1. LYMPHATIC DISEASE
Dr. Muthanna Alassal

2. Acute Lymphangitis:
Is caused by inf. Spreading from wounds in the drainage area of the involved lymphatic vessels.
It is characterized by the appearance of red blushes & streaks in the skin corresponding to the inflamed lymphatics.
Sterptococcus is common infecting organism.
Toxaemia is often severe.
Perminant lymphatic occlusion may follow acute lymphangitis,leading to persistent oedema.
Treatment :1.bed rest 2.elevation of the affected limb.3.giving Ab (cloxacillin)which usu. causes rapid resolution.4.only wn there are definit signs of pus, an incision shd be made.

3. Chronic Lymphangitis:
May follow repeated attacks of acute lymphangitis. (Secondary lymphoedema).

4. Lymphoedema: Is caused by accumulation of fluid in the lymphatics.
In the limbs, it affects mainly the subcut. Tissue, wr there is increase in both, the stagnant lymphatic channels,& in the supporting fat.
It is either Congenital or Acquired.

5. A .Congenital malformations:
1.Aplasia : Failure of development of the main subcut. trunks.
2.Hypoplasia: the main trunks are few &under developed.
3.Dilated and varicosed lymphatic trunks: may be ass. with A-V fistula & also
with ‘chylous reflux’ .
Cong. lymphoedema is either hereditary or familial ( Milroy disease).

6. It may be unilat. or bilateral.
It may start at birth (Lymphoedema congenita)
or at puberty (Lymphoedema praecox)
or in adulthood ( Lymphoedema tarda).

7. :B. Acquired obstruction
secondary lymphoedema:
Causes:
Trauma :-eg.:Injury or removal of axillary L.N.in radical mastectomy.
Repeated acute infections : bare foots.
Chronic infection:T.B.,Filariasis, fungal inf.
Obstruction by malignant diseases.

8. Whatever the cause,the stagnation of lymph stream is followed by repeated infection. Each attack makes the obstruction worse, untill the limb is hugely swollen,the skin folded ,wrinkled &coarsened (like that of Elephant)with brown areas of dry desequamated keratin.
Ulceration then occures.

9. Differential Diagnosis
Bilateral oedema:
H.F.
Renal failure
Hypoprotinaemia (UTI, Liver Failure, Nutritional).
Unilateral oedema :
D.V.T.
Chronic venous insufficiency.
Iliac vein compression

10. TREATMENT Palliative: for the attacks of inflammation
Prolonged bed rest
Elevation
Antibiotics
Elastic stoking
Diuretics (intermittently)
Surgery :For severe cases
Split skin graft
Swiss role cake
microsurgery:Veno-lymphatic anastamosis