypertrophy, etc.).
Hyperemia – Excessive filling of blood vessels of any organ or tissue with blood

Dermatitis – A disease characterized by inflammation of the skin.

Expiration – Isolation, outflow of liquid or gaseous substance.

Calcium – a chemical element, a silver-white metal, which is part of limestone, marble, etc., used in metallurgy, construction, medicine.
Quarantine – temporary isolation of those who have an infectious disease and those who have come into contact with them in order to avoid the spread of the epidemic. The period during which a ship arriving from an area affected by the epidemic is not allowed to communicate with the shore.
Carapax – the upper (dorsal) part of the shell.
Cataract – Clouding of the lens of the eye, causing weakening and loss of vision.
Tick – A small arthropod animal of the arachnid class, parasitizing on the body (less often inside the body) of animals and humans, as well as plants.
Cloaca – the expanded terminal part of the hindgut with the ducts of the urinary and genital organs flowing into it in some vertebrates.
Conjunctiva – The mucous membrane that covers the back of the eyelids and the anterior part of the eyeball to the cornea.
Conjunctivitis – Inflammation of the conjunctiva.

Lactose – milk sugar found in mammalian milk and used in medicine (does not dissolve in reptiles).

Flatulence – Bloating due to the accumulation of gas in the intestines.

Neuropathy – General name for nervous diseases without permanent pathological and anatomical changes.
Necrosis – Death in a living organism of a group of cells, an organ or its part.

Edema – Swelling, distention of the body due to the accumulation of aqueous humor in the tissues. Swelling as a result of this bloating.

Paresis – Partial paralysis, weakening of the active motor ability of the muscles.
Plastron – the lower (abdominal) part of the shell.
Pneumonia – A general disease of the body with a predominant lesion of the lungs, caused by various bacteria (usually pneumococci); pneumonia.
Gout – A disease caused by metabolic disorders, with predominant damage to the joints.

Ramfoteka – bone formation that replaces teeth (beak).
Reflex – Involuntary – congenital or acquired – the reaction of a living organism to external irritation
Rhinitis – Inflammation of the nasal mucosa; runny nose.
Cornea – The transparent part of the outer shell of the eye.

Salmonellosis – Acute intestinal infection caused by Salmonella and characterized by general intoxication, fever, bowel dysfunction, etc.p.
Fistula – An abnormal canal that emerges on the surface of the body of a person or animal or connects hollow organs with each other.
Sepsis – General blood infection with putrefactive and pyogenic microbes and their toxins.
Sclera – Outer dense albuminous membrane of the eye, in front of the cornea.

Ultraviolet – electromagnetic radiation invisible to the eye, located in the spectrum between violet and X-rays, characterized by strong chemical and biological effects; ultra-violet rays.
UV lamp – an ultraviolet lamp, a lamp that gives an ultraviolet spectrum of rays.

Fluctuation – The sensation of one hand waving, obtained by jerking the fingers of the other hand when palpating over the accumulation of fluid in the cavities.