Differential diagnosis and treatment edema. Tactics gp

Chronic venous insufficiency
CVI is now the most urgent problem in medical therapy due to the high prevalence of chronic venous disease (HZV) of the lower limbs, as among the working population, and among elderly. The incidence of chronic venous disease in the adult population as a whole is about 30%, reaching 80% in the older age groups. Unfortunately, in actual practice, there is a stereotype of the therapist when the patient complained of typical of venous disease: the patient immediately receives a referral to a surgeon phlebologist etc. However, only 10-15% of patients with CVI require surgical treatment, and the basis of a treatment program for HZV are conservative funds: elastic compression and pharmacotherapy. The active participation of physicians in the diagnosis and treatment of HZV, timely administration of therapeutic agents prevent the development of severe, advanced forms of the disease (trophic disorders, swelling) and complications (deep venous thrombosis, pulmonary embolism).At the heart of HZV infringements of tone and restructuring the walls of veins of the lower limbs as a result of chronic aseptic inflammation, the formation of valve failure and damage to the surface tissues of the lower limbs as a result of leukocyte aggression. These features of the pathogenesis HZV explain the fact that the surgery is not a solution to the problems in most patients. Surgery, unfortunately, can not restore venous tone, remove the swelling and prevent the negative effects of the activation of leukocytes. Therefore become important therapeutic agents acting on the basic mechanisms of the pathogenesis of the disease.
Lipedema
- The etiology is not known.- You can talk about the inherited defect in subcutaneous tissue.
- Lipedemu detected only in women. A similar picture can also be seen in their relatives in descending or ascending line.
- Characterized by a symmetrical increase of subcutaneous fat only on the legs.
- The volume and shape of the thigh and foot are the same.
- Signs of CVI are not detected.- Wears orthostatic character.
- Amplifying before menstruation, prolonged sitting, bathing in warm water, uncontrolled use of salt.
- Palpation of the leg is often painful.Algorithms for the therapist in identifying a patient with HZV
1. Determine the need for surgery.
2. With contraindications to surgery or patient refusal of surgery therapist must appoint conservative treatment and recommend a medical check-up.
3. In identifying options HZV requiring surgery, and no contraindications to surgery therapist should refer the patient to a surgeon clinic.
4. In acute situations (varikotromboflebit, deep vein thrombosis), the therapist must urgently send the patient to consult a surgeon. The latter provides for confirmation of the diagnosis of the patient in hospital surgical hospital.