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Abstract
Lymphedema is defined as an abnormal, generalized, or regional accumulation of protein-rich interstitial fluid, resulting in edema formation and eventually in chronic inflammation with or without fibrosis. There are two types of lymphedema, primary and secondary. Primary lymphedema results from abnormalities or malformation of the lymphatic vessels and or lymph nodes. Primary lymphedema can occur at any age and is usually only confirmed once all possible causes of lymphedema have been ruled out. Secondary lymphedema is caused by damage to the lymphatic system resulting in functional deficiency .The most common form of secondary lymphedema is caused by filarial infection transmitted by the mosquito. Other key causative factors include, trauma and tissue damage, infection, malignancy, venous disease, inflammation and immobility. In the majority of patients, the diagnosis of lymphedema can be made by history and physical examination, excluding alternate causes of edema such as cardiac, renal, hepatic and venous disease. This disease is often first noticed by the patients as an asymmetry or increased circumference of an extremity. As swelling slowly progresses, patients may have difficulty fitting into clothing. In true lymphedema, swelling generally begins distally and progresses proximally over months to years. The edema is initially soft and pits easily. It gradually becomes nonpitting as fibrosis develops and the tissue becomes indurated. Skin changes may occur, but ulceration is infrequent. Patients may complain of fatigue or pressure in the extremity, but pain is infrequent.