Question 1: Based on the history what is the most likely problem with this patient?

 which type of edema patient has? (Generalized vs. local, uni- or bilateral)?
- The patient has bilateral edema, because it affects both his legs,
- Patient has Generalized edema; the fluid retains around his leg after prolong sitting.

 What is the duration of the edema (acute [72hours] vs. chronic)?

- Acute, patient has signs for 6 months

Question 2: Make an initial classification of possible causes of generalized and legs edema.
Possible causes Likely Less likely Not very likely
Heart failure
Liver cirrhosis
Pulmonary hypertension
Nephrotic syndrome
Deep vein thrombosis
Lymph obstruction
Drugs
Hypothyroidism
(myxedema)
Nutritional

Question 3. Discuss pathogenetic mechanisms of leg swelling formation related to possible

causes listed above.

Question 4. What additional history questions can you ask to proceed in identifying the real
cause of edema?

Surgical history, Timings (since when, duration of the day), medications history, changes of edema with
position, forced position
other systemic disease (hyper / hypothyroidism, graves diseases)
Allergies – hypersensitivity
family history, life style – exercises or not, food intake
DD HF LC NS VI DVT Lymph. Drugs PH IE
1. Legs edema > 72 hrs (appr. 6
months)
2. Painless swelling
3. Bilateral
4. Improves at night
5. Shortness of breath on
exertion
6. History of hypertension
7. Reduced urine volume
8. Consuming salty meals

Question 5: What diagnoses are more likely now?

Question 6: Which components of the physical examination and diagnostic tests should you
perform? How can these examinations help to distinguish between different conditions
leading to legs edema?

In physical examination, Blood pressure, Heat Rate, Respiratory rate, JVP, type of edema (pittingor
not), tenderness, skin changes, and temperature are evaluated, check for symmetry
Check the border of the suspected organs; liver, heart, kidney.
serum level, creatine analysis, urine analysis, antibody testing and ESR, liver function test, ECG,
Blood pressure, jugular venous pressure, thyroid tests,
cholesterol level in blood

Question 7. What do results of the physical, laboratory and diagnostic tests show? What is your
diagnosis now?
- list out the things from the case
- Notable changes are increase cholesterol levels, LDL levels, increased bnp

Question 8: What is the treatment for this patient?

 To treat edema - Exercises. Gentle contraction of the muscles in the arm or leg can help move the
excess fluid out of the swollen limb.
 Compression bandages. Using low-stretch bandages to wrap the entire limb encourages lymph fluid
to flow back toward the trunk of the body.
 massage-like technique - use very light pressure to move the trapped fluid in the swollen limb toward
an area with working lymph vessels.
 Reduce salt intake
 Diuretics
 Treatment for heart failure & hypertension Beta blockers decrease your heart rate and how hard the
heart has to work.
ACE inhibitors/Angiotensin II receptor blockers (ARBs)/ Angiotensin-receptor neprilysin
inhibitors (ARNIs) relax blood vessels and help remodel the heart.