27. Lymphangitis. limphadenitis. Elephantiasis. Flashcards
Lymphangitis - Definition
Lymphangitis: acute bacterial (group A) infx of peripheral channels
Lymphedema - Definition
Abnormal accumulation of protein-rich fluid in subcutaneous tissue
Results from lymphatic obstruction in their lymph nodes or lymphatics
Lymph Vessel Anatomy -
lymph vessels have tunica intima, media + adventitia
- Differ from bv in that they have absent (or poorly developed) basement membrane, this allows free intracellular diffusion of plasma proteins + lipids
- Lymphatic capillaries absent in bones, teeth, CNS.
- Lymphatic capillaries join with larger lymphatics collecting vessels which contain valves – these merge to form lymphatic trunk – 2 vessels receive lymph from L.trunks – right lymphatic trunk + thoracic duct
Lymphangitis - Etiology
- GABHS: elaborate fibrinolysis + hyaluronidase which aid their invasion of lymph channels
- S.aureus, pseudomonas species, strep.pneum, H.simplex, Leishmainias
Lymphangitis - Clinical Presentation
- Normal signs of infx (rubor, dolor, colour)
- Red streaks in skin along line of inflamed lymphatics
- Can progress rapidly to bacteremia + sepsis
- Blistering of affected skin, swollen lymph nodes
Lymphangitis - Diagnostic Investigations
- CBC = leucocytosis. Culture / aspiration of pus
Lymphangitis - Treatment
- Rest – to reduce lymphatic drainage + elevate to reduce swelling
- I.V. ab (penicillin), analgesia, NSAIDs
Lymphadenitis - Definition
Acute infx of one or more lymph nodes
Lymphadenitis - Etiology:
- Staph/ strep infx – other agents too
- Immunological disorders = juvenile RA
- Primary disease of lymphoid / reticuloendothelial tissue – ALL, non-hodgkin, thyroid carcinoma
- Primary hereditary lymphedema
o Hypoplasia of lymph vessels
o Hyperplasia of LV – Lymphangiectasia which increases size + decreased valve function
o Aplasia of LV – Milroy’s disease type 1
o Kinmonth syndrome = hypoplasia combined with fibrosis + groin lymphadenopathy
Lymphadenitis - Clinical Presentation
increased lymph nodes = pain + tenderness – overlaying skin = erythematous
- Fever. Cervical lymphadenitis = neck stiffness + torticollis (wry neck)
Lymphadenitis - Diagnostic Investigations
Culture + gram stain.
CBC, ESR + CRP.
US,
CXR
Biopsy
Lymphadenitis - Treatment
Antibiotics.
Chemo + radiation.
Tx with abx is normally sufficient if not = incision + drainage
Elephantiasis (Lymphedema): Definition
Extremity swelling that results from reduction in lymphatic transport + accumulation of lymph within the interstitial space
Elephantiasis - Etiology
- Anatomic/physiological abnormalities
o Lymphatic hypoplasia
functional insufficiency
absence of lymphatic valves
Elephantiasis - Types
- Primary lymphedema:
o Congenital = milroys disease – aplastic lymph vessels. Meiges syn = manifests during puberty – lower extremities - Secondary lymphedema:
o More common than primary
o Result of lymphatic obstruction/disruption. Most common cause = surgery or radiation therapy
Pathology: swollen limbs become vulnerable to infx. Any kind of cut, scratch, insect bite can cause infx = lymphangitis
Repeated infx = scarring + tissue hardening (fibrosis)
- Also occurs from insect bite (Wuchereria Bancrofti = round warm) – major cause of lymphatic filariasis
- Accumulation of sexually mature fillariae in lymph vessels slows disease lymph flow (lymphostasis) causing various dilation and enlargement of lymph nodes
o Tx: antihelmetics = albendazole, mebendazole
