Lymphatic dysfunction Notes

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Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Lymphatic dysfunction essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Lymphatic dysfunction by visiting the associated Learn Page.
NOTES NOTES LYMPHATIC DYSFUNCTION LYMPHEDEMA osms.it/lymphedema PATHOLOGY & CAUSES ▪ Lymphatic system becomes obstructed, causing protein-rich fluid buildup in tissues ▪ When flow is blocked, lymph gets backed up → drainage stops → fluid accumulates ▪ Inflammatory reaction: macrophages release inflammatory molecules → damages nearby cells → scarring, fibrosis (connective tissues thicken/scar tissue forms) → hardening CAUSES ▪ Filariasis: most common cause in lowincome countries ▫ Infection with nematode parasites (e.g. Wuchereria bancrofti) ▫ Nematode enters lymphatic system, causes fibrosis, creates a blockage ▪ Cancer, associated treatment: most common cause in high-income countries ▫ Removal of lymph nodes most common cancer treatment-related cause (e.g. axillary lymph nodes removed during mastectomy) ▪ Lymphedema praecox/primary lymphedema: congenital, results from lymphatic system not developing correctly < 35 years old ▪ Lymphedema tarda/primary lymphedema: > 35 years old, associated with genetic disorders (e.g. Turner syndrome) RISK FACTORS ▪ Older age, obesity, rheumatoid/psoriatic arthritis, Turner syndrome, smoking, cancer/ associated treatment (esp. breast cancer) Figure 13.1 Gross lymphedema of the left leg. STAGING ▪ Stage 0: latent stage. Damage to lymphatics but enough lymph still removed. Lymphedema not present ▪ Stage 1: spontaneously reversible. Tissue in pitting stage. Affected area normal/almost normal size in morning, progressively worsens throughout day ▪ Stage 2: spontaneously irreversible. Tissue spongy, non-pitting (bounces back when pressed). Fibrosis starts to develop → limbs harden, increase in size ▪ Stage 3: lymphostatic elephantiasis. Swelling irreversible, limbs large, hard from fibrosis OSMOSIS.ORG 95
COMPLICATIONS ▪ Recurrent cellulitis, limb swelling (esp. lower limbs), erythema, pain SIGNS & SYMPTOMS ▪ Chronic swelling , one limb larger than other ▪ Usually lower limbs; impairs movement ▪ Fatigue, fever, chills, weakness ▪ More likely to occur with superimposed bacterial/fungal skin infection ▪ Regional edema: begins as soft, pitting edema → progresses into chronic fibrosis without treatment DIAGNOSIS DIAGNOSTIC IMAGING Lymphoscintigraphy ▪ Nuclear imaging to assess lymphatic flow ▫ Radiotracer injected into affected limb → able to visualize dermal backflow, absent/delayed radiotracer movement, absent/delayed lymph node visualization TREATMENT ▪ No cure, no medication ▪ Depends on severity, limb fibrosis SURGERY ▪ Goal: improve drainage/reduce fluid load OTHER INTERVENTIONS ▪ Therapeutic exercises, self care ▪ Kinesio tape: applied to skin to channel lymph, reduce swelling ▪ Aquatic therapy Manual lymphatic drainage (MLD) ▪ Pneumatic pumps: substitute for MLD Compression ▪ Multilayer compression bandage: stop fluid accumulation ▪ Compression massages help lymph flow ▪ Compression garments MRI ▪ Shows severity, distribution of edema, lymphatic channels can be depicted after intracutaneous contrast injection MR venogram ▪ Helps differentiate lymphatic channels from superficial veins CT scan ▪ Assists in localization (subfascial, epifascial), characteristics (skin thickening, honeycomb pattern of edema) Ultrasound ▪ May be used to reveal blockages Figure 13.2 A plain X-ray of the forearm showing edema of the subcutaneous tissues. The subcutaneous fat shows characteristic streaky densities. 96 OSMOSIS.ORG

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Lymphatic dysfunction essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Lymphatic dysfunction by visiting the associated Learn Page.