Lymphatic pathologies

Question 1

Lymphangitis

Answer 1

Inflammation of the lymph vessels

Causes:
* Bacterial infection – usually streptococcus

Signs and symptoms:
* Swelling
* Painful red lines below skin surface along the lymph vessel course
* Fever
* Malaise
* Muscle ache
* Low appetite

Complications:
* Infection may spread to the blood = septicaemia (a medical emergency)

Question 2

Lymphoedema

Answer 2

Localised lymphatic fluid retention associated with a compromised lymphatic system so reduced lymphatic return

Pathophysiology:
* Obstruction of lymph vessels causes an increase in protein accumulation in the interstitial fluid
1) Raised protein = water retention, swelling of soft tissue (stage 1 – pitting oedema)
2) Raised protein = inflammation and activation of fibroblasts (stage 2 – fibrosis of vessels)

Causes:
* Primary: Congenital, poorly developed lymphatics e.g. vessels
* Secondary: Damage to the lymphatic system caused by radiotherapy or lymph node removal, Infections; e.g. cellulitis

Signs and symptoms:
* Severe fatigue of affected area
* Heavy, painful, swollen limb / area (‘pitting oedema’)
* Discolouration of the skin overlying the lymphoedema
* Recurring skin infections in the affected limb which may lead to thickening and hardening of the overlying skin

Complications:
* Recurrent infection, cellulitis, lymphangitis, septicaemia

Question 3

Lymphadenitis

Answer 3

Inflammation of the lymph nodes

Causes:
* Usually a bacterial infection

Signs and symptoms:
* Often following upper respiratory infection (i.e. sore throat)
* Enlarged lymph nodes that are often painful on palpation

Allopathic treatment:
* Antibiotics

Complications:
* Lymphangitis

Question 4

Splenomegaly

Answer 4

Enlargement of the spleen due to increased workload; associated with many diseases (megaly = enlargement)

Causes:
* Viral or bacterial infections (e.g. infectious mononucleosis, malaria
* Liver diseases (such as cirrhosis leading to portal vein hypertension
* Haemolytic anaemias (e.g. thalassaemia, sickle cell anaemia)
* Blood / lymphatiuc malignancies (Leukaemia & Hodgkins lymphoma)

Signs and symptoms:
* Abdominal pain
* Early satiety (due to splenic encroachment)
* Symptoms of haemolytic anaemia due to accompanying cytopenia
* Palpable left upper quadrant abdominal mass

Complications:
* Anaemia, increased bleeding, frequent infections
* Ruptured spleen