Normal Structure Of Lymphatics:-
The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste and other unwanted materials. The primary function of the lymphatic system is to transport lymph, a fluid containing infection-fighting white blood cells, throughout the body.
Lymphatic capillaries, lymphatic vessels and lymph nodes comprise the lymphatic system.
Lymphatic capillaries resemble blood capillaries, and larger lymphatics are identical to veins.
However lymphatics lined by a single layer of endothelium have thin muscle in their walls than in veins of the same size and the valves are more numerous.
Lymphatic capillaries and lymphatics form plexuses around tissues and organs. The walls of lymphatic capillaries are permeable to tissue fluid, proteins and particulate matter.
LYMPHOEDEMA:
Lymphoedema is swelling of soft tissues due to localised increase in the quantity of lymph. It may be primary (idiopathic) or secondary (obstructive).
Types:-
I. PRIMARY (IDIOPATHIC) LYMPHOEDEMA.
Lymphoedema occurring without underlying secondary cause is called primary or idiopathic lymphoedema. Its various types are as under:
1. Congenital lymphoedema.
Congenital lymphoedema has further 2 subtypes--familial hereditary form (Milroy’s
disease) and non-familial (simple) form.
i) Milroy’s disease is a form of congenital and familial oedema generally affecting one limb but at times may be more extensive and involve the eyelids and lips.
The disease is inherited as an autosomal dominant trait and is often associated with other congenital anomalies.
The condition results from developmental defect of lymphatic channels so that the affected tissue shows abnormally dilated lymphatics and the area shows honey-combed appearance.
Recurrent infection of the tissue causes cellulitis and fibrosis of
lymphatic vessels.
ii) Simple congenital lymphoedema is non-familial form with unknown etiology. It is often associated with-
Turners syndrome and affects one member of the family. The pathologic changes are similar to those of Milroy’s disease.
2. Lymphoedema praecox.
This is a rare form of lymphoedema affecting chiefly young females. The oedema usually begins in the foot and progresses slowly upwards to involve the whole extremity. With passage of time, the affected area becomes rough and the oedema is non-pitting.
The eitology(cause) is unknown but probably the condition is related to female reproductive system because of preponderance in females and aggravation during menses.
II. SECONDARY (OBSTRUCTIVE) LYMPHOEDEMA.
This is more common form of. lymphoedema Various causes of lymphatic obstruction causing lymphoedema are as under:
i) Lymphatic invasion by malignant tumour.
ii) Surgical removal of lymphatics e.g. in radical mastectomy.
iii) Post-irradiation fibrosis.
iv) Parasitic infestations e.g. in filariasis of lymphatics producing elephantiasis.
v) Lymphangitis causing scarring and obstruction.
Obstructive lymphoedema occurs only when the obstruction is widespread as otherwise collaterals develop.The affected area consists of dilatation of lymphatics distal to obstruction with increased interstitial fluid. With passage of time, there is inflammatory scarring and the lymphatic
become fibrosed with enlargement of the affected part.Rupture of dilated large lymphatics may result in escape of milk chyle into the peritoneum (chyloperitoneum), into the pleural cavity (chylothorax), into pericardial cavity (chylopericardium) and into the urinary tract (chyluria).
Symptoms:-
•) Reduced Mobility.
•) Irregular Puffiness.
•) Recurring Infection.
•) Feeling of Tightness & Heaviness.
•) Aching & Discomfort.
•) Swelling
Treatment:-
•) Excersise.
•) Massage.
•) Pneumatic Compression.
•) Compression Garments.
•) Complete Decongestive Therapy CDT.
LYMPHANGITIS:
Inflammation of the lymphatics or lymphangitis may be acute or chronic.
Acute lymphangitis occurs in the course of many bacterial infections. The most common organisms are (β-haemolytic
streptococci and staphylococci). Acute lymphangitis is often associated with lymphadenitis.
Grossly, the affected lymphatics are dilated and appear as cutaneous streaks.,
Microscopically the dilated lumen contains acute inflammatory exudate, cell debris and clotted lymph. There is inflammatory infiltration into the perilymphatic tissue along with hyperaemia and oedema. Acute
lymphangitis generally heals completely.
Chronic lymphangitis occurs due to persistent and recurrent acute lymphangitis or from chronic infections like tuberculosis, syphilis and actinomycosis.
Histologically, there is permanent obstruction due to fibrosis of affected lymphatics called chronic lymphoedema.
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