Leg swellings

Question 1

bilateral causes of leg swellings

Answer 1

• ↑ Venous Pressure (RHF, Venous insufficiency, Drugs: e.g. nifedipine)
• ↓ Oncotic Pressure (Nephrotic syndrome, Hepatic failure, Protein losing enteropathy)
• Lymphoedema
• Myxoedema (Hyper- / hypo-thyroidism)

Question 2

unilateral causes of leg swellings

Answer 2

• Venous insufficiency
• DVT
• Infection or inflammation
• Lymphoedema

Question 3

what is lymphoedema?

Answer 3

Collection of interstitial fluid due to blockage or absence

of lymphatics

Question 4

primary causes of lymphoedema

Answer 4

• Congenital absence of lymphatics

- May or may not be familial

Question 5

presentation of lymphoedema

Answer 5

• Congenital: evident from birth
• Praecox: after birth but <35yrs
• Tarda: >35yrs

Question 6

what it Milroy’s syndrome?

Answer 6

• Familial Autosomal dominant subtype of congenital lymphoedema
• F>M

Question 7

secondary causes of lymphoedema

Answer 7

FIIT

• Fibrosis: e.g. post-radiotherapy
• Infiltration (Ca: prostate, lymphoma, Filariasis: Wuchereria bancrofti)
• Infection: TB
• Trauma: block dissection of lymphatics

Question 8

Investigations for lymphoedema

Answer 8

• Doppler US
• Lymphoscintigraphy
• CT / MRI

Question 9

management of lymphoedema

Answer 9

1. Conservative
   - Skin care
   - Compression stocking
   - Physio
   - Treat or prevent comorbid infections
2. Surgical: debulking operation