A comprehensive overview of lymphedema covering subjects as symptoms, diagnostics, research, causes and pictures
Lymphedema is an abnormal collection of protein-rich fluid in the interstitial fluid due to a defect in the lymphatic system. Most commonly it affects the extremities, but it may involve the face, the genitals or the trunk.
Lymphedema may be primary through lymphatic hypoplasia or secondary by the blockage or the rupture of the lymphatic vessels. Lymphangitis may develop when bacteria enter through skin lesions and present the infection of the lymphatic vessels. Most frequently, lymphangitis is strep; causing erysipelas sometimes can be also staph. The affected limb becomes red and hot, red branches can be seen starting at the entry of pathogens and it develops lymphadenopathy. Rarely the skin can break.
Primary lymphedema is obvious and the diagnosis is based on the characteristic of the soft swelling tissue. Secondary lymphedema diagnosis is obvious after physical examination. Additional tests are indicated when dealing with the secondary one. Computed tomography and magnetic resonance imaging can identify blocked lymphatic sites . The progression of the disease is quantified by measuring the limb circumference, measuring the water volume disrupts by the immersed member or by the use of skin and soft tissue.
Primary lymhedema treatment includes surgical reduction of soft tissue and limb reconstruction. Secondary lymphedema treatment includes treating the cause. You can use several strategies to mobilize the fluid - the decongestant therapy. These include manual lymph drainage, bandages that determine a certain pressure on the member, exercise and massage for the affected member, including intermittent pneumatic compression.
Preventive measures include avoiding heat, doing vigorous exercises and the application of compression bandages on the affected limb. Nail and skin care requires special attention, vaccination, intravenous catheterization in the affected limb should be avoided. Lymphangitis and cellulites are treated with antibiotics which are effective against gram-positive organisms.
The prognosis for people with lymphedema depends on its chronicity, the complications that result and the disease that causes lymphedema. The angiosarcomas development within lymphedema represents the most serious complication of secondary lymphedema.
Lymphedema Pathogenesis - Physiology of the lymphatic system
The normal function of lymphocytes is to return proteins, lipids and water from the intravascular space gap. 40-50% of serum proteins are transported through this route every day. High hydrostatic pressure in blood capillaries forces the fluid rich in protein to pass into the interstitial fluid, resulting in the increased oncotic pressure.
The interstitial fluid normally helps to nourish the tissues. Approximately 90% of it returns to circulation via venous capillaries. The remaining 10% is composed of large protein molecules and their associated water through oncotic force, which are too large to pass through venous capillaries back into circulation. The result is their collection of lymphatic capillaries where pressure is typically sub atmospheric and can accumulate large amounts of protein and water. Then the proteins migrate as lymph through numerous lymphatic filters from the nodes and eventually rejoin the venous circulation.
In the sick persons, the carrying capacity of the lymph is reduced, interstitial fluid exceeded by the lymphatic rate of return and the stagnation of the proteins with high molecular weight in the gap. The phenomenon usually occurs after 80% reduction of the lymphatic return. The result, compared with other forms of swelling which shows high concentrations of proteins is a lymphedema with a protein concentration of 1. 0-5. 5 g / ml. This oncotic pressure draws additional water accumulation.
Physiopathology of lymph accumulation
The massive accumulation of the interstitial fluid leads to dilatation of the lymphatic tracts remained functional and the valve incompetence that cause leakage of subcutaneous tissue in the dermal plexus. It can form spontaneous lymphatic shunts. The lymph nodes shrink and become tough, losing its normal architecture.
The interstitial, the accumulated fluid and the protein initiate an inflammatory reaction. The activity of macrophages increases with the destruction of the elastic fibers and produce fibrous tissue. Fibroblasts migrate in the gap and deposit collagen. The result is the transformation of the initial fluffy swelling in a brown one, it becomes rough.
Primary and secondary lymphedema
Lymphedema is caused by a compromised lymphatic system that prevents or reduces the return of the lymph. The secondary lymphedema of the lymphatic drainage is disrupted by a blockage in the lymph nodes or by breaking the local lymphatic by recurrent attacks of the neoplasms, obesity or surgery. Whatever the cause, the result is the insufficient lymph drainage, with interstitial edema and increase in volume of the affected area. Sometimes people use by mistake the terms lymphadema or lymphodema when discussing the primary or secondary lymphedema, they are not correct.
It determines the crack and the infection of the epidermis, allowing bacteria to enter and colonize the place. Verrucous elephantiasis occurs by chronic lymphedema.
One theory proposes that chronic lymphedema change the protein from the lymph in the affected areas. There were reported decreases in the level of alpha-globulin and the increasing of albumin-globulin fraction. Proteins modification and their results- slow transport to lymphoid tissue have been suggested to play a role in reducing the immune surveillance and the early prevention of detection of tumor specific antigens.