The Curbsiders Internal Medicine Podcast REBOOT #316 Lower Extremity Edema with The Curbsiders
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Aug 14, 2023 AI Snips
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Episode notes
Mechanisms Behind Edema
- Edema arises from three mechanistic failures: increased hydrostatic pressure, decreased oncotic pressure, or leaky capillaries.
- Patients often have multiple overlapping causes rather than a single clear etiology.
Use Laterality And Time Course
- Use laterality and chronicity to narrow the differential: bilateral chronic swelling favors venous causes while acute unilateral swelling raises DVT concern.
- Ask whether swelling improves overnight and whether it's painful to help distinguish venous from lymphatic causes.
Key Physical Exam Maneuvers
- Check for pitting edema at the shins and dorsum of the foot, and test Stemmer's sign for lymphedema by pinching the skin at the toes.
- Inspect for lipedema (fat distribution sparing the feet) and differentiate it from true edema.