Lymphedema Flashcards
(38 cards)
What are the primary or central lymphatic organs?
thymus
bone marrow
What are the primary or central lymphatic organs?
thymus
bone marrow
What are the secondary of peripheral lymphatic organs?
- lymph nodes
- spleen
- Peyer’s patches in GIT
- tonsils
What are the functions of lymphatics?
- substance transport
- filtration
- lipid absorption
What are the substances carried from interstitial fluid through the lymphatics back to the circulation?
- water
- electrolytes
- polypeptides, cytokines, growth factors (low molecular-weight moieties)
- fibrinogen, albumin, globulins, coagulations & fibrinolytic factors (macromolecules)
What is the first-line of the immune system’s defense?
filtration of microbes in interstitial space by lymph nodes
Where does lipid absorption occur?
in Peyer’s patches in the bowel
An abnormal limb swelling caused by the accumulation of increased amounts pf high protein ISF secondary to defective lymphatic drainage in the presence of near normal net capillary filtration is the definition of?
lymphedema
what is the difference between edema & lymphedema?
EDEMA
- capillary filtration rate is pathologically high due to venous impairment so it overwhelms the normal lymphatic system
- resulting in accumulation of low-protein edema fluid
LYMPHEDEMA
- capillary filtration rate is normal & edema fluid is relatively high in protein
- primary problem is in the lymphatics
What is the end result of any edema?
- protein rich edema fluid
- increased deposition of ground substance
- subdermal fibrosis
- dermal thickening & proliferation
Where is lymphedema confined to?
epifascial space
in which type of edema will there be compensation?
- VENOUS INSUFFICIENCY can be compensated by increase in lymph flow (because lymphatic vessels can remove fluids)
- LYMPHATIC INSUFFICIENCY can’t be compensated because the venous system cannot reabsorb HMW proteins
What are the mechanisms of lymphedema?
- lymphatic aplasia or hypoplasia
- lymphatic dysmotility
- congenital lymphatic obliteration
What are the types & cause of PRIMARY lymphedema?
cause is congenital lymphatic dysplasia
LYMPHEDEMA CONGENITA
LYMPHEDEMA PRAECOX
LYMPHEDEMA TARDA
which type of primary lymphedema occurs after 35 years?
Lymphedema tarda
What type pf primary lymphedema occurs in patients aged <2 years?
lymphedema congenita
What type of lymphedema has an onset between 2-35 year old patients?
lymphedema praecox
what are the types of secondary lymphedema?
- traumatic
- post irradiation
- infective
- malignant (breast cancer)
- post-thrombotic
How is does traumatic lymphedema develop?
- POST OP: post-mastectomy lymphedema (never give saline in same side)
- KELOIDS: obstruct lymph return
- ACCIDENTAL: circumferential skin loss following extensive injury or burn
How does infective lymphedema develop?
- Bacterial infection
- Fungal infections (tinea pedis)
- Parasitic (filariasis): Elephantiasis Arabum
What is the initial presentation of lymphedema?
PAIN from heaviness & swelling
What is the clinical presentation of the early stages of lymphedema?
- usually involves the foot
- contour of ankle is lost through infilling of submalleolar depressions
- buffalo hump forms on dorsum of foot
- toes appear square due to confinement of footwear
- Stemmer’s sign (skin on dorsum of foot can’t be pinched due to subcutaneous fibrosis)
- pitting edema that pits less in the morning
REVERSIBLE STAGE
What are the late clinical manifestations in lymphedema?
- failure to control reversible stage -> fibrosis, dermal thickening, & hyperkeratosis
- chronic eczema & fissuring
- fungal infection of skin & nails (dermatophytosis & onychomycosis)
- verrucae & papillae (warts)
- lymphangiomas
- lymphangiosarcoma
dilated dermal lymphatics that blister onto skin were seen in a patient, the patient complained that they usually weep. What is your diagnosis & what is the sequele of this symptom?
LYMPHANGIOMA
weeping -> lymphorrhea, chylorrhea
will later thrombose & fibrose forming hard nodules
