Legs Swelling: Peripheral Edema

"Hi everyone, welcome back to the channel! I’m Dr. PK, internal medicine physician and your guide to better understanding your health. Today’s topic is something very common yet often misunderstood—leg swelling, also known medically as peripheral edema. If you've noticed your legs, ankles, or feet swelling up, this video is for you. Let’s talk about what it means, what causes it, and how we investigate and treat it. Don’t forget to like, share, and subscribe!"

"First things first—leg swelling simply refers to fluid buildup in the tissues of your lower extremities. It may be mild and temporary, or severe and persistent. It can happen on one leg or both, and that distinction is very important for diagnosis.

So let’s break it down."

• Unilateral swelling (one leg only) — often suggests a local problem like:
  • Deep vein thrombosis (DVT)
  • Cellulitis or infection
  • Lymphedema
  • Trauma or injury
• Bilateral swelling (both legs) — typically suggests a systemic issue like:
  • Congestive heart failure
  • Kidney disease
  • Liver disease (cirrhosis)
  • Chronic venous insufficiency
  • Medications (e.g. amlodipine, NSAIDs)
  • "Let’s go deeper and break down the top causes based on location, severity, and symptoms."
    🔴 1. Deep Vein Thrombosis (DVT)
    • Usually one leg
    • Pain, tenderness, redness, warmth
    • Risk factors: recent surgery, cancer, immobility, estrogen therapy
    • High risk: potential for pulmonary embolism
  • 💔 2. Congestive Heart Failure
    • Bilateral, pitting edema
    • Often worse in the evening
    • Associated with shortness of breath, fatigue, orthopnea
    • Heart can’t pump blood efficiently—fluid backs up
  • 🧬 3. Liver Cirrhosis
    • Low albumin → oncotic pressure drops → edema
    • Associated with ascites, jaundice
  • 💡 4. Kidney Disease
    • Nephrotic syndrome: massive protein loss in urine
    • Puffy face + leg swelling
    • Check urine protein, creatinine, GFR
  • 🧦 5. Chronic Venous Insufficiency
    • Damaged valves in leg veins → poor return of blood
    • Worse after long standing
    • Skin changes: hemosiderin staining, ulcers
  • ⚡ 6. Lymphedema
    • Non-pitting, chronic swelling
    • Often after cancer treatment or lymph node removal
    • Thickened skin over time
  • 💊 7. Medication-induced
    • Calcium channel blockers (like amlodipine)
    • NSAIDs
    • Steroids
    • Hormones
    • "Let’s say you show up to clinic with swollen legs—what do we do?"
      🩻 1. History & Physical
      • Onset, duration, one leg or both?
      • Pain? Fever? Shortness of breath?
      • Medications, recent travel, surgeries?
    • 🧪 2. Labs
      • CBC: check for infection or anemia
      • BMP: kidney function
      • Liver panel: albumin, enzymes
      • BNP: heart failure marker
      • Urinalysis: protein in urine for nephrotic syndrome
      • D-dimer: if suspicious for DVT (not definitive)
    • 🖥️ 3. Imaging
      • Venous Doppler Ultrasound: for DVT
      • Echocardiogram: for heart failure
      • Chest X-ray: heart size, fluid in lungs
      • Lower extremity CT/MRI: if concern for lymphatic obstruction or tumor
      • "Now for the important part—how do we treat leg swelling?"
        ❤️ 1. Heart Failure
        • Diuretics like furosemide
        • Manage BP, fluid/sodium restriction
        • Treat underlying heart disease
      • 🧬 2. Kidney Disease
        • Diuretics + treat cause