Swelling, or oedema, is an accumulation of fluid in the body’s tissues, which can occur in various parts of the body or be more generalized.
Causes of Swelling
- Inflammation: Response to injury or infection.
- Fluid Retention: Common in heart failure, kidney or liver disease.
- Venous Insufficiency: Poor blood flow in the veins, often in the legs.
- Lymphedema: Blockage in the lymphatic system.
- Medications: Certain drugs like antihypertensives, steroids, and NSAIDs can cause swelling.
- Pregnancy: Common due to increased blood and fluid needed.
- Injury or Trauma: Sprains, fractures, or other injuries.
- Allergic Reactions: Can cause localized or generalized swelling.
- Blood Clots: A deep vein thrombosis (DVT) can cause swelling in one leg.
- Infections: Cellulitis or other infections can lead to localized swelling.
Types of Swelling
- Localized Swelling: Confined to one specific area, often due to injury or infection.
- Generalized Swelling (Anasarca): Affects the whole body; usually related to systemic conditions like heart failure, kidney failure, or severe malnutrition.
Diagnosis
- History: Duration, pain, recent injuries, underlying medical conditions, medication history, and other associated symptoms like shortness of breath, weight gain, or fever.
- Physical Examination: Assess the area of swelling for redness, warmth, pain, and compare with the opposite side. Examine other body systems as well, depending on the suspected cause (e.g., cardiac, respiratory, renal).
- Investigations:
- Blood Tests: To check for kidney, liver, and thyroid function, and electrolyte balance.
- Imaging: Ultrasound for suspected DVT, echocardiogram for heart failure, X-rays for injury.
- Urine Analysis: For kidney disease.
- Venous Doppler Studies: For venous insufficiency or DVT.
Differential Diagnosis (DDx)
- DVT: Especially with unilateral leg swelling.
- Heart Failure: Look for other signs like shortness of breath, orthopnea.
- Kidney Disease: Check for proteinuria, elevated creatinine.
- Liver Disease: Look for jaundice, ascites.
- Cellulitis: Red, warm, painful swelling, usually localized.
Management
- Treat Underlying Cause: Manage heart, kidney, or liver disease appropriately.
- Elevation and Compression: For venous insufficiency and lymphoedema
- Massage: For lymphoedema
- Diuretics: For fluid overload, but must be used cautiously depending on the cause.
- Diet and Lifestyle Changes: Low-salt diet, weight management, exercise.
- Medication Adjustment: Review current medications for potential contributors to swelling.
- Anticoagulation: For DVT.
- Surgery: In cases of obstructive lymphoedema or severe chronic venous insufficiency.
Conclusion
Swelling is a symptom with a wide array of potential causes, ranging from benign to life-threatening. A thorough history, physical examination, and appropriate investigations are crucial to identify the underlying cause. Management should be directed at treating the underlying condition, while symptomatic relief can be provided through measures like elevation, compression, and, in some cases, diuretics. Coordination with specialists may be necessary depending on the underlying cause and severity of the swelling.