SU27.7-8 | Lymphatic System Disorders and Examination — Summary & Reflection

KEY TAKEAWAYS

Lymphatic surgical disease presents as a swollen limb, a red streak, or an enlarged node. Lymphoedema is accumulation of protein-rich fluid from impaired lymphatic drainage, classically non-pitting with a positive Stemmer's sign; it is primary (congenita/praecox/tarda) or secondary — in India most commonly filariasis (Wuchereria bancrofti), and worldwide commonly post-node-clearance or post-radiotherapy after cancer, plus infection, trauma and malignant infiltration. Lymphangitis is acute streptococcal infection of lymphatic vessels (red streaks + tender lymphadenitis), which can cause sepsis. Lymphomas are malignancies of lymphoid tissue — Hodgkin (Reed-Sternberg cells, contiguous spread) and non-Hodgkin — presenting as painless rubbery nodes ± B-symptoms. Examine the regional node groups systematically (cervical incl. supraclavicular/Virchow's, axillary, epitrochlear, inguinal — recording site, size, consistency, tenderness, fixity, matting) and the limb (non-pitting, Stemmer's, circumference, primary source). Investigate with a night blood smear (filariasis), lymphoscintigraphy (lymphoedema) and excision biopsy of a whole node (lymphoma). Manage lymphoedema with lifelong skin care, compression, manual lymphatic drainage and infection control (DEC for active filariasis), lymphangitis with antibiotics, and lymphoma with chemotherapy/radiotherapy under oncology (Hodgkin highly curable).

REFLECT

Think about how you examine a patient with a lump or a swollen limb. Do you have a fixed, systematic routine for palpating every regional node group — or do you check only the obvious area and miss the supraclavicular node that could change the diagnosis? When you next meet a chronically swollen leg, will you consciously decide whether it pits, elicit Stemmer's sign, and — in our setting — ask about filariasis exposure? And when you find a persistent, painless, rubbery node, will you act on it with a biopsy rather than watching it grow? Reflect on the human burden of filarial elephantiasis and how much of it is preventable, and on the responsibility that a careful lymph node examination places on you to find the curable lymphoma early.