Index
The sign of Godet is a maneuver that reveals the existence of edema.
The doctor presses his finger on the tissue or suspicious mucosa. The sign is positive if the doctor sees an imprint that takes a few seconds to disappear when the finger is removed.
Edema is the name given to the swelling located somewhere in the body. The best known is the edema that occurs in the legs. However, the east can occur anywhere in the body—pulmonary edema, cerebral edema, laryngeal edema, lingual edema, etc.
Contrary to what one might imagine, our blood vessels are not waterproof and have pores that allow the entry and exit of cells, bacteria, proteins, and water.
Swelling occurs when there is excessive fluid leakage. The excess water flows into the interstitial space, the space between the cells of the tissues.
When inflammation occurs, blood vessels become more permeable to facilitate the arrival of defense cells to the site of infection or trauma. With the enlargement of the pores, there is more significant extravasation of fluid in the surrounding tissues.
Consequently, the mark of the sign of Godet takes place, being the reason why this mark takes in disappears when being pressed on the skin in the zone that presents the swelling.
Formation of inflammation
The process of edema formation in trauma or infection is easy to understand. The problem is that edema can form in many other situations. There are three mechanisms for constructing edema and a more excellent permeability of the vessels.
Increase in pressure
This increase has nothing to do with hypertension, which is the elevation of blood pressure. It is worth remembering that the arteries carry blood from the heart to the organs and tissues, while the veins bring blood back from the tissues to the core.
The increase in venous pressure occurs when some type of obstruction, even partial, of the venous blood flow. We call it increased hydrostatic pressure, which is when the pressure of the volume of liquid inside the container is on the wall itself.
Varicose veins
Varicose veins have a hard time bringing blood back to the heart.
It is worth noting that the veins of the legs must act against gravity, and when there is a defect in this system, there is a repression of blood in the lower extremities.
The blood accumulated in the veins increases the pressure inside them and causes extravasation of fluid in the subcutaneous tissue. This situation is called venous insufficiency of the lower limbs.
A similar mechanism occurs in the case of heart failure, where a weak heart can not pump blood efficiently, which favors the same situation in the lower extremities.
In both heart failure and venous insufficiency in the lower extremity, edema appears and worsens when the patient stands up for a long time and tends to disappear after a few hours in bed when gravity does not exert an opposite force.
One of the typical signs of swelling in the legs is the sign of Godet. They are showing excess fluid in the subcutaneous tissue.
In some diseases, especially of renal origin, there is an accumulation of sodium (salt) in the body.
This excess of salt increases the amount of body water, which consequently increases the blood pressure and the venous pressure, favoring the appearance of bumps.
The two mechanisms described above (vascular permeability and increased venous pressure) cause localized edema in the legs or the affected trauma or inflammation site. In the case of salt retention, the edema tends to be more diffuse.
Decrease in blood viscosity
Another mechanism for the formation of lumps is the decrease in blood viscosity, called oncotic pressure, and is mainly caused by the concentration of protein in the blood.
While the increase in pressure within the veins promotes fluid leakage, the oncotic force acts oppositely. Therefore, edema formation is a balance between hydrostatic pressure and oncotic pressure.
When one has a condition that reduces blood proteins (albumin is the main one), the patient tends to form edema, even though the pressure inside the veins is normal.
In this case, inflammation is widespread since the lack of proteins occurs throughout the body.
Lymphedema
Another type of edema, less common, is the origin of the lymphatic. It is called lymphedema and occurs due to obstruction of the lymphatic vessels.
It occurs in elephantiasis, cancers, in the morbidly obese limbs and upper limbs of patients who perform a mastectomy and remove their axillary lymph nodes. In venous insufficiency, severe and untreated associated lymphoedema can also occur.
Lymphedema is more paralyzing than venous edema and can be pretty asymmetric. Swelling is often caused by more than one mechanism.
Swelling can be a symptom of …
Increase in hydrostatic pressure and sodium retention:
- Venous insufficiency.
- Heart failure.
- Renal insufficiency.
- The pregnancy.
- Venous thrombosis
Decreased oncotic pressure:
- Cirrhosis and liver disease.
- Nephrotic syndrome.
- Chronic diseases.
- Malnutrition.
Increase in vascular permeability:
- Septicemia.
- Great burns
- Inflammation (local edema)
- Allergic reaction.
Lymphedema:
- Cancer.
- Resection of the lymph.
- Elephantiasis (lymphatic filariasis).
- Obesity.
- Severe hypothyroidism (myxedema)
Edema without apparent cause (idiopathic edema):
A swelling mainly occurs in young, healthy people, usually associated with the menstrual period. It is also associated with obesity and depression. There is no apparent cause.
