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LYMPHATIC SYSTEM Flashcards

1
Q

Lymphatics develop by

A

6-7 weeks of GESTATION

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2
Q

⭐ LOWER LIMB & ABDOMINAL LYMPHATICS drain into

⭐ Upper LIMB & Head & Neck LYMPHATICS drain into

A

⭐ LOWER LIMB & ABDOMINAL LYMPHATICS drain into
🎯 THORACIC DUCT (via CISTERNA Chylii)

⭐ Upper LIMB & Head & Neck LYMPHATICS drain into
🎯 Right INTERNAL jugular Vein

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3
Q

LYMPHATIC SYSTEM starts DEVELOPING by

A

6-7 weeks of GESTATION

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4
Q

Which LYMPHATIC vessels have VALVES?

A

Terminal LYMPHATICS (have BICUSPID Valve)

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5
Q

How LYMPHATIC Vessels push their content forward?

A
  1. Lymphangions are CONTRACTILE in Nature
    ⬇️
    Pushes the LYMPH FORWARD
  2. Transient ⬆️ in INTERSTITIAL pressure 2° to MUSCLE CONTRACTION
  3. Prevention of REFLUX by VALVES
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6
Q

Lymphangions

A

Valves partition LYMPHATICS into segments

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7
Q

CYSTIC HYGROMA develops DUE TO:

A

Sequestered LYMPHATIC tissue
⬇️
Cyst does NOT Communicate with NORMAL Lymphatics
⬇️
Lymph gets absorbed, Clear Fluid ➕

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8
Q

⚡⚡ MOST COMMON SITE OF CYSTIC HYGROMA

A

POSTERIOR triangle of NECK

Other:
Axilla
Inguinal Region

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9
Q

🧑🏻‍⚕️ Clinical Features of CYSTIC HYGROMA

A
  1. Fluctuations ➕
  2. Partly COMPRESSIBLE
  3. Brilliantly TRANS-ILLUMINANT swelling
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10
Q

Brilliantly TRANS-ILLUMINANT swelling
🧠⚡CREaM H ⚡

A

• Hydrocele
• Epididymal cyst
• Cystic hygroma
• Ranula
• Meningocele

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11
Q

Presentation of CYSTIC HYGROMA

A
  1. Detected in-utero in USG
  2. Obstructed labor
  3. RESPIRATORY distress
  4. Swelling
  5. Secondary Infection
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12
Q

🩺 IOC for CYSTIC HYGROMA

A

FNAC

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13
Q

💊💉 MANAGEMENT of CYSTIC HYGROMA

⭐ Normal Lesion
⭐ Very Large Lesion

A

⭐ Normal Lesion
Aspiration ➡️ Surgery

⭐ Very Large Lesion
Aspiration ➕ Sclerotherapy
⬇️
Surgery

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14
Q

Which nerve can get injured during CYSTIC HYGROMA Surgery

A

Spinal Accessory Nerve
⬇️
Shoulder Dysfunctions

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15
Q

Organisms ASSOCIATED with ACUTE LYMPHANGITIS

A
  1. Streptococcus
  2. Staphylococcus aureus
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16
Q

🧑🏻‍⚕️ Clinical Features of ACUTE LYMPHANGITIS

A
  1. Pain
  2. Reddish Streaks
  3. Fever
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17
Q

💊💉 MANAGEMENT of ACUTE LYMPHANGITIS

A
  1. Limb elevation
  2. Analgesics
  3. Broad spectrum antibiotics
  4. If ≥ 48 hours ➡️ Suspect ABSCESS
    ⬇️
    INCISION & DRAINAGE
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18
Q

Lymphedema
meaning

A

Occurs DUE TO: Inability of LYMPHATIC System to clear INTERSTITIAL FLUID COMPARTMENT

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19
Q

⭐ 1° LYMPHEDEMA

⭐ 2° LYMPHEDEMA

A

⭐ 1° LYMPHEDEMA
🎯 PRODUCTION is NORMAL ➕ DEFECTIVE LYMPHATICS

⭐ 2° LYMPHEDEMA
🎯 ⬆️ PRODUCTION (OR) ⬇️ DRAINAGE

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20
Q

Effect of LYMPH STASIS

A

⭐ Fibrosis
⭐ Skin Changes

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21
Q

🧑🏻‍⚕️ Clinical Features of LYMPHEDEMA

A

✨ Lymph swelling
✨ Dull aching (OR) Sharp PAIN
✨ Skin changes

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22
Q

Brunner’s classification used for

A

Clinical classification of LYMPHEDEMA

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23
Q

Brunner’s CLASSIFICATION

A
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24
Q

Skin changes in LYMPHEDEMA

A
  1. BUFFALO HUMP: Loss of ANKLE CONTOUR
  2. STEMMER’S SIGN: Skin becomes FIBROSED & CANNOT BE PINCHED
  3. Squaring of TOES
  4. Fungal Infections
  5. Cancer development
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25
Identify
STEMMER'S SIGN
26
Identify
Buffalo HUMP sign
27
Identify
SQUARING OF TOES
28
Gold standard for QUANTIFICATION OF LYMPHEDEMA
Water Plethysmography
29
GOLD STANDARD TO IDENTIFY TYPE OF LYMPHEDEMA ⭐ DYE USED
Direct LYMPHANGIOGRAPHY ⭐ INDIGO CYANIN GREEN
30
Patterns of 1° LYMPHEDEMA
1. Congenital Hyperplasia of LYMPHATICS 2. DISTAL OBSTRUCTION 3. PROXIMAL OBSTRUCTION
31
Congenital Hyperplasia of LYMPHATICS
⬆️ in NUMBER of LYMPHATICS but they are DEFECTIVE
32
⚡⚡ MOST COMMON PRIMARY LYMPHEDEMA
LYMPHEDEMA PRAECOX
33
⚡⚡ MOST COMMON PATTERN seen in LYMPHEDEMA PRAECOX
Distal OBSTRUCTION
34
Proximal OBLITERATION
OBSTRUCTION at level of AORTO-ILIAC & INGUINAL NODES
35
Which INVESTIGATION is useful to DIFFERENTIATE LYMPHEDEMA, VENOUS EDEMA & LIPOEDEMA
Single AXIAL CT through MID-CALF
36
Single AXIAL CT through MID-CALF findings
LYMPHEDEMA 🎯 RETICULAR, HONEYCOMB pattern in an enlarged SUBCUTANEOUS compartn5 VENOUS EDEMA 🎯 ⬆️ Volume of MUSCULAR COMPARTMENT LIPOEDEMA 🎯 ⬆️ SUBCUTANEOUS FAT
37
LIPOEDEMA: 🧑🏻‍⚕️ Clinical Features
1. Symmetrical 2. B/L 3. ♀️ > ♂️
38
1° LYMPHEDEMA 🧠⚡CPT⚡
1. Lymphedema Congenita 2. Lymphedema PRAECOX 3. Lymphedema TARDA
39
⚡⚡ MOST COMMON AGE GROUP FOR 1. Lymphedema Congenita 2. Lymphedema PRAECOX 3. Lymphedema TARDA
1. Lymphedema Congenita 🎯 0-2 years 2. Lymphedema PRAECOX 🎯 2-35 yrs 3. Lymphedema TARDA 🎯 > 35 yrs
40
GENDER PREDOMINANT IN 1. Lymphedema Congenita 2. Lymphedema PRAECOX 3. Lymphedema TARDA
1. Lymphedema Congenita 🎯 ♂️ > ♀️ 2. Lymphedema PRAECOX 🎯 ♀️> ♂️ 3. Lymphedema TARDA 🎯 ♂️ > ♀️
41
Familial VARIENT OF 1. Lymphedema Congenita 2. Lymphedema PRAECOX
1. Lymphedema Congenita 🎯 NOONE MILROY SYNDROME 2. Lymphedema PRAECOX 🎯 MEIGE'S DISEASE
42
Body parts involved in: 1. Lymphedema Congenita 2. Lymphedema PRAECOX
1. Lymphedema Congenita 🎯 Multiple Limbs, Face & Genitalia 2. Lymphedema PRAECOX 🎯 U/L Lower Limb till Knee
43
Noone MILROY SYNDROME ⭐ MUTATION
Familial LYMPHEDEMA Congenita ⭐ FLT-4 ⭐ VEGF
44
MEIGE'S DISEASE ⭐ MUTATIONS
Familial LYMPHEDEMA PRAECOX ⭐ GJC gene
45
SYNDROMES ASSOCIATED with LYMPHEDEMA
1. HENNEKAM SYNDROME 2. EMBERGER SYNDROME 3. OLEDAID SYNDROME
46
Microcephaly ➕ Unusual Facies ➕ LYMPHEDEMA affecting all 4 limbs
HENNEKAM SYNDROME
47
HENNEKAM SYNDROME MUTATION
FAT4 gene
48
Myelodysplasia ➕ Warts ➕ RECURRENT Viral & Bacterial Infections ➕ Hypoplasia of LYMPHATICS
Emberger SYNDROME
49
EMBERGER SYNDROME Mutation
GATA2
50
Ectodermal dysplasia ➕ Anhidrotic ➕ Osteopetrosis ➕ Immunodeficiency
OLEDAID Syndrome
51
OLEDAID Syndrome MUTATION
IKBKG gene
52
⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA OVERALL
Filariasis
53
⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in UPPER LIMB ⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in LOWER LIMB
⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in UPPER LIMB 🎯 POST-MASTECTOMY LYMPHEDEMA ⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in LOWER LIMB 🎯 FILARIASIS
54
CHANCE OF POST-MASTECTOMY LYMPHEDEMA is ⬆️ ⬆️ if
1. Radiotherapy is given to AXILLA after Surgery 2. Lymph node Clearance above AXILLARY VEIN
55
Effect of DEC in ELEPHANTIASIS Treatment
⭐ Kills Microfilariae ⭐ Cannot REVERSE LYMPHEDEMA (OR) Skin Changes
56
STEWART TREVE'S SYNDROME
Development of LYMPHANGIOSARCOMA in long standing LYMPHEDEMA (8-10yrs)
57
💊💉 MANAGEMENT of STEWART TREVE'S SYNDROME
Aggressive SURGERY & CHEMOTHERAPY
58
STEWART
59
Cancers ASSOCIATED with LYMPHEDEMA
1. Lymphangiosarcoma 2. Kaposi Sarcoma 3. Squamous cell Carcinoma 4. Liposarcoma 5. Basal cell Carcinoma 6. MALIGNANT melanoma 7. Lymphoma
60
Lymphangioma
Dilated LYMPHATIC can THROMBOSE in LONG RUN ⬇️ FIBROSIS ⬇️ Form NODULES
61
🌸 TYPES of LYMPHANGIOMA 🧠⚡ACD ⚡
1. LYMPHANGIOMA AB IGNE: Arranged in RETICULAR FASHION 2. LYMPHANGIOMA CIRCUMSCRIPTUM: < 5 cm 3. LYMPHANGIOMA DIFFUSUM: > 5cm
62
💊💉 MANAGEMENT of LYMPHEDEMA
1. Pain Relief 2. Skin Care 3. Control of SWELLING: Decongestive LYMPHEDEMA Therapy ✨ 1st Phase: INTENSIVE SUPERVISED THERAPY ✨ 2nd Phase: MAINTAINANCE Phase: Self Care Regime 4. Exercise: Slow rhythmic movements & Swimming 5. Surgery ✨ Reconstructive ✨ Resective
63
1st Phase: INTENSIVE SUPERVISED THERAPY includes
1. Manual LYMPHATIC drainage 2. Multiplayer LYMPHEDEMA bandaging
64
MLLB Advantages
65
Difference BETWEEN Compression Stockings for VARICOSE VEINS & PRESSURE GARMENTS
66
If ARTERIAL DISEASE is ➕, with LYMPHEDEMA, MLLB can be only DONE if
ABPI > 0.8-0.9
67
Vigorous Exercise & Anaerobic Isometric Exercise can
WORSEN LYMPHEDEMA
68
Indications of SURGICAL MANAGEMENT in LYMPHEDEMA
1. ⬆️ in SWELLING DESPITE MEDICAL Management 2. Skin Changes 3. RECURRENT Infections
69
Types of SURGICAL PROCEDURES in LYMPHEDEMA
⭐ Reconstructive ✨ KINMOTH Procedure ✨ NEBULOWITZ Procedure ⭐ RESECTIVE ✨ Homan's procedure ✨ Thompson procedure ✨ Sistrunk Procedure ✨ Charles Procedure
70
KINMOTH Procedure
Ileal Mucosal Patch anastamosis
71
NEBULOWITZ PROCEDURE
⭐ Super Microsurgery Anastamosis of LYMPH NODES & LYMPHATICS with VEINS
72
Homan's Procedure
Wedge of Skin & SUBCUTANEOUS tissue is removed
73
⚡⚡ MOST COMMON COMPLICATION OF Homan's Procedure
Skin NECROSIS
74
⚡⚡ MOST SATISFYING SURGERY FOR CALF LYMPHEDEMA
Homan's Procedure
75
THOMPSON PROCEDURE
Flap is RAISED & SUBCUTANEOUS tissue is cleared ⬇️ Flap is de-epithelized & sutured
76
⚡⚡ MOST COMMON COMPLICATION OF THOMPSON PROCEDURE
Skin Necrosis
77
⚡⚡ MOST COMMONLY DONE RESECTIVE SURGERY PROCEDURE
SISTRUNK PROCEDURE
78
SISTRUNK PROCEDURE
Wedge of skin & SUBCUTANEOUS tissue is resected & Primary Closure is done
79
⚡⚡ MOST DISFIGURATIVE PROCEDURE FOR LYMPHEDEMA MANAGEMENT
Charles Procedure
80
CHARLES PROCEDURE
Entire skin is removed ⬇️ Split Thickness Skin Grafting
81
Pilonidal Sinus Formation is COMMONLY seen following
THOMPSON'S PROCEDURE
82
Hydrocele of the Neck
Cystic Hygroma
83
Cyst in Cystic Hygroma is
Multilocular

VASCULAR SYSTEM (5 decks)

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