Causes of bilateral ankle oedema

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Causes of bilateral ankle oedema

  •  Right ventricular failure—2° to chronic lung disease.
  •  Congestive cardiac failure (CCF)—cardiomyopathy, constrictive pericarditis,
  • etc.
  •  Hypoalbuminaemia—nephrotic syndrome, hepatic cirrhosis, proteinlosing
  • enteropathy, malnutrition (starvation or malabsorption),
  • (gravity).
  •  Dependent oedema (immobility).
  •  Drugs—Ca2+ channel blockers, NSAIDS.
  •  Idiopathic/cyclical oedema syndrome.
  •  Pregnancy.
  •  Wet beriberi (rare in Western societies but commoner in Africa).

Essential investigations

  •  U&E.
  •  LFTS.
  •  Urine dipstick for proteinuria.
  •  Urine protein/creatinine ratio or 24h urine protein excretion.
  •  CXR.
  •  12-lead ECG.
  •  Echocardiogram.

Consider
  •  Liver USS.
  •  Doppler studies of leg veins.
  •  Contrast venography.
  •  Filariasis serology/blood film.
  •  Xylose breath test.
  •  OGD with small bowel biopsy.

All the causes of unilateral ankle oedema may also cause bilateral
oedema.

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