Generalized Edema Below the Diaphragm

Aka: Generalized Edema Below the Diaphragm, Bilateral Leg Edema, Leg Edema, Leg Swelling, Lower Extremity Edema

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II. Causes: Bilateral Lower Extremity Edema - Cardiovascular

  1. Decreased Cardiac Output
    1. Congestive Heart Failure
      1. Left Heart Failure results in Pulmonary Edema
      2. Right Heart Failure results in Generalized Edema
    2. Constrictive Pericarditis
    3. Pericarditis with effusion
  2. Venous Obstruction
    1. Inferior vein obstruction
    2. Venous obstruction due to intraluminal metastasis
    3. Thrombophlebitis
  3. Decreased venous tone
    1. Seen in sedentary patients

III. Causes: Bilateral Lower Extremity Edema - Non-cardiovascular

  1. Gastrointestinal
    1. Hepatic Cirrhosis or liver failure
    2. Portal Vein obstruction
    3. Protein-losing Enteropathy
  2. Renal
    1. Renal Failure
    2. Nephrotic Syndrome
  3. Malnutrition or Hypoalbuminemia
    1. Anemia
    2. Kwashiorkor or "starvation edema"
    3. Beriberi
  4. Carbohydrate Loading or cyclic Carbohydrate binging
    1. Patients who fast during week and eat on weekends
    2. Frequent travelers with altered eating habits
    3. Anorexia Nervosa
    4. Bulimia Nervosa
  5. Miscellaneous causes
    1. Pregnancy Induced Hypertension (after 20 weeks gestation)
    2. Tight clothing (e.g. garter belt)
    3. Medication Causes of Edema
    4. Menstruation or pregnancy
    5. Systemic Vasculitis
    6. Idiopathic Edema
    7. Allergic Reaction (e.g. Angioedema)
    8. Obstructive Sleep Apnea
      1. Mechanisms include Pulmonary Hypertension
    9. Thyroid Disease
      1. Hypothyroidism: Generalized Myxedema
      2. Hyperthyroidism: Pretibial Myxedema (in Grave's Disease)

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