A 40 yrs old male patient complaint huge pitting edema over legs since7-8 years, aggravated by movement and edema disappeared on rest. this began after fell down from 25fits height. diagnose it?



Pt have any other complication?


Bilateral swelling is usually due to systemic conditions (eg, cardiac failure) and unilateral is often due to local trauma, venous disease or lymphatic disease. Localised causes:---- ●Trauma (fracture, haematoma, muscle injury). ●Deep vein thrombosis.Chronic venous insufficiency and lipodermatosclerosis. ●Other venous causes: varicose veins, obstruction of venous return (eg, pregnancy), pelvic tumours, inferior vena cava obstruction,thrombophlebitis. ●Lymphoedema: lymphatic obstruction due to malignancy, post-irradiation, surgery, recurrent infection, lymphatic hypoplasia, filariasis. ●Lipoedema. ●Congenital malformations (eg, arteriovenous fistula).Malignancy (eg, of bone or muscle). ●Stasis: paralysis, poor mobility and dependency, obesity. Systemic causes:---- ●Congestive cardiac failure. ●Hypoproteinaemia - eg, liver failure, nephrotic syndrome, malnutrition, protein-losing enteropathy. ●Acute kidney injury and chronic kidney disease. ●Fluid overload.Anaemia. ●Medication - eg, calcium antagonists, non-steroidal antiinflammatory drugs. ●Hypothyroidism. ●Hereditary angioneurotic oedema. ●Obstructive sleep apnoea. ●Idiopathic conditions. Investigations:--- ●Duplex Doppler, ●venography: deep vein thrombosis, arteriovenous fistula. ●Lymphangiography: demonstrates cause of lymphoedema and whether due to hypoplasia or obstruction. ●Lymph node biopsy: infection, tumour.Renal biopsy. Here modalities justified the character of Dependent pitting oedema ..... may caused by Cardiac, Renal or Liver pathology. So require thorough investigations of above mentioned organs like ※ Echo cardiography. ※Renal and Liver profiles.

Good explanation sir

OEDEMA THE ACCUMULATION OF FLUID IN BODY TISSUES (EITHER INTRACELLULAR OR EXTRACEL LULAR) CAUSES:- 1) INCREASED HYDROSTATIC PRESSURE 2) DECREASED PLASMA PROTEINS 3) BLOCKAGE OF LYMPHATIC RETURNS 4) INCREASED CAPILLARY PERMEABILITY FURTHER DETAILS:- 1) INCREASED HYDROSTATIC PRESSURE a) Kidney failures b) hyperaldosterone c) high venous pressure d) decreased arterial resistance 2) DECREASED PLASMA PROTEINS a) Loss of protein in urine b) loss of proteins via burns c) failure to make proteins (MAINLY LIVER FAILURE) d) chronic malnutrition e) Vitamin B 12 deficiency Because B12 is required to make methenoine and further to make proteins 3) INCREASED CAPILLARY PERMEABILITY a) any immune reaction b) bacterial infection c) vitamin C deficiency which is necessary for collagen formation and further help in capillary wall. d) burns e) prolonged ischemia 4) BLOCKAGE OF LYMPHATICS a) Cancer b) infection c) surgery d) congenital absence of lymphatics

Nice explanations Dr. Yashpal Chadha sir.

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Proper investigation such as MRI is needed as it looks like a case of venous congestion due to injury.Venesection may be beneficial under expert supervision

What kind of injuries received by patient on that time ,and location of injuries, and sensation of patient's complaint s

Filariasis.. Give..phosphorus 1M..1 dose AcoBell..1C..20 drops TDs Hydrocotyle Q Also do cupping.

Namaskar Dr sab. The patient may be suffering from ASTHI VIDRADI (TRAUMATIC) or DVT

Need investigating mri coller doppler etc.

Filariasis? Advice Hijama /wet cupping

Good tret Dr shab..
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