Doctor, my legs are so puffy!

This morning we discussed a case of new onset bilateral leg edema. 

Approach to is to think about one or more of the following etiologies: 1. increased capillary hydrostatic pressure (e.g. CHF) 2. decreased capillary oncotic pressure (e.g. nephrotic syndrome) 3. increased capillary permeability (e.g. inflammation)

As we discussed, focus your history on cardiac, hepatic, or renal disease, or drugs that affect any of those systems.

 Physical examination should focus on the pattern of edema. Is the JVP elevated? Is there pulmonary edema? Is there ascites? Is the edema localized or generalized? Is it pitting or non-pitting? Is it acute or chronic? Pattern of edema will help you narrow down your differential diagnosis.

  Here is a reference on the topic.