Edema

[Guest guest]

,

You wrote, " I have had swelling...in the form of indentations that stay in...I

mentioned to my Internist...but I have not my G.I. Should I be concerned?

I went back and re-read my post #54411...hmmm? I sure can ramble. At any rate,

chronic disease is so complicated and is difficult to isolate into different

body systems.

Re: informing your physicians, I have the records from each of my visits sent to

each member of the healthcare team, so everyone knows what everyone else is

doing.

Re: pitting edema, the kind that feels like one of those rubbery stress balls,

(when pressing a finger against a swollen area for 10 seconds and then quickly

removing it, an indentation is left that fills slowly)

I thought the best thing would be to help explain the different types and causes

of edema, and questions you can ask yourself to collect data to give to your

doctor. I never want to insult anyone's knowledge, but explaining in the

simplest ways possible may help others.

Edema is an observable swelling in certain parts of the body, most commonly

occurs in the feet and legs, where it also is referred to as peripheral edema.

The swelling is the result of the accumulation of excess fluid under the skin in

the spaces within the tissues that are outside of the blood vessels. These

spaces are known as interstitial spaces. Most of the body's fluids that are

found outside of the cells are normally stored in two spaces; the blood vessels

(where the fluids are called the blood volume) and the interstitial spaces

(where the fluids are called the interstitial fluid).

There are a few things to consider when evaluating edema:

1. Is the edema localized to one area of the body; ie; lower extremities?

2. Is the edema generalized throughout the body?

3. Is the edema symmetrical or asymmetrical?

4. Is the edema prompted when the legs are in a dependent position, ie; walking,

standing?

5. Is the edema cyclical consistent with hormonal cycles or time of day?

6. Does the edema resolve when the legs are elevated?

Edema is caused by either 1) local conditions involving just the affected

extremities or by 2) systemic diseases, that is, diseases that affect the

various organ systems of the body,

Re: Localized Causes

The veins in the legs are responsible for transporting blood up to the veins of

the torso, where it is then returned to the heart. The veins of the legs have

valves that prevent the blood from backing up in the veins. Venous insufficiency

is incompetence of the veins that occurs because of dilation, or enlargement, of

the veins and dysfunction of their valves. This leads to inadequate pumping of

the blood by the veins. The resulting increased back-pressure in the veins

forces fluid to leak into the interstitial tissue spaces (edema). This is a

problem that is localized to the legs. One leg may be more affected than the

other (asymmetrical edema). The response to therapy with diuretic drugs in

patients with venous insufficiency tends to be unsatisfactory. This is because

the continued pooling of fluid in the lower extremities makes it difficult for

the diuretics to mobilize the edema fluid. Elevation of the legs periodically

during the day and the use of compression stockings may alleviate the edema.

Edema of the legs also can occur with an episode of deep vein thrombophlebitis,

which is a blood clot within an inflamed vein. In this situation, the clot in

the deep vein blocks the return of blood and consequently causes increased

back-pressure in the leg veins.

Re: Systemic Causes

In systemic diseases, edema is a consequence of the hypoalbuminemia and

activation of the renin-angiotensin- aldosterone hormonal system, which is an

imbalance of salt, fluid, and protein.

The kidneys control salt, the heart controls fluid, and malnutrition controls

protein. [Not exactly, but for the sake of explanation]. It doesn’t really

matter which came first, the chicken or the egg, they feedback system cycles

either way. Systemic diseases that are associated with fluid retention generally

cause the same amount of edema in both legs (symmetrical), and can also cause

edema and swelling elsewhere in the body

Re: Loss of Protein:

1. The heavy loss of protein results in a reduction in the concentration of

albumin in the blood (hypoalbuminemia).

2. Since albumin helps to maintain blood volume in the blood vessels, a

reduction of fluid in the blood vessels occurs.

3. The kidneys then register that there is depletion of blood volume,

4. To counter the seeming loss of fluid, the kidneys retain salt and water.

5. Consequently, fluid moves into the interstitial spaces, thereby causing

pitting edema.

Re: Impaired Heart Function:

1. In persons with impaired heart function has a decreased volume of blood

pumped out by

the heart.

2. This so called cardiac output is responsible for a decreased flow of blood to

the kidneys.

3. As a result, the kidneys sense that there is a reduction of the blood volume

in the body.

4. To counter the seeming loss of fluid, the kidneys retain salt and water.

5. Consequently, fluid moves into the interstitial spaces, thereby causing

pitting edema.

Re: Impaired Kidney Function:

1. Persons who have impaired renal function develop edema because of a

limitation in the kidneys' ability to excrete sodium into the urine.

2. Consequently, fluid moves into the interstitial spaces, thereby causing

pitting edema.

3. As a result, the heart senses there is a reduction of the blood volume in the

body.

4. To counter the seeming loss of fluid, the heart works harder, but

inefficiently, thereby having a lower output, etc.

You asked, if you should be concerned? As long as the edema is addressed on your

care plan, and is being followed, that is the most important thing to do. Anyone

with chronic pancreatitis should live " as if " , and don't assume you are the

exception. We know that the pancreas plays a pivotal role in all of the other

organs and body systems, though the negative impact may not yet be apparent.

Therefore I do what I can to nurture them for optimum function and not stress

them out. [Key word: stress]

Since I do have impaired and at risk body systems that have resulted in the

presence of edema, both peripheral, localized, as well as systemic, I put my

efforts to minimizing any secondary complications, which the edema may cause.

Lastly, when I can understand how the body systems work and depend upon

oneanother, it helps me understand and make better lifestyle choices.

Karyn E. , RN

Executive Director, PAI

http://www.pancassociation.org

Pancreatitis Association International