SOA: What to Consider

Swelling of the ankles generally presents as such


Important causes of SOA include organ failure (heart; liver; kidney)

• But such conditions are generally well-documented in the patient's PHx or present with symptoms or signs other than SOA alone
• SOB
• Raised liver enzymes
• Reduced eGFR

Think

1. Uni- or bi-lateral?
2. Pitting or non-pitting?
3. Painful or not?
4. Tender or non-tender?
5. JVP ?elevated

Bilateral
=> Hot environment
=> Relative immobility (permanent; temporary - sitting; travel)
=> Obesity
=> Menstrual (mid-cycle)
=> Chronic venous insufficiency
=> Medication
Calcium antagonists
Glitazones
C.steroids (systemic)
NSAID
COCP (combined oral contraceptive pills)

=> Organ failure (low serum albumin => liver or kidney; normal level => cardiac)

Unilateral
=> inflammation or infection


Pitting edema
=> excess interstial fluid

Pain
=> inflammation or infection or clot (superficial phlebitis; DVT)

Tenderness
=> inflammation or infection or clot (superficial phlebitis; DVT)


JVP raised
=> cardiac




Ix to consider initially

• Urinalysis - office dipstick test; urine for mcs; MAU
• Serology - UCEs; eGFR; LFTs
• Haematology - FBC; CRP
• Imaging - US scan leg veins; CXR; EchoC