pendahuluan

• Lymphedema is defined as a pathologic condition in which there is an interstitial accumulation of protein-rich fluid

• Lymphedema occurs secondary to an anatomic or functional obstruction in the lymphatics or the lymph nodes.

• Although it can result in edema in the truncal area, it usually occurs distally in the upper and lower extremities

• Lymphedema can be a difficult and frustrating condition to treat because most patients cannot be helped by surgery

• As a result, therapy is focused around education about the disease, elastic compression, phisical therapy, drugs, and other conservative measures

• Treatment is important; if patients fail to be vigilant in their treatment program, the condition typically worsens, leading to repeated infections, enlargement of the limb, thickening of the skin, disfigurement, and potential disability

Anatomy and Physiology

• The lymph system is a complex network composed of fine lymphatic vessels and lymph nodes, along with other specialized structures such as spleen, thymus, and tonsils

• It helps maintain water and protein balance in the tissues and assists the immune system

• Fluids, proteins, and other soluble substances extravasate from the capillaries into the interstitial space

• As fluid build up, tissue pressure pushes fluid from the interstitial space into the lymph vesels

• Valves located within the lymphatics ensure that the lymph flows in only one direction

• The rate of lymph flow can be increased by skeletal muscle contraction, increased heart rate, passive movement from other body parts

Classification

• Primerprimery lymphedema occurs in the absence of obvious cause. It is more common in girls and women and usually occurs sin the lower extremity. Primary lymphedema is thought to arise from an inborn defect in the development of lymphatic vessels; it can be present at birth or can occur before the age of 1 year, in which case it is classified as congenital lymphedema

• Secondarycaused by injury. It can occur as a result of surgery in which the lymph nodes are removed, or it can develop as a side effect of radiation therapy. Secondary lymphedema is occasionally caused by trauma or by chronic infections of the lymph system. Infections of the lymph system are generally bacterial

Patofisiologi

• Lymphedema develops when the lymphatic load exceeds the transport capacity of the lymphatic system

• When this occurs, the tissue becomes indudated with the protein-rich edema fluid

• Without treatment, the protein-rich interstitial fluid is eventually replaced by fibrous tissue and collagen, which can lead to progressive fibrosis and, in later stages, irreversible tissue enlargement

Signs and symptomps

• The diagnosis of lymphedema is often made or suspected based upon clinical examination

• Patients with lymphedema primary give histrory in which swelling occurs spontaneously

• Patients exhibiting secondary lymphedema can usually describe the precipitating event such as surgery, radiation therapy, or infection

• The physical examination typically reveals swelling (edema) with an appearance and distribution consistent with lymphedema

• The patient might present with swelling of the extremity; this often starts at the ankle and can progress to involve the entire limb

• It usually painless• Examination of the extremity can reveal a square

appearance to the toes, and the skin may be thick and/or the edema hard and nonpitting

• In addition, the skin can have a red discoloration caused by recurrent episodes of lymphangitis or celullitis

• Other changes of the skin such as verrucae and small vesicles (containing clear lymph) may also be presen

Diagnosis banding

• Kondisi lain yg menyerupai limfadema sprt heart failure, venous disease, celullitis, drug-induced swelling, tumor, lipidema , kidney disease

• Kerusakan pembuluh darah jg bs menghasilkan edem vena.

• Px sprt CT, atauu venogram membantu menyingkirkan DD

• MRI membantu membedakan limfadema dengan jenis bengkak kaki

• Limpedema (abnormal fatty deposition) srng terjadi pd ekstermitas bawah sprt halnya limfedema tp pd limfadema bagian kaki sampai jari2 kakinya terdpt edem, kl lipedema tidak sampai jari2 kaki

Treatment

• Tergantung etologinya• Obat antibiotik atau antiparasit pada pasien

dengan limfadema sekunder• Pd limfadema ringa, utk mengurangi edemnya

bs digunakan perban kompersi• Pd limfadema yg lbh berat, utk mengurangi

edem bisa digunakan stocking pneumatik selama 1-2 jam/hari

Pencegahan

• Hindari membawa barang yang berar• Sering banyak minum• Jaga kondisi kulit aar ttp sehat