Oedema is the accumulation of excessive tissue fluid in the subcutaneous tissue, causing swelling. It can be caused by low plasma oncotic pressure, high capillary hydrostatic pressure, increased capillary permeability, or obstructed lymphatic drainage. Symptoms include localized or whole body swelling, facial puffiness, and pain or tightness in affected areas. Examination involves applying pressure to check for pitting edema, which indicates increased interstitial fluid, versus non-pitting edema with protein deposition. Common causes of pitting edema are congestive heart failure, cirrhosis, nephrotic syndrome, and hypoproteinemia.

1. OEDEMA

3. DEFINITION
Accumulation of excessive amount of tissue
fluid in the subcutaneous tissue due to
increase in extravascular (interstitial)
component of the extracellular fluid volume
resulting in swelling of tissue.

4. MECHANISM:
1. Low plasma oncotic pressure
eg: hypoproteinemia
2. High capillary hydrostatic pressure
eg: congestive cardiac failure
3. Increased capillary permeability
eg: acute inflammation
4. Obstructed lymphatic drainage
Eg: filariasis

6. SYMPTOMS:
1. Localized swelling (feet, ankles,
hands)/swelling of whole body
2. Facial puffiness
3. Bloating
4. Rapid weight gain (10-15% increase in body
weight)
5. Pain and tightness of the affected part
6. Breathlessness

7. EXAMINATION:
• Pedal edema: apply firm pressure with tip of right
thumb for atleast 15 sec to maximally upto 30 sec
over medial malleolus, above medial malleolus,
lower end of tibia (medial surface), upper part of
shin bone. Look for any dimple or pitting i.e
indentation.
Pitting edema reflects increased interstitial fluid
Non pitting edema reflect protein deposition.
• AMBULATORY PATIENT:
Edema on the dependent part i.e pedal edema
(ankle), sacral edema

9. CAUSES OF PITTING EDEMA:
• Congestive cardiac failure
• Cirrhosis of liver
• Nephrotic syndrome
• Hypoproteinemia with severe anaemia eg: protein
losing enteropathy, starvation, kwashiorkor
• Pericardial effusion
• Constrictive pericarditis
• Drugs: amlodipine, cortocosteroids, estrogen
• Venous obstruction (SVC syndrome, IVC syndrome,
varicose veins in legs, DVT)

10. Causes of Non-pitting edema
• Myxoedema (infiltative edema due to deposition of
mucinous material)
• Lymphatic edema (late stage): peau d’orange appearance of
skin
eg: deposition of protein rich fluid in filariasis
Malignant infiltration
Radiation injury
• Angioneurotic edema
• Chronic venous obstruction
• Scleredema (post-streptoccocal, self limited, painless
edematous induration of face, scalp, neck, trunk and upper
extremities)

11. Oedema in Systemic Diseases
• Congestive cardiac failure:
Legs – face – ascites
• Nephrotic syndrome:
Face (periorbital puffiness) – legs – ascites
• Cirrhosis of liver:
Ascites – legs – face
• Nutritional edema:
oedema feet with puffiness of face - ascites