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Swelling...medical consulting

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In this page talks about ( Swelling...medical consulting ) It was sent to us on 05/08/2021 and was presented on 05/08/2021 and the last update on this page on 05/08/2021

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Key Points about Swelling










Swelling may be widespread or confined to a single area.




Not all swelling is harmful.




The main causes of widespread swelling are heart liver and kidney disorders.




The main causes of swelling of a single limb are blood clots in a vein and an infection.




Sudden onset of swelling may indicate a serious disorder so people should see a doctor right away.





Evaluation of Swelling











Although swelling may seem like a minor irritation especially if it does not cause discomfort and goes away while a person is sleeping it can be a symptom of a serious disorder. The following information can help people decide when a doctor's examination is needed and to know what to expect during the evaluation.

Warning signs

In people with swelling certain symptoms and characteristics are cause for concern. They include





Sudden onset




Swelling of only one leg




Significant pain or tenderness




Shortness of breath




Coughing up blood




When to see a doctor

People who have warning signs should see a doctor right away. People without warning signs who have a history of heart lung or kidney disease or who are pregnant should see a doctor within a few days. Other people without warning signs should schedule a doctor's appointment when convenient. Typically a delay of a week or so is not harmful.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the swelling and the tests that may need to be done.



Doctors ask about the location and duration of the swelling and presence and degree of pain or discomfort. Women are usually asked whether they are pregnant or whether swelling seems related to menstrual periods. Doctors also ask whether the person has any disorders (for example heart liver or kidney disorders) or takes any drugs (for example minoxidil nonsteroidal anti-inflammatory drugs angiotensin-converting enzyme [ACE] inhibitors or amlodipine and other calcium channel blockers) that are known to cause swelling. Doctors also ask about the amount of salt used in cooking and at the table because excess salt can make swelling worse particularly in people with heart or kidney disorders.



Doctors look for symptoms that may indicate the cause of swelling. For example people with heart failure may have shortness of breath during exertion or may wake at night with shortness of breath. People with swelling and easy bruising may have a liver disorder and people who have recently had surgery or a cast on their leg may have deep vein thrombosis.



Doctors may ask people with swelling that is long lasting to keep a record of their daily weight so that increases in swelling are detected quickly.



During the physical examination doctors pay particular attention to the area of swelling but they also carefully examine the person for other signs. Doctors listen to the heart and lungs with the stethoscope because swelling may be a sign of a heart disorder.




Table










Some Causes and Features of Swelling






Cause




Common Features*




Tests†








Angioedema (allergic idiopathic or hereditary)




Painless swelling most often affecting the face lips and sometimes tongue



Sometimes itching or tight sensation



Swelling that does not remain indented after being pressed (nonpitting swelling)




Only a doctor's examination






A blood clot in a deep-lying vein in a leg (typically) an arm or the pelvis (deep vein thrombosis)




Sudden swelling



Usually pain redness warmth and/or tenderness in the affected area



If the clot travels and blocks an artery to the lung (pulmonary embolism) usually shortness of breath and sometimes coughing up blood



Sometimes in people who have risk factors for blood clots such as recent surgery an injury bed rest a cast on a leg hormone therapy cancer or a period of immobility such as a long airplane flight




Ultrasonography






Chronic venous insufficiency (causing blood to pool in the legs)




Swelling in one or both ankles or legs



Chronic mild discomfort aching or cramps in the legs but no pain



Sometimes reddish brown leathery areas on the skin and shallow sores on the lower legs



Often varicose veins




Only a doctor's examination






Drugs (such as minoxidil nonsteroidal anti-inflammatory drugs estrogens fludrocortisone and some calcium channel blockers)




Painless swelling in both legs and feet




Only a doctor's examination






Heart failure




Painless swelling in both legs and feet



Often shortness of breath during exertion or while lying down and during sleep



Often in people known to have heart disease and/or high blood pressure




Chest x-ray



ECG



Usually echocardiography






Infection of the skin (cellulitis)




An irregular area of redness warmth and tenderness on part of one limb



Swelling



Sometimes fever




Only a doctor's examination






Infection deep under the skin or in the muscles (rare)




Deep constant pain in one limb



Redness warmth tenderness and swelling that feels tight



Signs of severe illness (such as fever confusion and a rapid heart rate)



Sometimes a foul discharge blisters or areas of blackened dead skin




Blood and tissue cultures



X-rays



Sometimes MRI






Kidney disease (mainly nephrotic syndrome)




Widespread painless swelling



Often fluid within the abdomen (ascites)



Sometimes puffiness around the eyes or frothy urine




Blood tests to evaluate kidney function



Measurement of protein in a urine specimen






Liver disease if chronic




Widespread painless swelling



Often fluid within the abdomen (ascites)



Causes that are often apparent based on history (such as alcohol abuse or hepatitis)



Sometimes small spiderlike blood vessels that are visible in the skin (spider angiomas) reddening of the palms and in men breast enlargement and a decrease in the size of the testes




Measurement of albumin in the blood



Other blood tests to evaluate liver function






Lymphatic vessel obstruction due to surgery or radiation therapy for cancer




Painless swelling of one limb



A cause (surgery or radiation therapy) that is apparent based on history




Only a doctor's examination






Lymphatic filariasis (a lymph vessel infection due to certain parasitic worms)




Painless swelling of one limb and sometimes the genitals



In people who have been in a developing country where filariasis is common




Examination of a blood sample under a microscope






Normal swelling




A small amount of swelling of both feet and/or ankles that occurs at the end of the day and resolves by morning



No pain redness or other symptoms




Only a doctor's examination






Pregnancy or a normal premenstrual symptom




Painless swelling in both legs and feet



Usually relieved to some extent by rest and leg elevation



In women known to be pregnant or about to have a menstrual period




Only a doctor's examination






Pregnancy with preeclampsia




Painless swelling in both legs and feet and sometimes hands



High blood pressure (often new)



Usually occurring during the 3rd trimester of pregnancy




Measurement of protein in urine






Pressure on a vein (for example by a tumor pregnancy or extreme abdominal obesity)




Painless swelling that develops slowly




Ultrasonography or CT if a tumor is suspected








* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.






† In most people with swelling doctors do a complete blood count other blood tests and urinalysis (to check for protein in the urine).






CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging.















Testing

For most people with widespread swelling blood tests are done to evaluate the function of the heart kidneys and liver. Urinalysis is usually also done to check for large amounts of protein which can indicate nephrotic syndrome or in pregnant women preeclampsia. Other tests are done based on the suspected cause. For example in people with isolated leg swelling doctors may do ultrasonography to look for blockage of a vein in the leg.



Causes of Swelling











Swelling that occurs throughout the body has different causes than swelling that is confined to a single limb or part of a limb.



Widespread swelling is most commonly caused by





Heart failure




Liver failure




Kidney disorders (especially nephrotic syndrome)






These disorders all cause fluid retention which is the cause of the swelling.



Another cause of swelling of the lower legs is pooling of blood in the legs. Many obese middle-aged or older people normally have a small amount of swelling at the end of the day due to blood pooling. This swelling typically goes away by morning. Blood can also pool in the legs if the valves in the veins are widened or damaged (chronic venous insufficiency) such as may occur in people who previously had blood clots in the legs. In such people the swelling usually does not go away overnight.



Many women normally have some swelling during the later stages of pregnancy. However women who have a large amount of swelling particularly if swelling also involves the hands and face and is accompanied by high blood pressure may have preeclampsia which can be dangerous.



Swelling that is confined to a single limb or part of a limb is most commonly caused by





A blood clot in a deep-lying vein in a limb (deep vein thrombosis)




Skin infection (cellulitis)






Many disorders increase risk of blood clots in a vein. Most often these clots develop in a leg vein but sometimes they occur in an arm vein. Blood clots in a vein can be dangerous if the clot breaks off and travels to the lungs blocking an artery there (called pulmonary embolism).



Cellulitis typically causes swelling of the skin over only part of a limb. Much less often an infection deep under the skin or in the muscles can cause the whole limb to swell.



Blockage of a lymph vessel (such as occurs in lymphedema) is a less common cause. Lymph vessels which occur throughout the body help drain fluid from tissues. If a tumor pushes on the lymph vessels or surgery is done to remove some lymph vessels or nodes (for example when women with breast cancer have lymph nodes removed from the armpit) a limb can swell. In many tropical countries certain parasites can block lymph vessels and cause swelling (lymphatic filariasis).



Sometimes an allergic reaction causes swelling around areas such as the mouth (angioedema). Angioedema can also be a hereditary disorder in which swelling comes and goes at irregular intervals.


Treatment of Swelling











Specific causes are treated (for example anticoagulants [blood thinners] are given to people with blood clots in the legs). Any drugs that caused the swelling are stopped or changed if possible.



Because swelling itself is not harmful doctors do not give water pills (diuretics) to people unless they are needed to treat the cause of the swelling (such as heart failure). However some simple general measures such as sitting with the legs elevated or limiting the amount of salt in the diet sometimes help relieve swelling.


simple explanation



Swelling is due to excess fluid in the tissues. The fluid is predominantly water.


Swelling may be widespread or confined to a single limb or part of a limb. Swelling is often in the feet and lower legs. However people who are required to remain in bed for extended periods (bed rest) sometimes develop swelling in the buttocks genitals and back of the thighs. Women who lie on only one side may develop swelling in the breast they lie on. Rarely a hand or an arm swells.


Sometimes a limb suddenly swells. More often swelling develops slowly beginning with weight gain puffy eyes upon awakening in the morning and tight shoes at the end of the day. Swelling may develop so gradually that people do not notice until the swelling is considerable. Sometimes people have a feeling of tightness or fullness. Other symptoms may be present depending on the cause of the swelling and may include shortness of breath or pain in the affected limb.


Swelling that occurs throughout the body has different causes than swelling that is confined to a single limb or part of a limb.


Widespread swelling is most commonly caused by


Heart failure


Liver failure


Kidney disorders (especially nephrotic syndrome)


These disorders all cause fluid retention which is the cause of the swelling.


Another cause of swelling of the lower legs is pooling of blood in the legs. Many obese middle-aged or older people normally have a small amount of swelling at the end of the day due to blood pooling. This swelling typically goes away by morning. Blood can also pool in the legs if the valves in the veins are widened or damaged (chronic venous insufficiency) such as may occur in people who previously had blood clots in the legs. In such people the swelling usually does not go away overnight.


Many women normally have some swelling during the later stages of pregnancy. However women who have a large amount of swelling particularly if swelling also involves the hands and face and is accompanied by high blood pressure may have preeclampsia which can be dangerous.


Swelling that is confined to a single limb or part of a limb is most commonly caused by


A blood clot in a deep-lying vein in a limb (deep vein thrombosis)


Skin infection (cellulitis)


Many disorders increase risk of blood clots in a vein. Most often these clots develop in a leg vein but sometimes they occur in an arm vein. Blood clots in a vein can be dangerous if the clot breaks off and travels to the lungs blocking an artery there (called pulmonary embolism).


Cellulitis typically causes swelling of the skin over only part of a limb. Much less often an infection deep under the skin or in the muscles can cause the whole limb to swell.


Blockage of a lymph vessel (such as occurs in lymphedema) is a less common cause. Lymph vessels which occur throughout the body help drain fluid from tissues. If a tumor pushes on the lymph vessels or surgery is done to remove some lymph vessels or nodes (for example when women with breast cancer have lymph nodes removed from the armpit) a limb can swell. In many tropical countries certain parasites can block lymph vessels and cause swelling (lymphatic filariasis).


Sometimes an allergic reaction causes swelling around areas such as the mouth (angioedema). Angioedema can also be a hereditary disorder in which swelling comes and goes at irregular intervals.


Although swelling may seem like a minor irritation especially if it does not cause discomfort and goes away while a person is sleeping it can be a symptom of a serious disorder. The following information can help people decide when a doctor's examination is needed and to know what to expect during the evaluation.


In people with swelling certain symptoms and characteristics are cause for concern. They include


Sudden onset


Swelling of only one leg


Significant pain or tenderness


Shortness of breath


Coughing up blood


People who have warning signs should see a doctor right away. People without warning signs who have a history of heart lung or kidney disease or who are pregnant should see a doctor within a few days. Other people without warning signs should schedule a doctor's appointment when convenient. Typically a delay of a week or so is not harmful.


Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the swelling and the tests that may need to be done.


Doctors ask about the location and duration of the swelling and presence and degree of pain or discomfort. Women are usually asked whether they are pregnant or whether swelling seems related to menstrual periods. Doctors also ask whether the person has any disorders (for example heart liver or kidney disorders) or takes any drugs (for example minoxidil nonsteroidal anti-inflammatory drugs angiotensin-converting enzyme [ACE] inhibitors or amlodipine and other calcium channel blockers) that are known to cause swelling. Doctors also ask about the amount of salt used in cooking and at the table because excess salt can make swelling worse particularly in people with heart or kidney disorders.


Doctors look for symptoms that may indicate the cause of swelling. For example people with heart failure may have shortness of breath during exertion or may wake at night with shortness of breath. People with swelling and easy bruising may have a liver disorder and people who have recently had surgery or a cast on their leg may have deep vein thrombosis.


Doctors may ask people with swelling that is long lasting to keep a record of their daily weight so that increases in swelling are detected quickly.


During the physical examination doctors pay particular attention to the area of swelling but they also carefully examine the person for other signs. Doctors listen to the heart and lungs with the stethoscope because swelling may be a sign of a heart disorder.


Cause


Common Features*


Tests†


Angioedema (allergic idiopathic or hereditary)


Painless swelling most often affecting the face lips and sometimes tongue


Sometimes itching or tight sensation


Swelling that does not remain indented after being pressed (nonpitting swelling)


Only a doctor's examination


A blood clot in a deep-lying vein in a leg (typically) an arm or the pelvis (deep vein thrombosis)


Sudden swelling


Usually pain redness warmth and/or tenderness in the affected area


If the clot travels and blocks an artery to the lung (pulmonary embolism) usually shortness of breath and sometimes coughing up blood


Sometimes in people who have risk factors for blood clots such as recent surgery an injury bed rest a cast on a leg hormone therapy cancer or a period of immobility such as a long airplane flight


Ultrasonography


Chronic venous insufficiency (causing blood to pool in the legs)


Swelling in one or both ankles or legs


Chronic mild discomfort aching or cramps in the legs but no pain


Sometimes reddish brown leathery areas on the skin and shallow sores on the lower legs


Often varicose veins


Only a doctor's examination


Drugs (such as minoxidil nonsteroidal anti-inflammatory drugs estrogens fludrocortisone and some calcium channel blockers)


Painless swelling in both legs and feet


Only a doctor's examination


Heart failure


Painless swelling in both legs and feet


Often shortness of breath during exertion or while lying down and during sleep


Often in people known to have heart disease and/or high blood pressure


Chest x-ray


ECG


Usually echocardiography


Infection of the skin (cellulitis)


An irregular area of redness warmth and tenderness on part of one limb


Swelling


Sometimes fever


Only a doctor's examination


Infection deep under the skin or in the muscles (rare)


Deep constant pain in one limb


Redness warmth tenderness and swelling that feels tight


Signs of severe illness (such as fever confusion and a rapid heart rate)


Sometimes a foul discharge blisters or areas of blackened dead skin


Blood and tissue cultures


X-rays


Sometimes MRI


Kidney disease (mainly nephrotic syndrome)


Widespread painless swelling


Often fluid within the abdomen (ascites)


Sometimes puffiness around the eyes or frothy urine


Blood tests to evaluate kidney function


Measurement of protein in a urine specimen


Liver disease if chronic


Widespread painless swelling


Often fluid within the abdomen (ascites)


Causes that are often apparent based on history (such as alcohol abuse or hepatitis)


Sometimes small spiderlike blood vessels that are visible in the skin (spider angiomas) reddening of the palms and in men breast enlargement and a decrease in the size of the testes


Measurement of albumin in the blood


Other blood tests to evaluate liver function


Lymphatic vessel obstruction due to surgery or radiation therapy for cancer


Painless swelling of one limb


A cause (surgery or radiation therapy) that is apparent based on history


Only a doctor's examination


Lymphatic filariasis (a lymph vessel infection due to certain parasitic worms)


Painless swelling of one limb and sometimes the genitals


In people who have been in a developing country where filariasis is common


Examination of a blood sample under a microscope


Normal swelling


A small amount of swelling of both feet and/or ankles that occurs at the end of the day and resolves by morning


No pain redness or other symptoms


Only a doctor's examination


Pregnancy or a normal premenstrual symptom


Painless swelling in both legs and feet


Usually relieved to some extent by rest and leg elevation


In women known to be pregnant or about to have a menstrual period


Only a doctor's examination


Pregnancy with preeclampsia


Painless swelling in both legs and feet and sometimes hands


High blood pressure (often new)


Usually occurring during the 3rd trimester of pregnancy


Measurement of protein in urine


Pressure on a vein (for example by a tumor pregnancy or extreme abdominal obesity)


Painless swelling that develops slowly


Ultrasonography or CT if a tumor is suspected


* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.


† In most people with swelling doctors do a complete blood count other blood tests and urinalysis (to check for protein in the urine).


CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging.


For most people with widespread swelling blood tests are done to evaluate the function of the heart kidneys and liver. Urinalysis is usually also done to check for large amounts of protein which can indicate nephrotic syndrome or in pregnant women preeclampsia. Other tests are done based on the suspected cause. For example in people with isolated leg swelling doctors may do ultrasonography to look for blockage of a vein in the leg.


Specific causes are treated (for example anticoagulants [blood thinners] are given to people with blood clots in the legs). Any drugs that caused the swelling are stopped or changed if possible.


Because swelling itself is not harmful doctors do not give water pills (diuretics) to people unless they are needed to treat the cause of the swelling (such as heart failure). However some simple general measures such as sitting with the legs elevated or limiting the amount of salt in the diet sometimes help relieve swelling.


Swelling may be widespread or confined to a single area.


Not all swelling is harmful.


The main causes of widespread swelling are heart liver and kidney disorders.


The main causes of swelling of a single limb are blood clots in a vein and an infection.


Sudden onset of swelling may indicate a serious disorder so people should see a doctor right away.
  • The Author: wikbe
 
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