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Lymphoedema (Examination (Inspection (Gross leg swelling, Bilateral or…
Lymphoedema
Examination
Inspection
Gross leg swelling
Bilateral or unilateral
Thick, indurated skin
Lichenification
Yellow nail discoloration
Palpation
Initially: pitting
Later: non-pitting
Palpate for inguinal nodes
Completion
Exclude RHF
↑ JVP
Hepatomegaly
Take a Hx: esp. re hereditary conditions
Viva
Limb Swelling Differential
Bilateral
↑ Venous Pressure
RHF
Venous insufficiency
Drugs: e.g. nifedipine
↓ Oncotic Pressure
Nephrotic syndrome
Hepatic failure
Protein losing enteropathy
Lymphoedema
Myxoedema
Hyper- / hypo-thyroidism
Unilateral
Venous insufficiency
DVT
Infection or inflammation
Lymphoedema
Lymphoedema
Collection of interstitial fluid due to blockage or absence of lymphatics
Primary
Congenital absence of lymphatics
May or may not be familial
Presentation
Congenital: evident from birth
Praecox: after birth but <35yrs
Tarda: >35yrs
Milroy’s Syndrome: 2% of primary lymphoedema
Familial AD subtype of congenital lymphoedema
F>M
Secondary: FIIT
Fibrosis: e.g. post-radiotherapy
Infiltration
Ca: prostate, lymphoma
Filariasis: Wuchereria bancrofti
Infection: TB
Trauma: block dissection of lymphatics
Mx
Conservative
Skin care
Grade 3 compression stockings
Treat or prevent cellulitis
Physio
Raise leg as much as possible
Surgical
Debulking operation
Bypass procedures