Lymph and Veins Disease

Lymph System

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 Lymph System
This system functions parallel to the circulatory system and
consists of lymph vessels, lymph nodes, and lymphoid tissues.
The most important role of the lymphatic system is to absorb
and transport large molecules (including protein and cellular
debris) which are too large to be collected by veins and
venous capillaries.
This lymph fluid is then transported to lymph nodes that act
as “filtering stations” in the body.
 In the lymph nodes, cells from the body’s natural defense
system,called lymphocytes,help fight bacteria and viruses. 

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 Lymphangitis

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 Overview
 The lymphatic system encompasses a network of vessels,
glands, and organs located throughout the body. 
 However, when pathogenic organisms enter the lymphatic
channels, invading directly through an abrasion or wound
or as a complication of infection, local inflammation and
subsequent infection ensue, manifesting as red streaks on
the skin. The inflammation or infection then extends
proximally toward regional lymph nodes. Bacteria can
grow rapidly in the lymphatic system.

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 Etiology
 In individuals with normal host defenses, species of group
A beta-hemolytic streptococci (GABHS) are the most
common causes of lymphangitis.
 Lymphangitis caused by GABHS can rapidly progress and
has been associated with serious complications.
 In addition, individuals with diabetes, immunodeficiency,
varicella, chronic steroid use, or other systemic illnesses
have increased risk of developing serious or rapidly
spreading lymphangitis.

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 Presentation
A history of minor trauma to an area of skin distal to
the site of infection is often elicited in patients with
lymphangitis.
Children with lymphangitis often have fever, chills,
and malaise, and some children may report a headache,
loss of appetite, and muscle aches.
Lymphangitis can progress rapidly to bacteremia and
disseminated infection and sepsis, particularly when
caused by group A streptococci.

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 Work up
In any individual who presents with lymphangitis, a
complete blood cell (CBC) count and blood culture
should be obtained. In addition, a leading-edge culture
or aspiration of pus should be considered. The CBC
count and differential often reveal marked
leukocytosis.
Cultures and Gram staining of fluid may help in the
identification of the causative organism and the
selection of appropriate antimicrobial agents.

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 Should be treated with an appropriate antimicrobial
agent.
Parenteral antibiotics may be required for patients with
signs of systemic illness (eg, fever, chills and myalgia,
lymphangitis) , if not , oral antibiotic is adequate
Analgesics to control pain, and anti-inflammatory to
reduce inflammation and swelling.
 An abscess may require surgical drainage.

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 Medication
Analgesics can help to control pain in patients with lymphangitis, and
anti-inflammatory medications can help to reduce inflammation and
swelling.
Antibiotics, including the following, can be used in the treatment of
group A beta-hemolytic streptococci (GABHS) and S aureus infections:
Dicloxacillin
Cephalexin
Cefazolin
Cefuroxime
Ceftriaxone
Clindamycin
Nafcillin
Trimethoprim and sulfamethoxazole (TMP/SMZ)

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 Lymphadenitis

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 Overview
Lymphadenitis is the inflammation or enlargement of a
lymph node.
The majority of cases represent a benign response to
localized or systemic infection.
Most children with lymphadenitis exhibit small,
palpable cervical, axillary, and inguinal lymph nodes.
 Lymphadenitis may affect a single node or a group of
nodes (regional adenopathy) and may be unilateral or
bilateral.

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 Etiology
Increased lymph node size may be caused by the
following:
Multiplication of cells within the node, including
lymphocytes, plasma cells, monocytes, or histiocytes
Infiltration of cells from outside the node, such as
malignant cells or neutrophils
Draining of an infection (eg, abscess) into local lymph
nodes

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 Presentation
Patients with a clinical history of any of the following
may be at risk for developing lymphadenitis:
Symptoms of an upper respiratory tract infection, sore
throat, earache, coryza, conjunctivitis, or impetigo
Fever, irritability, or anorexia
Contact with animals, especially kittens or livestock
Recent dental care or poor dental health

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 Medical Care
In patients with lymphadenitis, treatment depends on the causative
agent and may include expectant management, antimicrobial
therapy, or chemotherapy and radiation (for malignancy).
Antibiotics should target common infectious causes of
lymphadenopathy, including S aureus and GAS. Owing to the
increasing prevalence of community-acquired methicillin-
resistant S aureus(MRSA), empiric therapy with clindamycin
should be considered.
Trimethoprim-sulfamethoxazole is often effective for MRSA
infection, but it is not appropriate for GAS infections.
Chemotherapy and radiotherapy are used for treatment of
malignancies.

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 Artery and Vein

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Upper Extremity Vein

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 Veins of the lower limb

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 Varicose veins

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 Vein system

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 Overview
 Varicose veins are veins under the skin of the legs, which have become
widened, bulging, and twisted. They are very common and do not
cause medical problems in most people.   There are two main systems
of veins in the legs:
 Deep veins:  The leg muscles squeeze the deep veins during walking,
carrying most of the blood back up the legs to the heart.
 Superficial veins: These occur under the skin which are less important
and can form varicose veins.

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 Risk Factors
Varicose veins and spider veins often run in families
and there may be a hereditary component.   Women are
more likely to suffer from varicose veins and up to
50% of women may be affected.  
Hormonal factors including puberty, pregnancy,
menopause, the use of birth control pills, and HRT
affect the disease.

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 symptoms
Many people have no symptoms at all.
Cosmetic embarrassment
The most common symptoms of varicose veins are aching,
discomfort and heaviness of the legs, which are usually worse at
the end of the day.  Sometimes the ankle can swell, too.  These
symptoms are not medically serious, but can be treated if they are
sufficiently troublesome.
Although varicose veins can get worse over the years, this often
happens very slowly.   In a few people the high pressure in the
veins causes damage to the skin near the ankle, which can become
brown in colour, sometimes with scarred white areas.   Eczema (a
red skin rash) can develop.   If these skin changes are allowed to
progress, or if the skin is injured, an ulcer may develop. 

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 Treatments  

The operation
Endovenous Laser Therapy
Foam Sclerotherapy
Radiofrequency ablation

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 Deep Vein Thrombosis

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 Rudolf Virchow postulated the interplay of three
processes resulting in venous thrombosis, now known
as Virchow's triad: a decreased blood flow rate (
venous stasis), increased tendency to clot (
hypercoagulability), and the endothelial dysfunction 

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Virchow’s Triad
Risk Factors Are Cumulative

Cancer
Estrogen use Surgery
Family history Prior DVT
IBD Central venous access
Nephrotic syndrome Cancer chemotherapy
Blood transfusions or radiotherapy
Thrombophilia

Age >40 years

Immobilization
MI
CHF
Paralysis

CHF=congestive heart failure; DVT=deep vein thrombosis; IBD=inflammatory bowel disease; MI=myocardial infarction.
Geerts et al. Chest. 2004;126(suppl):338S-400S.
VTE – risk factors
Persistent Transient

Acquired  Pregnancy

 Age  Oral contraceptives

 History of VTE
 Hormone replacement
 Malignancy therapy
 Antiphospholipid antibody  Immobilisation
syndrome
 Surgery
Genetic
 Thrombophilia
Clinical Features Of DVT
Asymtomatic

Symtomatic :

 Leg Swelling +/- pitting edema

 Leg Pain

 Redness and Warmth

 Pallor or Cyanotic

 Homan’s Sign

 Moses Sign
Homan’s Sign Moses Sign
Well’s Criteria (DVT)
Well’s Criteria (DVT)

 Active cancer (tx within <6 months or palliative care) (1)

 Calf swelling (3 cm difference – 10 cm below tib tub) (1)

 Collateral superficial veins (1)

 Paralysis, paresis, or recent immobilization LE (1)
 Pitting edema confined to involved leg (1)
 Bedridden within 3 days or surgery w/anesth <3mths (1)

 Swollen leg (1)

 Alternate diagnosis more likely (-2)

Probability: Low (0 pts) Intermediate (1-2) High (3)

Lancet 2002;350:1796.
 Common signs and symptoms of DVT include pain or
tenderness, swelling, warmth, redness or discoloration,
and distention of surface veins, although about half of
those with the condition have no symptoms.

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Algorithm for Diagnosing DVT

European Heart Journal (2017) 00, 1–14

 Work up
Well’s Score (high/ low probability)
High : CUS
Low : D dimer
If positif : treat with anticoagulant

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 Vasculitis

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 Overview
Vasculitis is an inflammation of arterial blood vessels.
It causes changes in the walls of blood vessels,
including thickening, weakening, narrowing and
scarring. These changes restrict blood flow, resulting
in organ and tissue damage.
There are many types of vasculitis, and most of them
are rare. 

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 Some type of vasculitis
Buerger's disease. This condition causes inflammation and clots in the blood
vessels of the hands and feet. It can cause pain in the hands, arms, feet and
legs, and ulcers on your fingers and toes. This disorder is linked with cigarette
smoking. It is also called thromboangitis obliterans. Thromboangitis obliterans
is a segmental nonatherosclerotic inflammatory disorder that involves primarily
the small and medium arteries, veins, and nerves of the extremities.
Kawasaki disease. This condition most often affects children younger than age
5. Signs and symptoms include fever, rash and eye inflammation. Affect small
and medium size of arteries. It is also called mucocutaneous lymph node
syndrome.
Takayasu's arteritis. This form of vasculitis affects the larger arteries in the
body, mainly the aorta and its branches. It typically occurs in young women.
Signs and symptoms include a feeling of numbness or cold in the limbs, loss of
pulse, high blood pressure, headaches, and visual changes.

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 Tromboangitis obliterans

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 Therapy
Aspirin
Cilostazol
Stop Smoking
Manipulate the other atherosclerotic factors

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 Kawasaki Disease is an autoimmune disease

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 Kawasaki Disease

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 Takayasu disease (pulseless disease)

It's likely that Takayasu's arteritis is an autoimmune

disease in which your immune system malfunctions
and attacks your own arteries as if they were foreign
substances. The disease may be triggered by a virus or
other infection.

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 Kawasaki and Takayasu treatment
High calorie and high protein nutrition
Well Hydrated if not Decomp
anti inflamation

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 Terima Kasih

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