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

Classification
Primer
primery 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

 Secondary
caused 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