John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Edema definition and facts
- What is edema?
- What is pitting edema and how does it differ from non-pitting edema?
- What is a pitting edema measurement scale?
- What does pitting edema look like (picture)?
- What causes pitting edema?
- Does salt intake affect edema?
- What causes edema during pregnancy?
- What kind of doctors treat edema?
- Why does a person with heart disease retain fluid?
- Why do people with liver disease develop ascites and edema?
- Why do people with kidney disease have pitting edema?
- What causes pitting edema by heavy loss of protein in the urine?
- What medications treat pitting edema caused by heavy loss of protein in the urine?
- What causes pitting edema in people with impaired kidney (renal) function?
- What is idiopathic edema?
- What is the treatment for idiopathic edema?
- What is the treatment for patients with idiopathic edema who have become dependent on diuretics?
- How does venous insufficiency cause edema?
- Which diuretics are used to treat edema?
- Do people taking diuretics need a diet high in potassium?
- Are diuretics used for other diseases or conditions?
- Find a local Internist in your town
What is pitting edema and how does it differ from non-pitting edema?
Pitting edema can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If the pressing causes an indentation that persists for some time after the release of the pressure, the edema is referred to as pitting edema. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema. This type of edema may be normal depending on the severity. Almost everyone who wears socks all day will have mild pitting edema by the end of the day.
What is a pitting edema measurement scale?
Some doctors may use a scale to determine the severity of the pitting edema. These scales are subjective based on either how deep the pitting is, or how long the pitting persists.
Following are two examples of edema measurement using 4-point scales, with 1 point being minor edema, to 4 points being severe edema.
|S.B. O'Sullivan and T.J. Schmitz|
Physical rehabilitation: assessment and treatment
|1+||Barely detectable impression when finger is pressed into skin.||2mm depression, barely detectable. Immediate rebound.|
|2+||Slight indentation. 15 seconds to rebound||4mm deep pit. A few seconds to rebound.|
|3+||Deeper indentation. 30 seconds to rebound.||6mm deep pit. 10-12 seconds to rebound.|
|4+||> 30 seconds to rebound.||8mm: very deep pit. > 20 seconds to rebound.|
In non-pitting edema, which usually affects the legs or arms, pressure applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system such as lymphedema, which is a disturbance of the lymphatic circulation that may occur after a mastectomy, lymph node surgery, radiation therapy, morbid obesity, venous insufficiency, or be present from birth (congenitally).
Another cause of non-pitting let edema is called pretibial myxedema, which is a swelling over the shin that occurs in some people with hypothyroidism. Non-pitting leg edema is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling.
The focus of the rest of this article is on pitting edema, as it is the most common form of edema.
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