Why do my feet swell? I am eating a lot of salt?

magavigo08 (31)in #medicastudent • 5 years ago

Why do my feet swell? I am eating a lot of salt?

EDEMA

Increase in volume of an area by an increase in the amount of fluid present in the interstitial space (this definition adapts it to what she tried to say). Increase in the volume of water in interstitial spaces (this definition is attached below).

The law that regulates that the liquids are not leaking from the vessels is Starling's law, where she talked about hydrostatic pressure (inside the vessels) and colloid osmotic pressure (in the interstitium). For the circulation to occur and for the organs to nourish a balance between these pressures is necessary.

We are 60% water, two thirds are intracellular.

We have on the arterial side a hydrostatic pressure that keeps the blood inside the vessels, and a colloid osmotic that is in the interstitium, when the hydrostatic increases it will come out and thanks to the colloid osmotic pressure it returns, it is reabsorbed. What remains that fails to return to the venous part is collected by the lymphatics

The causes of this fluid leaking out and edema occurs, is:

an increase in hydrostatic pressure
a decrease in colloid osmotic pressure,
a lymphatic obstruction.
an increase or retention of sodium.
the inflammation.

• Increased hydrostatic pressure: alteration of venous return, either because we have an alteration in most of the veins, or that during work we spend a lot of time standing or sitting so that at the end of the afternoon you have swollen feet. In patients with heart failure, we will also see edema, the heart does not fulfill its pump function, and then if it is on the left side, we will see how the lung is full of blood and that will compromise its function. In constrictive pericarditis (I think he said that) there is edema because the pericardial vessel is full of fluid or may be inflamed and the heart cannot contract by altering its pump function and thus generating an increase in hydrostatic pressure. When there is obstruction or venous compression, an increase in hydrostatic pressure can also occur. All this leads to an increase in fluid in the interstitial space, thus forming an edema.

• Causes of the decrease in plasma osmotic pressure: in nephrotic syndrome, in cirrhosis, poor nutrition and in enteropathies with endothelin losses.

• In lymphatic obstruction: either due to swollen glands or lymphatic pathways, due to compression or occupation of the lymph nodes due to a neoplasm, post surgical, post radiation due to anatomy alterations.

• Sodium retention: patients with renal insufficiency, due to an increase in sodium reabsorption, hypovolemia or hypoperfusion, patients with heart failure and we say that here also because in this situation the organism triggers its alarm system because the heart does not pump well , this system is the renin angiotensin aldosterone system, it is at the kidney level and this allows to ensure the volemia in those spaces where the blood that should arrive through the circulation is not reaching, then this is going to be that everything is retained, then, when sodium is retained, water is also retained, and we have to be very aware because in patients with left heart failure, in addition to edema due to the increase in hydrostatic pressure, there is an edema produced by renal hypoperfusion, which will trigger the alert mechanism causing liquid to be retained.

• In inflammation, we will also talk about edema because there is an increase in vascular permeability, causing the outflow of fluid.

When we talk about edema we must remember that it is associated with hemodynamic disorders, the edema that we see that is associated with the output, the increase in hydrostatic pressure due to heart failure is known as transudate, and that liquid when sent to the laboratory chemist we ask a cytochemist will tell us that it has a density of 10 2 and that indicates that it has a heart failure, has an increase in hydrostatic pressure and that is why that liquid is going out to the extracellular space, and that is what we will find in the socket lights in patients with acute lung edema; The patient is suffering from heart failure and it is because he had a heart attack, a mitral stenosis, a hypertensive crisis and the patient will arrive with a lung edema, due to this the space that must be occupied by air, will be filled with fluid and that reason to auscultate it we will find crackling.
When that edema is a product of increased vascular permeability, what comes out is known as exudate, and if you send a patient who has pneumonia or pericarditis for any reason that is of inflammatory origin, they send that liquid to Performing a cytochemistry will tell us that it has a density of 10 20, because there will be proteins such as albumin, and that will have a higher density, normally the density should be up to 10 2, and we must also remember that normally there should be no liquid. In a patient with heart failure, who has fluid outflow to the pericardium, we will call this with the name of hydropericardium, if the liquid is in the chest we will call it hydrothorax, and when it is in the abdomen that liquid we will call it ascites fluid.

When we eat something and an eye swells for example, we will have that the cause of that edema is a type 1 hypersensitivity reaction. In people who wake up with swollen eyes we can presume that that edema is of renal origin.

In patients with cerebral edema we will see small grooves and convolutions flatten, the patient can die by interlocking cerebellar tonsils in the foramen magno.

In lymphedema, we see a patient who presents it after an operation of a breast carcinoma, after emptying the axillary region, we will see that it is a cold edema, and we have to know that in him edema of heart failure there will be no increase of temperature, it is a cold edema, unlike the edema of inflammation that if there is an increase in temperature.

Here we have ascites, which we will see in patients with heart failure, as well as in the cirrhotic and in the malnourished as well, and there the cause would be due to protein deficit in the case of the malnourished and in the cirrhotic the protein metabolism is compromised for liver failure

This is a patient with edema due to heart or venous insufficiency leaving the sign of the fovea in it. Let us highlight the difference between inflammation and heart failure, we see that there is not only fluid leakage, but also an increase in the dilation of vascular beds, producing hyperemia, and of course if we touch we feel it increased in temperature.

Here we see cerebral edema, this space that looks optically empty, that we highlight as a decrease in cell density. As the water does not color and she is in interstitium and separates the structures, we can say that there is edema. And in the tissues we will recognize it because there is a decrease in cell density.

In a intestine, we see that there are clear spaces, what was extravaso was water, and that is not colored, so that it is colored with H-E stains, there must be presence of proteins such as albumin, the first component that usually comes out; We usually see this in the lung.

Remember that this type of edema occurs in left heart failure.

What are the effects of edema:

Increased volume of the affected area, compromising the function of the organ, can prevent healing of that region due to the large increase in fluid, and death (remember cerebral edema).

Patient with edema of the lower limb, compromising both the function and the trophic of the skin, this is seen in patients with varicose veins or altered lymphatic circulation that being that skin so exposed, with any scratch or sting, that region is It will infect.

The skin is distended any rose will make it a gateway to any infection, so it is more prone to infection.

In conclusion:

Definition of edema, this process is not produced by the regulatory action of pressures given by Starling's law.

The ways we can see edema, the organs that possess it are gaining weight
Another edema that can cause death is that of glottis, as a type hypersensitivity reaction.
Solving the myth, the truth is that excessive salt consumption can have serious health consequences such as high blood pressure and when this pathology is present it is likely that our heart begins to handle different volumes of fluids and therefore begin to retain it in the limbs lower. Another aspect is to assess whether it is the case of pregnancy, because in this state different volumes are managed, so that fluids are retained and blood pressure figures should also be evaluated in case it is not preclamsia.