Differential diagnosis and treatment edema. Tactics gp

Lymphostasis
Primary (idiopathic) Elephantiasis is a genetically determined defect in the lymph vessels of the legs at the level of the collectors. This disease is more common in younger women. Swelling may appear at first on one leg, then the process involved both legs. But the asymmetry is generally preserved. The process takes place in series three stages of lymphedema (swelling of the lymph soft) transition, with the gradual development of fibrosis in the distal extremity fibredemy (with total tissue fibrosis). In the first stage of swelling variable. They are worse in hot weather and on long standing, decreases in supine position. Consistency testovatoy, with pressure remains fossa. The skin is not changed, easily dislodged, pale. Further there is a seal of the distal extremities, the skin thickens, bad moves, with pressure does not remain fossa. With further progression join hyperkeratosis, papillomatosis, growth of tissue in the form of shapeless mounds ("pillows"), separated by deep folds. Characterized by excessive sweating and hypertrichosis on the affected side. Join complications chylorrhea skin lesions (the swelling can be reduced), dermatitis, ulcers, can develop purulent-septic infection.Secondary elephantiasis develops after recurrent erysipelas, lymphadenitis and transferred limfangiitov, pyoderma, chronic vaginitis and proctitis, with compression of the lymphatic vessels scarring after mechanical injury of deep burns. This complication is also possible after radiation therapy and surgical removal of collecting lymphatic vessels and lymph nodes in patients with cancer. Clinical manifestations are similar to those observed in primary elephantiasis. For the diagnosis is essential relevant medical history. With lymphography revealed tortuosity of lymphatic vessels. Often found multiple lymphangiectasia.
idiopathic edema
Idiopathic edema are more common in middle-aged women (35-50 years old) who are prone to excess weight and autonomic disturbances, especially in menopause. Idiopathic edema is usually small, soft, appear on the feet and legs by the end of the day, in the morning may be on the eyelids and fingers (hard to put the ring), more pronounced in hot weather. Fluid retention periods may be followed by periods of spontaneously copious diuresis with the advent of general weakness. Most of the swelling are alone. Effective in small doses of aldosterone antagonists (veroshpiron).