Differential diagnosis and treatment edema. Tactics gp

Edema associated with the violation of the venous outflow
Venous edema
-Associated with acute and chronic deep venous thrombosis of the limbs. 
- One-sided defeat.- Swelling appears suddenly, often against a background of health.
- For acute thrombosis typical tenderness of edema with the advent of the pit on pressure.
-Swelling covers both shin and thigh.- In the early days of swelling increasing wear character, accompanied by a bursting pain in extremity
-Occurs with increased venous pattern on the thigh and groin area.
- A few weeks umenshaetsya swelling but does not disappear almost never.
Varicose veins of the lower extremities is common among the population. More often it occurs in women over 40. Often find other signs of congenital weakness of the connective tissue in the body: a hernia in different locations, piles, flat feet. Most of the involved leg veins, branches of the great saphenous vein. Characterized by a slow, gradual progression of the disease. Initially, there is a feeling of heaviness in the legs, sometimes - aching pain, muscle twitching at night. After a prolonged walking or standing celebrated pastoznost legs and feet. May later join a painful itching. Swelling of the feet are more pronounced in the evening, at night, they are reduced. Pain often unilateral and bilateral process with asymmetric. At a late stage of the disease join sores, dermatitis, eczema, recurrent erysipelas. Swelling due to become dense subcutaneous tissue induration, increase in complication of thrombophlebitis, limfangiitom. The diagnosis is usually at the examination. Evaluated the difference in the amount of limbs (centimeter tape measure) and the asymmetry of skin temperature. To assess the functional capacity of valvular veins (communication and deep) using sample
-Trendelenburg Troyanova, Perthes, Pretto and others detailed in surgical guides.Deep vein thrombosis legs (usually the front and posterior tibial veins, venous sinuses, soleus, etc.) is mostly secondary (diseases of the superficial veins), at least - the primary. Contribute to the presence of a primary lesion of venous adhesions, partitions, compression of veins tendon and ligament formations. Characterized by pain in the calf muscles, which are aggravated by movements of the ankle joint. A modest swelling of the legs at the ankle (to clarify the presence of edema should be measuring the circumference of both legs symmetrical sites). Observed local fever, tenderness of leg muscles.Check the following diagnostic symptoms
1) Homans: with the patient lying in the rear foot motion direction causes pain in the calf muscles;
2) Moses: for deep vein thrombosis pain results in compression of the leg in the anteroposterior direction, and does not appear when squeezing sideways (the latter is characteristic of myositis and inflammatory diseases of the subcutaneous tissue);
3) Lovenberga: compression middle third of the leg cuff sphygmomanometer pain occur at a pressure less than 150 mm, while a healthy person mild pain occurred only at a pressure of 180 mm or more.
Postthrombophlebitic syndrome is a consequence of suffering acute deep vein thrombosis (leaving a partial recanalization of the lumen of the vein), and fleboskleroza and insufficient venous valves, leading to chronic disorders of the venous outflow. In connection with the venous hypertension in the affected veins occurs pathological discharge of blood into the subcutaneous veins of secondary varicose. Most often affects the deep veins of the legs, at least - iliac-femoral venous segment. Among patients with predominantly women aged 30-60 years. Swelling of the feet are most pronounced in the legs, much less - at the hips. They grow in the evening, on long standing, decrease in the supine position, especially with one foot. Little is swelling, if the circumference of calf increased by 2 cm compared with the healthy leg, medium intensity - 2-4 cm, a sharp increase in the swelling gives more than 4 cm swelling accompanied by a feeling of heaviness, fullness in the leg, pulling pain, aggravated by exercise. When pressed fossa usually remains. Leather leg atrophies, disappears hair. Visible diffuse or patchy brown pigmentation of the skin, especially in the lower third of the leg, and cyanosis. There is usually a mild pronounced secondary varicose superficial veins. In contrast to primary varicose veins in postthrombotic syndrome veins small and trophic disorders (up to trophic ulcers) pronounced.