Lymphoedema

Question 1

What is lymphoedema? What is the difference between primary and secondary oedema?

Answer 1

Accumulation of excess tissue fluid due to impaired lymphatic drainage (impaired function of lymphatic capillaries in capillary bed)-> proteins-rich nature of fluid leads to swelling

Primary= genetic condition where lymphatics haven’t developed properly i.e. tends to present unilaterally and in younger people

Secondary= iatrogenic (surgery) or removal of LN or tumour infiltration
Eg removal of axillary LN in breast cancer surgery

Question 2

How might someone with lymphoedema present?

Answer 2

Swollen lower limbs (not usually painful)
Positive Stemmer’s sign
HX of recurrent infections which may have damaged lymphatic vessels
Ulcers

Question 3

How can lymphoedema be managed?

Answer 3

Elevate effected limb
Compression hosiery/wraps
Moisturise and remove dry skin= reduce risk of infection
Exercise= strength calf pump to maximise venous drainage
Massage techniques= manual lymphatic drainage

Prophylactic antibiotics to prevent cellulitis occuring

Question 4

What are the differential diagnoses for unilateral leg swelling?

Answer 4

Acute:

• DVT
• Trauma

Chronic:

• varicose veins
• chronic venous insufficiency

Question 5

What are the differential diagnoses for bilateral leg swelling?

Answer 5

Acute:

• Systemic CVD (HF)
• Liver or renal failure
• IVC thrombosis