Anasarca

What is Anasarca?

Anasarca is a medical condition that results in excessive fluid build-up in your body leading to widespread swelling. This can happen when your small blood vessels, or capillaries, release more fluid than your lymphatic system – a network of tubes throughout the body that helps to get rid of waste products – can drain. It can also occur when the pressure within your blood vessels increases, the walls of your capillaries become more permeable, the protein content within your capillaries drops, or there’s a fluctuation in pressure from a lack of protein.

While localized swelling can be confined to certain body areas, anasarca is characterized by intense and widespread swelling affecting multiple areas like your legs, arms, face, and abdomen. It generally becomes noticeable when the fluid volume exceeds 2.5 to 3 liters.

Anasarca isn’t a disease in itself but a symptom of an underlying medical condition, such as heart, kidney, or liver failure, or problems with the lymphatic system. It’s mainly diagnosed through a clinical evaluation that focuses on identifying the cause. Diagnostic tests might be used to determine the extent and location of the swelling, but their main objective is to find the underlying cause. Treatment usually involves the use of water pills, also known as diuretics, and addressing the root cause. This makes it critical to quickly diagnose and treat the underlying condition.

What Causes Anasarca?

Anasarca is a health condition where a person’s body swells up because of too much fluid under the skin. This usually happens because of a shift in the balance of forces that control the movement of fluids between blood vessels and spaces around cells. There are many underlying health problems that could potentially lead to anasarca, such as:

1. Heart failure: Congestive heart failure, which is one of the most common causes of anasarca, can lead to this. If the heart isn’t pumping well enough, more fluid from the vessels can leak out and gather around the body’s tissues and cells.

2. Kidney failure: Diseases like glomerulonephritis, which affect the kidneys, can cause important proteins to be lost from your body. This leads to a decrease in the pressure inside your blood vessels, which then allows fluids to escape and cause edema, or swelling. Sometimes, if you have a kidney condition, swelling can occur if too much salt and water builds up in your body.

3. Liver diseases: If you have a liver condition like cirrhosis, your body might not produce enough of a protein called albumin. This protein helps maintain the pressure inside your blood vessels. Without enough albumin, fluid can move out from your blood vessels into the spaces around your cells.

4. Malnutrition: If your diet lacks enough protein or calories, it can lead to anasarca. This happens due to a decreased level of albumin and fluid retention.

5. Protein-losing enteropathy: Some intestinal diseases such as celiac disease can cause loss of protein from the body, making fluids seep out from the vessels.

6. Endocrinopathies: Certain hormonal imbalances like hypothyroidism can cause fluid retention leading to swelling that doesn’t indent when you press on it.

7. Collagenopathies: Inflammatory conditions such as systemic lupus erythematosus, dermatomyositis, or rheumatoid arthritis can result in anasarca because of increased fluid leakage through the blood vessel walls.

8. Medications: Some drugs such as corticosteroids, nonsteroidal anti-inflammatory drugs, or calcium channel blockers can also cause severe fluid retention.

Risk Factors and Frequency for Anasarca

There isn’t a lot of research on how often anasarca, a medical condition that causes swelling in the body, occurs. Peripheral edema, which is a similar condition characterized by swelling, is thought to affect about 20% of adults over 50. As for anasarca, one study found that almost 30% of patients who had abdominal surgery ended up developing the condition.

Signs and Symptoms of Anasarca

Anasarca is a condition where there is a lot of fluid buildup in different parts of the body, including under the skin, in the lungs, in the abdomen, and in your arms and legs. This can cause a range of symptoms, including:

• Significant swelling all over the body, including the face, hands and feet, tummy area, and the genitals
• Difficulty moving swollen body parts
• Weight gain due to holding onto extra fluid
• Fluid in the lungs that causes breathlessness that gets worse when you lie down, a cough, and chest pain
• Ascites (fluid in the abdomen) leading to a swollen belly
• Passing small amounts of urine or not at all
• Fatigue

In addition, you might see changes in the skin over swollen areas, such as redness, stretching, shiny, weeping, and taut skin. Some people may have other symptoms related to the underlying conditions causing anasarca, like heart failure, kidney disease or liver problems.

Diagnosing anasarca involves a physical examination. Doctors will first collect a detailed medical history, including when the symptoms first started, which areas are affected, any pain felt, and whether certain positions (like raising the legs) improve the swelling. They will also ask about any other symptoms, like breathlessness and chest pain, and whether you have any other conditions like heart or kidney disease that could cause fluid to build up. The visuals signs from the examination can often give doctors clues about the root cause of the swelling. For example, ‘pitting’ edema that forms a dent when you press it, gives an indication that there’s excess water trapped under the skin. Whereas ‘non-pitting’ edema may suggest blockage of the lymph nodes or low thyroid hormone levels. Similarly, a swollen belly could suggest liver disease, and signs of heart failure might point to a heart-related cause.

Testing for Anasarca

If you have anasarca, which is severe, widespread swelling throughout the body, your doctor will first work on figuring out what’s causing it. Frequently this requires teamwork between doctors of different fields, such as cardiology (heart health), nephrology (kidney health), gastroenterology (digestive health), and oncology (cancer), since anasarca often affects multiple body systems at once. This could include your urinary, cardiovascular (heart and blood vessel), and respiratory (breathing) systems. Here are the tests your doctor may use to find out why you have anasarca.

Laboratory Studies

Firstly, doctors will likely conduct a CBC (Complete Blood Count). This test helps to examine the overall health and detect a wide range of disorders. If the test detects any abnormalities it may indicate there is an issue that needs further investigation. For example, a low count on your platelets or a high white blood cell count. A full metabolic panel can also be beneficial, this looks at your kidney operation, albumin level, and liver function. The results can assist in understanding the cause; for instance, if your kidneys aren’t filtering waste and excess fluid as well as they should, causing the body to swell, or if your liver isn’t working as it should.

Dipstick urine tests are often used to identify albumin, a protein that can indicate kidney issues if found in the urine. If a urine protein-to-creatinine ratio test is positive for protein, combined with low albumin levels and swelling, this could indicate you have nephrotic syndrome (a kidney disorder that causes your body to excrete too much protein in your urine).

Doctors may also check your brain natriuretic peptide (BNP) levels. BNP is a hormone that your heart and blood vessels produce. High BNP levels could be a sign of CHF (Congestive Heart Failure). Thyroid tests can also be useful in the diagnosis process, if your thyroid isn’t working properly it can sometimes cause swelling in the body.

Imaging Studies

Imaging tests can be extremely useful in identifying the cause of anasarca. A chest X-ray allows doctors to assess if your heart is enlarged, or if you have fluid in the lungs (pulmonary edema), or excess fluid around the lungs (pleural effusions).

A computerized tomography (CT) scan can help identify any fluid buildup in the tissues in your chest wall, underarm area, pelvic area, and around your heart and lungs. With an echocardiogram, your doctor can evaluate the performance of your ventricles (the two large chambers of the heart that collect and expel blood) and check for fluid around the heart, all of which could potentially cause anasarca. Echocardiograms are also recommended for people who have or may have sleep apnea that is blocking their breathing during sleep, which can cause pulmonary hypertension (high blood pressure in the lungs).

An ultrasound of the veins could be the test of choice when there is a suspicion of deep vein thrombosis (a blood clot in a deep vein, usually in the legs), while an ultrasound of the kidneys is often used when kidney disease or protein loss in the urine is suspected. Doctors will look at the size of the kidneys and check for kidney disease and hydronephrosis (when a kidney swells due to urine failing to properly drain from the kidney to the bladder).

A lymphoscintigraphy (a special type of imaging) could be used to check the lymph system if a physical exam doesn’t provide enough information. Finally, a Magnetic Resonance Imaging (MRI) scan might be used to take a deeper look at any musculoskeletal (muscle and bone) causes of anasarca, or to check for lymphedema (blockage in your lymphatic system that prevents lymph fluid from draining well, and as a result it builds up and causes swelling).

Treatment Options for Anasarca

Anasarca, a condition that results in total body swelling, is usually a symptom of another underlying medical condition. To treat anasarca, doctors primarily focus on managing this underlying disease. In addition, most patients with anasarca are prescribed drugs called diuretics that help the body get rid of excess fluid. This is particularly crucial in patients who have a fluid imbalance, such as those with fluid build-up in their lungs (pulmonary edema), because if left untreated, it can lead to serious problems, including increased risk of death.

Anasarca can generally be managed at a steady pace. However, if pulmonary edema occurs, it’s a medical emergency requiring immediate attention. Diuretics are the usual treatment if a patient has generalized swelling due to heart failure, nephrotic syndrome (a kidney disorder that causes the body to excrete too much protein in the urine), or primary sodium retention (the body retains too much sodium). The American Heart Association emphasizes that heart failure patients with fluid overload and shortness of breath should get fast treatment with diuretics, because earlier intervention usually leads to better results.

While diuretics can be beneficial in certain situations, they can also lead to the body losing too much fluid in some patients. In severe conditions like congestive heart failure, diuretics such as furosemide or bumetanide are usually the first-line therapy. Anasarca resulting from cirrhosis, a chronic liver disease, may be treated with spironolactone alone or combined with other diuretics like furosemide. Please note, the specific medication, dosage, and combination will vary depending on each patient’s unique situation and response.

Non-drug treatments also play a crucial role in managing anasarca. Those with conditions such as cirrhosis or heart failure that cause major fluid build-up are usually asked to limit their intake of sodium and fluids. The American Heart Association recommends a limit of 2 liters per day for most patients with fluid overload. Sodium intake should also be reduced to 2000 mg per day according to The International Ascites Club. In some cases, addressing nutritional deficiencies through a balanced diet, treating infections with antibiotics, or using hemodialysis (a process that filters waste and extra fluid in the blood using a dialysis machine) in patients with kidney failure can also help manage anasarca. These complementary treatments to diuretic therapy are key to preventing the recurrence of anasarca.

As part of following up with patients with anasarca, doctors will monitor and adjust diuretic dosages based on the concentration of sodium in urine. Certain day-to-day practices like elevating legs and wearing compression stockings can help treat swelling in the legs. In cases of lymphedema (swelling due to obstruction or damage to lymph vessels), treatments include lymphatic massage, compressive bandages, and ongoing use of compression stockings or devices. However, in these cases, diuretics are often ineffective.

What else can Anasarca be?

When trying to diagnose anasarca (a serious condition where the body swells up due to fluid buildup), doctors might consider the following possible causes:

• Heart failure
• Kidney diseases, such as IgA nephropathy, glomerulonephritis, and nephrotic syndrome
• Autoimmune diseases, like juvenile dermatomyositis
• Blood disorders, like acute myeloid leukemia
• TAFRO syndrome, which includes symptoms like low platelet count, anasarca, fever, kidney problems, and enlarged organs
• Liver cirrhosis
• Low protein in the blood caused by malnutrition or intestinal diseases that cause protein loss
• Hypothyroidism
• Skin infection or sepsis
• Blood clot in a deep vein
• Side effects from some medications such as calcium channel blockers or nonsteroidal anti-inflammatory drugs
• Severe allergic reactions
• Lymphedema (swelling due to blocked or damaged lymph nodes)
• Pregnancy
• Certain cancers, particularly advanced stages
• Amyloidosis, which is a buildup of abnormal proteins

Remember, it’s important for healthcare providers to thoroughly consider all these factors to make a correct diagnosis.

What to expect with Anasarca

The outlook for anasarca, which means widespread swelling of the body, depends on the condition causing it and how quickly that condition can be treated. If the underlying causes can be effectively addressed, anasarca is usually reversible. For example, if medications or infections are the cause, stopping the medication or treating the infection can often resolve the swelling. This would mean the prognosis, or outlook, is generally good.

However, if the anasarca is due to long-term conditions like severe heart failure, kidney disease, or liver failure, the outlook may not be as positive. This is because the severity and advanced stage of these diseases can make it more difficult to reverse the swelling.

Possible Complications When Diagnosed with Anasarca

Anasarca can lead to several complications affecting different parts of the body. These complications can include:

• Organ dysfunction
• Skin ulcers
• Skin infections
• Reduced ability to move
• Lack of sufficient nutrients
• Weight gain
• Slow healing of wounds
• Deep vein thrombosis (a condition where clots form in deep veins)
• Respiratory distress (a state of not being able to breathe comfortably)
• Pericardial effusion (a buildup of excess fluid around the heart)
• Pericardial tamponade (a serious condition where fluid in the pericardium puts high pressure on the heart)
• Complications related to underlying causes or treatment with diuretics (medications that help remove extra fluid from the body)

Preventing Anasarca

Treating anasarca, a condition characterized by severe, widespread swelling of the body, as soon as possible is key to preventing it from getting worse. Teaching patients about their health is a crucial part of preventing anasarca and the complications that come with it. This is because anasarca often appears as a later symptom of other health conditions that have not been properly managed, like heart failure, kidney disease, liver disease, or certain inflammatory disorders.

Patients should know about chronic health conditions that could lead to anasarca if they do not take care of these conditions well. Knowing about the risk factors and early signs can encourage people to get medical help quickly. Lifestyle changes can also be very helpful in preventing and managing conditions that could lead to anasarca, including high blood pressure, diabetes, and obesity.

It is vital for patients to take their medications as prescribed, especially if they already have health conditions that could increase their risk of anasarca, such as heart failure. They should also understand how important it is to limit how much sodium and fluid they consume. Doctors should teach patients about the early signs of anasarca, such as pronounced swelling in the legs, ankles, and face, as well as shortness of breath. Suitable patients should be told about using compression stockings, which can help improve blood flow and reduce swelling.

Doctors should also teach patients about how to manage swelling at home, such as raising their legs when they are sitting or lying down and doing gentle exercises to improve blood circulation. For patients who have had anasarca before, understanding what makes their condition worse, like high salt consumption or certain allergens, is very beneficial to avoid triggering the condition again.