Lower limb swelling refers to the local tissue swelling of the lower limbs, which is manifested as a clinical phenomenon of thickening the circumference of the limb and increasing muscle tone. It is both a local manifestation of systemic disease and a clinical sign of local disease.
symptom
Typical manifestationsLower limb swelling typically manifests as localized tissue swelling, increased girth, and increased muscle tone. There are many causes and manifestations of lower limb swelling. Abscesses often cause redness and fluctuations in the skin; allergic reactions may be accompanied by itching and rashes; and poor blood circulation often causes bruising and pain.
reason
OverviewLower limb swelling can be caused by a variety of reasons, including local inflammation, hematoma, vascular occlusion, etc. It may also be caused by systemic diseases such as cardiac disease and renal disease.
Cause of symptoms
1. Lower limb swelling caused by local tissue lesions
(1) Soft tissue diseases
①Acute infectious diseases: acute cellulitis, erysipelas, acute lymphangitis.
② Trauma: soft tissue contusion, intracutaneous hematoma, muscle hematoma, and fracture.
(2) Vascular system diseases
① Venous system: phlebitis, varicose veins of the great saphenous vein, venous thrombosis, and veno-occlusive disease.
②Arterial system: aneurysm, arteriovenous fistula.
③Capillary system: cavernous hemangioma.
(3) Lymphatic system diseases
①Primary lymph node swelling: congenital valvular insufficiency or developmental disorder.
② Secondary lymph node swelling: infectious diseases include parasitic diseases and filariasis; suppurative diseases include erysipelas and fungal infections; traumatic surgeries include lymph node dissection and tumor compression.
2. Lower limb swelling caused by compression of local diseases
(1) Pelvic disease
Pregnant uterus, uterine fibroids, ovarian cysts, ovarian cancer, bladder tumors.
(2) Retroperitoneal disease
Lymphoma, lymphosarcoma, fibroma, hemangioma, mesothelioma.
(3) Celiac disease
Liver cancer, cirrhosis, rectal cancer, mesenteric cyst, mesenteric lymphosarcoma.
(4) Heart disease
Pericarditis, pericardial effusion, cardiomyopathy, valvular heart disease.
3. Systemic diseases causing lower limb swelling
(1) Cardiogenic diseases
Common diseases that cause lower limb swelling include coronary heart disease and heart failure, cor pulmonale, valvular heart disease and heart failure, cardiomyopathy, constrictive pericarditis or pericardial effusion.
(2) Nephrogenic diseases
Common diseases that cause lower limb swelling include chronic nephritis, pyelitis, hydronephrosis, uremia, etc.
(3) Hepatic diseases
Common diseases that cause lower limb swelling include chronic hepatitis, liver fibrosis, portal hypertension, Budd-Chiari syndrome, and hepatic hypoproteinemia.
(4) Metabolic diseases
People with diabetes and malnutrition-related hypoproteinemia may experience lower limb swelling.
(5) Pulmonary diseases
Common diseases include emphysema, pulmonary fibrosis, cor pulmonale, pneumonia and respiratory distress syndrome, all of which can cause systemic edema and lower limb swelling.
(6) Parasitic diseases
The most common causes of lower limb swelling are filariasis, schistosomiasis, and paragonimiasis.
Common diseases
Acute cellulitis, erysipelas, acute lymphangitis, soft tissue contusion, intracutaneous hematoma, muscle hematoma, fracture, phlebitis, emphysema, pulmonary fibrosis, cor pulmonale, pneumonia, respiratory distress syndrome, filariasis, schistosomiasis, paragonimiasis, etc.
Seeking medical treatment
Emergency (120) indications
1. Persistent and worsening dyspnea, accompanied by cyanosis of the face and lips, coughing up pink foamy sputum, etc.
2. Sudden severe chest pain and massive hemoptysis;
3. High fever and chills occur, and the body temperature continues to rise;
4. Confusion, drowsiness, or even coma occurs;
5. Other critical situations occur.
If severe or rapid edema of the lower limbs occurs, accompanied by the above critical conditions, emergency treatment must be sought promptly, and an emergency number should be called if necessary.
Outpatient indications
1. Long-term or recurring swelling and discomfort in one or both lower limbs;
2. Accompanied by lower limb muscle tension and pain;
3. Accompanied by lower limb joint swelling, pain, deformity, and limited movement;
4. Accompanied by symptoms such as redness, swelling, thickening, and hyperkeratosis of the skin of the lower limbs;
5. Accompanied by swelling and discomfort in other parts of the body such as the upper limbs;
6. Accompanied by systemic symptoms such as fever, fatigue, nausea, vomiting, oliguria, loss of appetite, and weight loss;
7. History of lower limb trauma or surgery;
8. History of use of hormones or other special drugs;
9. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
Patients in critical condition should seek medical attention in the emergency department immediately. For patients in stable condition, they may seek medical attention in departments such as vascular surgery, orthopedics, and cardiology, depending on their condition.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. The doctor will conduct a comprehensive physical examination of the patient’s lower limbs or whole body. In order to facilitate the examination, it is recommended that the patient wear loose clothing.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. For patients with severe symptoms, the elderly and frail, or minors, it is recommended that family members accompany them to seek medical treatment.
6. Patients can prepare a list of questions they want to ask in advance.
What questions might a doctor ask a patient?
1. When did the swelling in your lower limbs begin? How long has this symptom lasted? Is there any pattern in the swelling?
2. Are there any signs of worsening or relief? Under what circumstances would the symptoms worsen or improve?
3. Did the swelling of the lower limbs occur suddenly or gradually?
4. In addition to the swelling in the lower limbs, are there any other parts of the body with swelling?
5. In addition to lower limb swelling, do you have other symptoms, such as nausea and vomiting, fatigue, abdominal pain and diarrhea, etc.?
6. Have you recently suffered any trauma to your lower limbs? Have you ever had any trauma or surgery in the past?
7. Have you ever had any disease of your heart, kidney, lung, liver, etc.?
8. Do you have diabetes or other diseases?
9. Have you seen a doctor before? What treatment did you receive? How effective was the treatment? Has the disease recurred?
10. How have your sleep, diet, and bowel movements been since the onset of the disease?
What questions can patients ask their doctor?
1. What is the most likely cause of swelling in my lower limbs?
2. Are there any other possible reasons?
3. What tests do I need to do?
4. Do I need to be hospitalized?
5. What treatment methods will be used to treat my disease? Can it be cured?
6. What are the risks of these treatments? Will they have other adverse effects on my body?
7. Is there a definitive diagnosis? What is the diagnosis? How can I cooperate?
8. I have other physical discomforts. Will it affect my treatment?
9. What aspects of my daily life do I need to strengthen? What should I pay attention to?
10. If medication is possible, what are the usage, dosage, and precautions?
11. Do I need a follow-up check? How often? What are the items that are usually checked?
examine
Scheduled inspectionIt mainly includes checking whether there is any swelling in the upper limbs and eyelids in addition to swelling. Other related auxiliary examinations include routine blood tests, color Doppler ultrasound of lower limbs, routine urine tests, echocardiography, etc.
Physical examination
1. Lower body examination
Lower limb swelling accompanied by redness, significant tenderness, and localized warmth suggests infectious swelling. Diffuse redness and swelling with unclear borders suggests acute cellulitis. Localized swelling, elevated above the skin, and accompanied by severe pain suggests erysipelas. Swelling limited to the venous course and accompanied by redness and tenderness suggests superficial phlebitis. Extensive swelling involving the entire lower limb or calf, with marked swelling without redness, increased muscle tone, no tenderness, and significant pitting edema, suggests deep venous thrombosis. Swelling limited to one lower limb, with gradual development of severe swelling accompanied by thickened and roughened skin and non-pitting swelling, suggests lymphatic edema and lymphatic drainage disorders, commonly associated with filariasis, schistosomiasis, and paragonimiasis. Of course, pelvic tumor compression and obstruction of venous lymphatic space should also be considered. If swelling is limited to the lower limb, with no redness or tenderness in some subcutaneous muscle spaces, a soft, cystic sensation when palpated, and deep cyanosis beneath the skin, a cavernous hemangioma should be considered. If there is a pulsating sensation in the swollen limbs, beware of arteriovenous fistulas or aneurysms. If bilateral lower extremity swelling is symmetrical and gradually accompanied by upper extremity and facial edema, consider the presence of a systemic disease.
2. System Checkup
Symmetrical swelling of the lower limbs, accompanied by facial edema and tenderness in the renal area should be considered as a sign of renal disease; symmetrical swelling of both lower limbs, accompanied by distended neck veins should be considered as a sign of cardiac disease.
Laboratory testsIt includes routine blood tests, routine urine tests, related indicators of heart and kidney function, parasite complement fixation tests and parasite-related tests (such as blood microfilariae detection).
Imaging examinations
1. Echocardiogram: It can determine whether there is heart disease.
2. Color Doppler ultrasound of lower limbs: can determine the blood flow condition of lower limbs.
Other tests
Angiography (including arterial angiography and venography), blood flow mapping, electromyography, lymphangiography, and other examinations can also be performed.
diagnosis
Diagnostic principles
The cause of the disease can usually be diagnosed based on the patient’s history of cardiopulmonary disease, the rapidity of lower limb swelling, whether there is depression when pressed, and whether the swelling is unilateral or bilateral, combined with relevant auxiliary examinations.
Differential diagnosis
1. Cardiogenic edema
Most of them have underlying diseases such as coronary heart disease, diabetes, and hypertension, which manifest as edema of both lower limbs accompanied by cough, chest tightness, shortness of breath, difficulty breathing, decreased urine volume, and inability to lie flat at night. Cardiac ultrasound can assist in diagnosis.
2. Hepatic edema
Patients with a clear history of liver disease, which is more common in cirrhosis, present with edema of both lower limbs accompanied by abdominal distension, loss of appetite and other digestive tract symptoms. Liver function tests, liver ultrasound, CT, etc. can assist in diagnosis.
3. Nephrogenic edema
Edema of both lower limbs is accompanied by increased foamy urine, decreased urine volume, increased nocturia, eyelid and facial edema, etc., and is diagnosed by routine urine test and renal ultrasound.
4. Malnutrition edema
It is more common in the elderly, often with symptoms such as emaciation and weight loss. It can be diagnosed by routine blood tests and blood albumin.
5. Endocrine edema
If the thyroid function is hypoactive, there is obvious edema in the face and lower limbs, accompanied by apathetic expression and slow reaction, thyroid function tests can be used for diagnosis.
6. Edema caused by drugs
It is more common in patients who take hormones for a long time.
7. Idiopathic edema
It occurs almost exclusively in women, mainly in the lower parts of the body, being more pronounced when standing upright and disappearing when lying down.
treat
Expected treatmentIf lower limb swelling occurs, the cause should be identified as soon as possible and treated accordingly. Different treatments should be taken depending on the cause, including anti-infection, limb immobilization, thrombolysis, and surgery.
Treatment
1. Handle anti-infection treatment
Use penicillin, gentamicin or cephalosporin antibiotics, elevate the limb, apply immobilization, and wet compresses, and treat the primary cause of the infection at the same time.
2. Treatment of deep vein thrombosis
Absolute bed rest for 4 weeks, with limb elevation, rigorous massage, and pushing. Thrombolytic therapy should be given, and parasitic drugs should be used to treat lymphatic obstruction caused by parasitic diseases.
3. Surgical treatment
Valvuloplasty can be used for deep venous valve insufficiency of the lower limbs; thrombectomy can be used for deep vein thrombosis; and venolymphatic anastomosis can be performed for lymphatic occlusion.
daily
Nursing principles
You should pay attention to rest in your daily life, avoid standing for long periods of time, and engage in appropriate physical activities; after recovering for a period of time, you should follow the doctor’s advice for regular check-ups, and seek medical attention at any time if you feel unwell.
Life Management
1. Pay attention to rest. When resting, you can raise the affected limb to promote venous return.
2. Avoid standing for long periods of time.
3. Engage in appropriate activities to promote blood circulation.
4. Pay attention to weather changes, keep warm and prevent colds.
Follow-up InstructionsFollow your doctor’s advice for regular checkups and seek medical attention at any time if you feel unwell.
diet
Dietary adjustment
A scientific and reasonable diet can ensure the normal functioning of the body, help control the disease, maintain the treatment effect, and promote recovery from the disease.
Dietary recommendations
Pay attention to a healthy diet, eat more fruits and vegetables, supplement vitamins, eat more protein-rich foods, and ensure nutrition.
Dietary taboos
During the recovery period, you should try to avoid eating greasy, spicy and irritating foods.