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LYMPHATIC SYSTEM Flashcards

1
Q

Lymphatics develop by

A

6-7 weeks of GESTATION

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2
Q

⭐ LOWER LIMB & ABDOMINAL LYMPHATICS drain into

⭐ Upper LIMB & Head & Neck LYMPHATICS drain into

A

⭐ LOWER LIMB & ABDOMINAL LYMPHATICS drain into
🎯 THORACIC DUCT (via CISTERNA Chylii)

⭐ Upper LIMB & Head & Neck LYMPHATICS drain into
🎯 Right INTERNAL jugular Vein

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3
Q

LYMPHATIC SYSTEM starts DEVELOPING by

A

6-7 weeks of GESTATION

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4
Q

Which LYMPHATIC vessels have VALVES?

A

Terminal LYMPHATICS (have BICUSPID Valve)

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5
Q

How LYMPHATIC Vessels push their content forward?

A
  1. Lymphangions are CONTRACTILE in Nature
    ⬇️
    Pushes the LYMPH FORWARD
  2. Transient ⬆️ in INTERSTITIAL pressure 2° to MUSCLE CONTRACTION
  3. Prevention of REFLUX by VALVES
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6
Q

Lymphangions

A

Valves partition LYMPHATICS into segments

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7
Q

CYSTIC HYGROMA develops DUE TO:

A

Sequestered LYMPHATIC tissue
⬇️
Cyst does NOT Communicate with NORMAL Lymphatics
⬇️
Lymph gets absorbed, Clear Fluid ➕

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8
Q

⚡⚡ MOST COMMON SITE OF CYSTIC HYGROMA

A

POSTERIOR triangle of NECK

Other:
Axilla
Inguinal Region

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9
Q

🧑🏻‍⚕️ Clinical Features of CYSTIC HYGROMA

A
  1. Fluctuations ➕
  2. Partly COMPRESSIBLE
  3. Brilliantly TRANS-ILLUMINANT swelling
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10
Q

Brilliantly TRANS-ILLUMINANT swelling
🧠⚡CREaM H ⚡

A

• Hydrocele
• Epididymal cyst
• Cystic hygroma
• Ranula
• Meningocele

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11
Q

Presentation of CYSTIC HYGROMA

A
  1. Detected in-utero in USG
  2. Obstructed labor
  3. RESPIRATORY distress
  4. Swelling
  5. Secondary Infection
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12
Q

🩺 IOC for CYSTIC HYGROMA

A

FNAC

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13
Q

💊💉 MANAGEMENT of CYSTIC HYGROMA

⭐ Normal Lesion
⭐ Very Large Lesion

A

⭐ Normal Lesion
Aspiration ➡️ Surgery

⭐ Very Large Lesion
Aspiration ➕ Sclerotherapy
⬇️
Surgery

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14
Q

Which nerve can get injured during CYSTIC HYGROMA Surgery

A

Spinal Accessory Nerve
⬇️
Shoulder Dysfunctions

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15
Q

Organisms ASSOCIATED with ACUTE LYMPHANGITIS

A
  1. Streptococcus
  2. Staphylococcus aureus
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16
Q

🧑🏻‍⚕️ Clinical Features of ACUTE LYMPHANGITIS

A
  1. Pain
  2. Reddish Streaks
  3. Fever
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17
Q

💊💉 MANAGEMENT of ACUTE LYMPHANGITIS

A
  1. Limb elevation
  2. Analgesics
  3. Broad spectrum antibiotics
  4. If ≥ 48 hours ➡️ Suspect ABSCESS
    ⬇️
    INCISION & DRAINAGE
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18
Q

Lymphedema
meaning

A

Occurs DUE TO: Inability of LYMPHATIC System to clear INTERSTITIAL FLUID COMPARTMENT

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19
Q

⭐ 1° LYMPHEDEMA

⭐ 2° LYMPHEDEMA

A

⭐ 1° LYMPHEDEMA
🎯 PRODUCTION is NORMAL ➕ DEFECTIVE LYMPHATICS

⭐ 2° LYMPHEDEMA
🎯 ⬆️ PRODUCTION (OR) ⬇️ DRAINAGE

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20
Q

Effect of LYMPH STASIS

A

⭐ Fibrosis
⭐ Skin Changes

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21
Q

🧑🏻‍⚕️ Clinical Features of LYMPHEDEMA

A

✨ Lymph swelling
✨ Dull aching (OR) Sharp PAIN
✨ Skin changes

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22
Q

Brunner’s classification used for

A

Clinical classification of LYMPHEDEMA

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23
Q

Brunner’s CLASSIFICATION

A
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24
Q

Skin changes in LYMPHEDEMA

A
  1. BUFFALO HUMP: Loss of ANKLE CONTOUR
  2. STEMMER’S SIGN: Skin becomes FIBROSED & CANNOT BE PINCHED
  3. Squaring of TOES
  4. Fungal Infections
  5. Cancer development
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25
Q

Identify

A

STEMMER’S SIGN

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26
Q

Identify

A

Buffalo HUMP sign

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27
Q

Identify

A

SQUARING OF TOES

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28
Q

Gold standard for QUANTIFICATION OF LYMPHEDEMA

A

Water Plethysmography

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29
Q

GOLD STANDARD TO IDENTIFY TYPE OF LYMPHEDEMA

⭐ DYE USED

A

Direct LYMPHANGIOGRAPHY

⭐ INDIGO CYANIN GREEN

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30
Q

Patterns of 1° LYMPHEDEMA

A
  1. Congenital Hyperplasia of LYMPHATICS
  2. DISTAL OBSTRUCTION
  3. PROXIMAL OBSTRUCTION
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31
Q

Congenital Hyperplasia of LYMPHATICS

A

⬆️ in NUMBER of LYMPHATICS but they are DEFECTIVE

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32
Q

⚡⚡ MOST COMMON PRIMARY LYMPHEDEMA

A

LYMPHEDEMA PRAECOX

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33
Q

⚡⚡ MOST COMMON PATTERN seen in LYMPHEDEMA PRAECOX

A

Distal OBSTRUCTION

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34
Q

Proximal OBLITERATION

A

OBSTRUCTION at level of AORTO-ILIAC & INGUINAL NODES

35
Q

Which INVESTIGATION is useful to DIFFERENTIATE LYMPHEDEMA, VENOUS EDEMA & LIPOEDEMA

A

Single AXIAL CT through MID-CALF

36
Q

Single AXIAL CT through MID-CALF findings

A

LYMPHEDEMA
🎯 RETICULAR, HONEYCOMB pattern in an enlarged SUBCUTANEOUS compartn5

VENOUS EDEMA
🎯 ⬆️ Volume of MUSCULAR COMPARTMENT

LIPOEDEMA
🎯 ⬆️ SUBCUTANEOUS FAT

37
Q

LIPOEDEMA: 🧑🏻‍⚕️ Clinical Features

A
  1. Symmetrical
  2. B/L
  3. ♀️ > ♂️
38
Q

1° LYMPHEDEMA
🧠⚡CPT⚡

A
  1. Lymphedema Congenita
  2. Lymphedema PRAECOX
  3. Lymphedema TARDA
39
Q

⚡⚡ MOST COMMON AGE GROUP FOR

  1. Lymphedema Congenita
  2. Lymphedema PRAECOX
  3. Lymphedema TARDA
A
  1. Lymphedema Congenita
    🎯 0-2 years
  2. Lymphedema PRAECOX
    🎯 2-35 yrs
  3. Lymphedema TARDA
    🎯 > 35 yrs
40
Q

GENDER PREDOMINANT IN

  1. Lymphedema Congenita
  2. Lymphedema PRAECOX
  3. Lymphedema TARDA
A
  1. Lymphedema Congenita
    🎯 ♂️ > ♀️
  2. Lymphedema PRAECOX
    🎯 ♀️> ♂️
  3. Lymphedema TARDA
    🎯 ♂️ > ♀️
41
Q

Familial VARIENT OF
1. Lymphedema Congenita
2. Lymphedema PRAECOX

A
  1. Lymphedema Congenita
    🎯 NOONE MILROY SYNDROME
  2. Lymphedema PRAECOX
    🎯 MEIGE’S DISEASE
42
Q

Body parts involved in:

  1. Lymphedema Congenita
  2. Lymphedema PRAECOX
A
  1. Lymphedema Congenita
    🎯 Multiple Limbs, Face & Genitalia
  2. Lymphedema PRAECOX
    🎯 U/L Lower Limb till Knee
43
Q

Noone MILROY SYNDROME
⭐ MUTATION

A

Familial LYMPHEDEMA Congenita

⭐ FLT-4
⭐ VEGF

44
Q

MEIGE’S DISEASE

⭐ MUTATIONS

A

Familial LYMPHEDEMA PRAECOX
⭐ GJC gene

45
Q

SYNDROMES ASSOCIATED with LYMPHEDEMA

A
  1. HENNEKAM SYNDROME
  2. EMBERGER SYNDROME
  3. OLEDAID SYNDROME
46
Q

Microcephaly
➕
Unusual Facies
➕
LYMPHEDEMA affecting all 4 limbs

A

HENNEKAM SYNDROME

47
Q

HENNEKAM SYNDROME
MUTATION

48
Q

Myelodysplasia
➕
Warts
➕
RECURRENT Viral & Bacterial Infections
➕
Hypoplasia of LYMPHATICS

A

Emberger SYNDROME

49
Q

EMBERGER SYNDROME
Mutation

50
Q

Ectodermal dysplasia
➕
Anhidrotic
➕
Osteopetrosis
➕
Immunodeficiency

A

OLEDAID Syndrome

51
Q

OLEDAID Syndrome
MUTATION

A

IKBKG gene

52
Q

⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA OVERALL

A

Filariasis

53
Q

⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in UPPER LIMB

⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in LOWER LIMB

A

⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in UPPER LIMB
🎯 POST-MASTECTOMY LYMPHEDEMA

⚡⚡ MOST COMMON CAUSE of LYMPHEDEMA in LOWER LIMB
🎯 FILARIASIS

54
Q

CHANCE OF POST-MASTECTOMY LYMPHEDEMA is ⬆️ ⬆️ if

A
  1. Radiotherapy is given to AXILLA after Surgery
  2. Lymph node Clearance above AXILLARY VEIN
55
Q

Effect of DEC in ELEPHANTIASIS Treatment

A

⭐ Kills Microfilariae
⭐ Cannot REVERSE LYMPHEDEMA (OR) Skin Changes

56
Q

STEWART TREVE’S SYNDROME

A

Development of LYMPHANGIOSARCOMA in long standing LYMPHEDEMA (8-10yrs)

57
Q

💊💉 MANAGEMENT of STEWART TREVE’S SYNDROME

A

Aggressive SURGERY & CHEMOTHERAPY

58
Q

STEWART

59
Q

Cancers ASSOCIATED with LYMPHEDEMA

A
  1. Lymphangiosarcoma
  2. Kaposi Sarcoma
  3. Squamous cell Carcinoma
  4. Liposarcoma
  5. Basal cell Carcinoma
  6. MALIGNANT melanoma
  7. Lymphoma
60
Q

Lymphangioma

A

Dilated LYMPHATIC can THROMBOSE in LONG RUN
⬇️
FIBROSIS
⬇️
Form NODULES

61
Q

🌸 TYPES of LYMPHANGIOMA

🧠⚡ACD ⚡

A
  1. LYMPHANGIOMA AB IGNE: Arranged in RETICULAR FASHION
  2. LYMPHANGIOMA CIRCUMSCRIPTUM:
    < 5 cm
  3. LYMPHANGIOMA DIFFUSUM: > 5cm
62
Q

💊💉 MANAGEMENT of LYMPHEDEMA

A
  1. Pain Relief
  2. Skin Care
  3. Control of SWELLING: Decongestive LYMPHEDEMA Therapy
    ✨ 1st Phase: INTENSIVE SUPERVISED THERAPY
    ✨ 2nd Phase: MAINTAINANCE Phase: Self Care Regime
  4. Exercise: Slow rhythmic movements & Swimming
  5. Surgery
    ✨ Reconstructive
    ✨ Resective
63
Q

1st Phase: INTENSIVE SUPERVISED THERAPY includes

A
  1. Manual LYMPHATIC drainage
  2. Multiplayer LYMPHEDEMA bandaging
64
Q

MLLB
Advantages

65
Q

Difference BETWEEN Compression Stockings for VARICOSE VEINS & PRESSURE GARMENTS

66
Q

If ARTERIAL DISEASE is ➕, with LYMPHEDEMA, MLLB can be only DONE if

A

ABPI > 0.8-0.9

67
Q

Vigorous Exercise & Anaerobic Isometric Exercise can

A

WORSEN LYMPHEDEMA

68
Q

Indications of SURGICAL MANAGEMENT in LYMPHEDEMA

A
  1. ⬆️ in SWELLING DESPITE MEDICAL Management
  2. Skin Changes
  3. RECURRENT Infections
69
Q

Types of SURGICAL PROCEDURES in LYMPHEDEMA

A

⭐ Reconstructive

✨ KINMOTH Procedure
✨ NEBULOWITZ Procedure

⭐ RESECTIVE

✨ Homan’s procedure
✨ Thompson procedure
✨ Sistrunk Procedure
✨ Charles Procedure

70
Q

KINMOTH Procedure

A

Ileal Mucosal Patch anastamosis

71
Q

NEBULOWITZ PROCEDURE

A

⭐ Super Microsurgery

Anastamosis of LYMPH NODES & LYMPHATICS with VEINS

72
Q

Homan’s Procedure

A

Wedge of Skin & SUBCUTANEOUS tissue is removed

73
Q

⚡⚡ MOST COMMON COMPLICATION OF Homan’s Procedure

A

Skin NECROSIS

74
Q

⚡⚡ MOST SATISFYING SURGERY FOR CALF LYMPHEDEMA

A

Homan’s Procedure

75
Q

THOMPSON PROCEDURE

A

Flap is RAISED & SUBCUTANEOUS tissue is cleared
⬇️
Flap is de-epithelized & sutured

76
Q

⚡⚡ MOST COMMON COMPLICATION OF THOMPSON PROCEDURE

A

Skin Necrosis

77
Q

⚡⚡ MOST COMMONLY DONE RESECTIVE SURGERY PROCEDURE

A

SISTRUNK PROCEDURE

78
Q

SISTRUNK PROCEDURE

A

Wedge of skin & SUBCUTANEOUS tissue is resected & Primary Closure is done

79
Q

⚡⚡ MOST DISFIGURATIVE PROCEDURE FOR LYMPHEDEMA MANAGEMENT

A

Charles Procedure

80
Q

CHARLES PROCEDURE

A

Entire skin is removed
⬇️
Split Thickness Skin Grafting

81
Q

Pilonidal Sinus Formation is COMMONLY seen following

A

THOMPSON’S PROCEDURE

82
Q

Hydrocele of the Neck

A

Cystic Hygroma

83
Q

Cyst in Cystic Hygroma is

A

Multilocular

VASCULAR SYSTEM (5 decks)

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