Lymphoedema Flashcards
What is lymphoedema?
Chronic condition caused by impaired lymphatic drainage
What is primary lymphoedema/
Rare genetic condition
Due to faulty development of lymphathic system
Presents before 30
What is secondary lymphoedema?
due to separate condition that affects lymphatic system
e.g. after breast surgery - axillary clearance
What is lipoedema?
Abnormal build up of fat tissue in limbs
Differentiate between lipoedema + lymphoedema
- Lipoedema- abnormal build up of fat
- lymphoedema -build up of lymph due to impaired lymphatic drainage
- lipoedema spares the feet
Assessment of lymphoedema
- Stemmer’s sign - inability to pinch skin at bottom of 2nd toe or middle finger together, lift + tent it
- calculate limb volume
- bio electric impedance spectrometry
- lymphoscintgraphy
What can be used to calculate limb volume?
- circumferential measurements along the limb
- water displacement - measure volume of water displaced
- perometry - square frame of perpendicular light beams moved along limb
What is bio electric impedance spectrometry
- Measure volume of fluid collected in limb
- electrodes placed on limb
- electrical current passed through
- resistance estimates volume of lymph fluid in tissue
What is lymphoscintigraphy?
- nuclear medicine scan
- radioactive tracer injected into skin
- scintigraphy used to assess lymphathic system structure
Management of lymphoedema
- manual lymphatic drainage - massages
- compression bandages
- exercises to improve drainage
- weight loss
- good skin care
- lymphaticovenular anastomosis
What is lymphaticovenular anastomosis?
- surgical procedure
- attaching lymphatic vessels to nearby veins
- allows lymphatic vessels to drain into venous system
What is lymphatic filariasis?
- Infection caused by parasitic worms spread by mosquitos
- worms live in the lymphatic system > lymphoedema
- causes elephantiasis: thickening + fibrosis of skin + tissues
What is Hodgkin’s lymphoma?
Malignant proliferation of lymphocytes
Characterised by Reed Sternberg cells
Risk factors of Hodgkin’s lymphoma
HIV
Epstein Barr virus
Features of Hodgkin’s lymphoma
- lymphadenopathy
- most common cervical > axillar > inguinal
- weight loss
- night sweats
- Pruritus
Diagnosis of Hodgkin’s lymphoma
Reed Sternberg cells on lymph node biopsy
(Owl eye appearance)
Management of Hodgkin’s lymphoma
- chemotherapy (mainstay)
- radiotherapy
Risk factors of non-Hodgkin’s lymphoma
- elderly
- Caucasian
- Epstein Barr virus
- family history
- history of chemo or radio
- HIV
- diabetes mellitus
- SLE
Presentation of non-Hodgkin’s lymphoma
- painless lymphadenopathy
- fever
- weight loss
- night sweats
- dyspepsia + dysphagia
Management of non-Hodgkin’s lymphoma
- chemotherapy or radiotherapy
- rituximab with therapy
What screening is needed before starting rituximab + hy?
Hepatitis B
Can cause reactivation
