Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Diseases of lymphatic system PowerPoint PPT presentation
Diseases of lymphatic
system
Lymphatic system
Lymphatics commences from tissue
spaces and empty into veins
Lymph nodes
Epitheliolymphoid tissues ? walls of GIT ,
thymus spleen
Function ? return of protein rich fluid into
circulation
? Includes albumin, globulin, coagulation factors,
growth factors , cholesterol, fat soluble vitamins
etc
Development
Four cystic spaces .. Neck and groin
Cisterns
Lower limb abdomen ? through cisterna
chyli ? thoracic duct - left jugular vein
Head and neck to right
Lymphatics follow vein
No lymphatics in brain and bone cortex
Lymphatic system includes lymphatic
channels, lymphoid organs and
circulating elements
Starlings law plays a role
Lymph flows against a pressure gradient
? Helped by muscle contractions
? Contactions and relaxations of lymphangions
? Valves
Diseases
Acute lymphangitis
? Staph/streptococcus
? Lymphadenitis/abscess
? Fever pain etc
? Red streak
? Rest, elevation, IV antibiotics
? Incision and drainage
? Recurrences --- acute inflammatory episode
Chronic lymphangitis
? Repeated attacks of acute lymphangitis
? May be a cause for lymphoedema
Neoplasms
Benign neoplasms
? From birth
? Neck, axilla, shoulder, groin
? Localised clustures of dilated lymph sacs not
connected to lymphatic system ?
lymphangiomas
? Three types ? capillary/simple, cavernous,
cystic hygroma
Simple / capillary lymphangioma
lymphangioma circumscriptum
Dilated dermal lymphatics that blister on
to skin
Contains clear fluid or blood stained
Inner thigh, shoulder or axilla
Lymphangiography diagnostic ?
separate from main lymphatic trunk
Treatment excision ? after confirming the
dignosis
CAVERNOUS
(DIFFUSE)LYMPHANGIOMA
Bigger swelling
Face, mouth, lips, tongue
Intramuscular sometimes
Very difficult to remove
recurrence
Cystic hygroma
Most common
75% neck, 20% axilla, 5% in mediastinum,
pelvis, groin, retroperitoneum sometimes
combinations
Children from birth
Painless, infection ?produce pain
Complete surgical excision
Sclerotherapy ?
Recurrence
Malignant neoplasm
Lymphangiosarcoma
? Rare
? Long standing lymphoedema
? Post mastectomy
? Upper limb common
? Bluish/purple discoloration- nodule- ulcer ?
diffuse
? Treatment ineffective ? fatal
Lymphoedema
? defined as abnormal limb swelling caused
by the accumulation of increased amounts of
high protein ISF secondary to defective
lymphatic drainage in the presence of
(near) normal net capillary filtration.
1 in 6000 births
Physical , emotional , psychological
Unilateral lymphoedema
? Mild - < 20% limb volume
? Moderate ? 20 ? 40%
? Severe - > 40%
Pathophysiology of edema
? Capillary filtration abnormality
? Lymphahtic abnormality ( true lymphoedema)
? Both
Classification
Primary
? Cause unknown
? Congenital lymphatic aplasia/hypoplasia
Secondary
? Definite cause
Risk factors
Primary lymphoedema
Familial or sporadic
? Familial ? milroy's disease and Meige's disease
Age at onset
? Congenita ? 10% by birth
? Praecox ? 75% adolescence
? Tarda ? beyond 35 yrs ? 15%
There is some developmental anomaly
Unilateral in 50%
Family history 1/5th cases
Lymphangiographically three types
? Aplasia ? 15% , congenital type
? Hypoplasia ? solitary lymph channel- 75%
? Varicose/dilated lymph trunks in 12%-
associated AV malformations
Prognosis bad for aplasia and varicose
type
Secondary lymphoedema
Most common
Infection/inflammation/trauma/tumor
Filariasis commonest cause
Certain conditions can mimic
lymphodema like ? factitious, immobility,
lipoedema
Investigations
Routine
Lymphangiography
? Direct
? Indirect
Isotope lymphoscintigraphy
CT scan ? Mass lesions
MRI ? LN
USS ? Venous system /DVT
Management
Initial evaluation
Relief of pain
Control of swelling
? Bedrest, elevation, compression, bandaging,
exercise
? Manual lymphatic drainage (MLD)
? Multilayer lymphoedema bandaging (MLLB)
Skin care
Treat acute infective episodes
Exercises
Drugs
? Flavanoids / benzpyrones
? Diuretics ?
Surgery
Surgeries
Rare
Minimal benefit
Three types
Bypass procedures
? Gille's ? Omental/skin bridge
? Kinmonth ? ileal mucosal patch
? Neibulowitz ? LN to vein
? Lymphaticovenular Anastomosis (LVA)
Liposuction
Limb reduction procedures
? Sistrunk ? wedge excision and suturing
? Homans
? Thompson's
? Charle's
This post was last modified on 12 August 2021