Diagnosis and treatment options swelling of feet, the causes of which are unclear - a very common problem. In adults, the cause of leg swelling often becomes venous insufficiency. In women during the period of life between the menarche (first menstrual period) and menopause often occurs a problem such as idiopathic edema (previously they were also called cyclical). Another common but often overlooked cause leg edema pulmonary hypertension is often associated with sleep apnea.

Classification

There are two main types of leg edema: venous and lymphatic edema. Venous excess intercellular edema forms a low viscosity fluid and a small protein, resulting in reduced capillary permeability. Lymphoedema an excess of protein-rich interstitial fluid within the skin and subcutaneous tissues; cause the formation of such edema is a dysfunction of the lymphatic system. Sometimes swelling also include lipids, but rather, it is an uneven distribution of fat tissue than this edema.

Diagnostics

For the diagnosis of leg edema of unknown etiology medical need, first of all, to know the following:

• When the patient first came swelling? If severe swelling occurred suddenly, perhaps, their cause is deep vein thrombosis. This assumption may be confirmed, if the swelling is not held for 72 hours, and will not be revealed to other diseases which could cause edema.
• Swelling of the legs accompanied by any pain? Deep vein thrombosis usually causes quite a lot of pain. In chronic venous insufficiency, patients may complain of mild dull ache. Lymphoedema is usually completely painless.
• What medications the patient takes? Calcium channel blockers, prednisone, beta-blockers, clonidine, hydralazine, minoxidil, corticosteroids, estrogen Estrogen - the key to bone health , Progesterone Progesterone - norm and pathology , Testosterone, nonsteroidal anti-inflammatory drugs, pioglitazone, rosiglitazone, monoamine oxidase inhibitors - common causes of leg edema.
• Is there a history of systemic diseases (heart disease, liver or kidney?)
• Is there a history of a tumor in the abdominal or pelvic area, or the use of radiotherapy to treat them?
• Does reduced swelling of the night? Venous edema held overnight were significantly more likely than lymph.
• Is there a history of the patient's sleep apnea? This disorder can cause pulmonary hypertension, which is a common cause of swelling feet. If a person lives alone, and no one can say whether he snores at night, the grounds for suspicion of sleep apnea can be sleepy during the day and a neck circumference of 43 cm.

During the medical examination, the doctor draws attention to the following factors:

• Body mass index. Obesity is often associated with sleep apnea, and venous insufficiency.
• The distribution of edema. Swelling in one leg may indicate deep vein thrombosis, venous insufficiency or lymphedema. Swelling of both legs are often caused by local or systemic diseases such as heart failure or kidney disease. If not swollen feet only, but also other parts of the body, most all, the reason for this is a systemic disease.
• Sensitivity. If deep vein thrombosis is usually observed increased sensitivity of the skin on the feet, with lymphoedema this symptom is absent.
• Varicose veins. Chronic venous insufficiency is often accompanied by varicose veins.
• Skin changes. Actinic skin (hyperkeratosis) and pathological tissue sealing - typical characteristics of chronic lymphedema. Brownish hemosiderin deposits in the legs are often signs of venous insufficiency. Reflex sympathetic dystrophy initially leads to an increase in skin temperature and work up a sweat. Later, the skin becomes thin, shiny and cool. In the later stages of the disease there is atrophy of the skin.

Laboratory tests

The majority of patients older than 50 years is a cause leg edema venous insufficiency, but if the etiology is unclear, it is necessary to do some lab tests to rule out systemic diseases. As a rule, do a complete blood count, urinalysis, tests for electrolytes, creatinine Creatinine - will talk about the work of the kidneys , Blood sugar Blood sugar - one of the main indicators of human health , Thyroid stimulating hormone and albumin. The level of albumin in serum of less than 2 g / dl often leads to edema, and may be caused by diseases of the liver, nephrotic syndrome and protein-losing enteropathy. Depending on the results of the preliminary examination may be needed as the following diagnostic procedures:

• Patients who have leg swelling caused by heart disease, should undergo an electrocardiogram, echocardiogram and radiographs.
• In patients with acute edema of normal levels of D-dimer in the help is likely to exclude deep vein thrombosis, as lozhnootretsatelnye test results on the D-dimer is rare. However, if the D-dimer level is raised, it will be necessary to conduct Doppler because false positive assay for D-dimer are found, in contrast, it is very often.
• If you suspect a nephrotic syndrome in addition to the above analysis it is necessary to analyze the level of lipids in the blood serum.
• Young women idiopathic edema can be diagnosed without additional testing if, after studying the history and physical examination by a doctor does not appear suspicious to any disease that could be the cause of edema.
• Patients over 45 years old with edema feet of unknown etiology have to do an echocardiogram to rule out pulmonary hypertension. Lymphoscintigraphy may be useful to distinguish venous from lymphatic edema and identify the cause of lymphedema.

Vasculitis - a general term used to describe a variety of diseases associated with inflammation of the blood vessels. Inflamed blood vessels stretch, lose elasticity and either expand or narrow - to the extent that mogutpolnostyu close. Vasculitis can affect people of any age; some of its variations are found in certain age groups more frequently than others.

Some of the many types of vasculitis limited to certain organs. For example, vasculitis can zastragivat only vessels of the skin, eyes, brain and some internal organs. There are types of vasculitis, in which are immediately affected many organ systems. Some of such generalized forms of the disease do not need to flow, while others involve vital organs and can be extremely dangerous.

Causes of vasculitis

In many cases, the cause of vasculitis is unknown. Sometimes it is possible to establish the origin, studied the history of the patient - for example, the disease can be caused by viruses migrated recently. Allergic reactions and some medications may also serve as triggers vasculitis.

Most infections cure and goes unnoticed; In some cases, the infection is caused by abnormal immune system, resulting in damaged blood vessels. Vasculitis can also be associated with diseases of the immune system that have been in the patient for months or even years ago. For example, vasculitis may be rheumatoid arthritis oslodneniem Rheumatoid arthritis - debunking myths about the disease , Lupus or Sjogren's syndrome Sjogren's Syndrome: systemic autoimmune disease .

Danger vasculitis

For example, if a certain segment of the vessel became very weak, which may result in aneurysm - protrusion of the vessel wall. Sometimes the walls of the blood thinner before that do not stand up and torn; it could result in internal bleeding - a deadly condition. Fortunately, this happens rarely.

When inflammation and narrowing of the blood vessels may be partially or totally blocked blood flow to certain areas of the body. If the collateral vessels will not be able to deliver in these areas enough blood, tissue left without normal blood supply, begin to die off.

The symptoms of vasculitis

Because vasculitis affects various organs, it has many different symptoms. If the disease affects the skin, there may be a skin rash or itching. If amazed blood vessels that supply blood to the nerve tissue, can develop reduced sensitivity and muscle weakness. When the disease affects the blood vessels of the brain, increasing the risk of stroke, heart if struck - could have a heart attack.

Often the symptoms of vasculitis is fever, lack of appetite, weight loss, lack of energy.

Diagnosis and treatment

In order to make a diagnosis, you need a general survey, followed by a thorough study of the affected organs. Typically, if vasculitis developed an allergic reaction, it will be self treatment is not required. If, however, affect the lungs, brain, kidneys and other vital organs, need to start therapy immediately.

The goal of this therapy - to suppress the abnormal immune system response that resulted in damage to the blood vessels.

The prognosis for patients with vasculitis depends on the variety of the disease. With early diagnosis and the correct method of treatment may complete relief of symptoms of vasculitis Vasculitis - symptoms of systemic diseases   and preserve the ability to lead a full life.

Patients with severe forms of vasculitis, it is impossible to predict the duration of remission, so they need to be regularly examined by an experienced specialist.