chronic limb swelling Flashcards
when does pitting edema happen ?
pitting on pressure happens when the circumference of the limb is increased by 10%
what is the mechanism of oedema
increased capillary permeability
increased capillary pressure
decreased osmotic pressure of blood
impaired lymphatic drainage
what is starlings law of the capillaries ?
nearly as much fluid is reabsorbed as was filtered
what are some of the causes of non-vascular limb swelling?
cardiac failure
liver failure
angioedema
retroperitoneal fibrosis
what kind of drugs can cause limb swelling?
calcium channel blockers
what kind of vascular malformations can cause vascular limb swelling ?
klippel-trenaunay (arteriovenous fistula)
what are the superficial veins of the lower limb
great saphenous vein
small saphenous vein
what is lymphedema ?
abnormal limb swelling cause by the accumulation of increased amounts of high protein secondary to defective lymphatic drainage in the presence of normal net capillary filtration
what are the types of lymphedema ?
primary and secondary
what are the three types of primary lymphedema ?
congenital lymphedema
lymphedema praecox
lymphedema tarda
what distinguishes the three types of primary lymphedema ?
age of onset
- congenital lymphedema occurs at birth
- lymphedema praecox from puberty to the end of the third decade
- lymphedema tarda occurs after the age of 30
what is lymphedema that is both congenital and hereditary knows as ?
Milroy’s disease
what is the most common type pf primary lymphedema ?
lymphedema praecox
what is the main cause of secondary lymphedema in developed countries ?
obstruction by malignancies
post-surgical lymphedema (mastectomy)
what is the most common cause of secondary lymphedema in less-developed countries ?
parasitic obstruction ( elephantiasis)
what are the stages of lymphedema ?
stage 1 - present with soft pitting edema with little or no hardness, usually goes away with rest and elevation
stage 2- is irreversible , swelling doesn’t decrease with elevation, hard tissue and produces pitting edema
stage 3- is also irreversible and is considered elephantiasis with hardness of the tissue with skin papilloma
what is stemmers sign ?
is a test that is used to diagnose lymphedema, where the skin is pinched at the extremity ( not being able to pinch the skin is positive)
what is the treatment of lymphedema ?
lymphatic massage
skin care and hygiene
compression bandages
compression garments.
what are the stages of chronic venous insufficiency ?
C0 C1 C2 C3 C4A C4B C5 C6
what is post-thrombotic syndrome ?
swelling usually of the whole leg
comprises of skin changes
secondary varicose veins
venous claudications may be present
what is the difference between venous and lymphatic edema ?
lymphoedema : skin thickening enhanced skin creases hyperkeratosis papillomatosis
Venous hypertension: skin pigmentation varicose eczema atrophie blanche oedema venous ulceration lipodermatosclerosis
what is cellulitis
acute diffuse spreading of the skin infection
what are the causes of cellulitis ?
staph
streptococcus group A,B
pseudomonas
klebsiella
what is a bakers cyst
it is a distended bursa or herniation of the synovial membrane , through the posterior part of the knee
what is myexedma?
specific form of cutaneous and dermal edema secondary to deposition of connective tissue
associated with hypothyroidism
what is klippel-trenaunay’s syndrome ?
a rare mutation in the AGGF1
hemi-hypertrophy
what is lipoedema ?
abnormal fat deposition that is always bilateral and symmetrical with feet/toe sparing
what are the skin changes found on local examination ?
cellulitis
myxedema
chronic venous insufficiency
chronic lymphedema
what lab investigations would we perform ?
CBC urine routine liver function serum lipid and albumin serum TSH d-dimer
what type of imaging could be done
US abdomen
doppler and duplex
lympho-scincitiagraphy
echo
