Lymphoedema

Question 1

What is lymphoedema?

Answer 1

Accumulation of fluid in tissue due to inadequate lymphatic drainage

Question 2

Pathophysiology of lymphoedema

Answer 2

Fluid accumulation leads to Fibrosis - causes coarsening, folding and distortion of the skin and elephantiasis.

Question 3

Sequalae of lyphodema

Answer 3

Swelling
Increased risk of infection
Fluid leakage
Pain
Reduced mobility/function
Rarely: angiosarcoma

Question 4

Lyphoedema causes

Answer 4

Cancer - malignant infiltration of the lymphatic system
Radiotherapy
Surgery
Prev DVT
Cellulitis
Chronic venous disease
Primary - inherited (manufests at birth/puberty commonly)

Question 5

Differential for swelling

Answer 5

Heart failure
Renal failure
Cellulitis
Liver failure
DVT
Low albumin
Inferior vena cava/superior vena cava obstruction
Drugs: calcium channel blockers, steroids

Question 6

Main features of managing lymphoedema

Answer 6

Skin care
Massage
Exercise
Compression

Question 7

Main components of skin care

Answer 7

Daily washing with thorough drying
Liberal moisturising
Avoid sunburn/venepuncture/trauma/vaccinations and BP on affected limb

Question 8

What is the aim of compression bandaging in lymphoedema?

Answer 8

Break down fibrosis
Rapidly reduce oedema
Reshape the limb

Question 9

What is the difference between comprsssion bandaging and compression garments?

Answer 9

Bandaging - for intensive phase with aim to reduce lymphoedema/reshape limb
Garments - used to reduce and maintain lymphoedema

Question 10

Contraindication to compression bandaging

Answer 10

Acute heart failure
Arterial insufficiency
Severe peripheral neuropathy

Question 11

Contraindications for compression garments

Answer 11

Acute heart failure
Arterial insufficiency
Severe peripheral neuropathy
Lymphorroea (leaking fluid)
Extensive ulceration