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LIMFEDEMA 3A

PENGERTIAN
Limfedema terjadi akibat adanya disfungsi limfatik yang menimbulkan akumulasi abnormal cairan di interstisial yang mengandung protein dengan berat molekul besar.

ETIOLOGI

Primer : Bawaan
Penyakit

Milroy, dimana terdapat limfatik awal disfungsional dan kegagalan penyerapan cairan interstisial (Mutasi pada gen VEGFR-3 pada kromosom 5 ) Lymphedema-distichiasis, dimana ada kegagalan katup limfatik sehingga menimbulkan refluks getah bening (mutasi pada FOXC2 )

NEXT . .

Sekunder : Didapat
Infeksi

& peradangan (filariasis, sirosis hepatis, gagal ginjal), trauma, keganasan, gagal jantung, dll

SIGNS AND SYMPTOMS


Pembengkakan cronis pada extremitas (80%) Demam, lemah Fatigue b.d ukuran dan berat extremitas Recurrent bacterial or fungal infections

PATOMEKANISME
Peningkatan tekana Hidrostatik ?? Hipoalbumin ?? Obstruksi saluran Limfe ??

LANGKAH-LANGKAH PENEGAKAN DIAGNOSIS

ANAMNESIS, PEMERIKSAAN FISIK PEMERIKSAAN PENUNJANG (Imaging is not necessary to make the diagnosis of lymphedema, but it can be used to confirm it)

Plain radiographs: To exclude abnormalities of the bone CT-scan When malignancy is suspected MRI: When malignancy is suspected or to show lymph trunk anatomy and causes of obstructive secondary lymphedema Ultrasonography: To evaluate the lymphatic and venous systems Lymphoscintigraphy: Criterion standard for evaluation of the lymphatic system

Pem. Laboratorium (If a renal or hepatic etiology is suspected)


Liver function tests Blood urea nitrogen/creatinine levels Urinalysis

PENANGANAN

Pada dasarnya penanganan dengan farmako terapi pada penyakit limpoedema tidak terlalu efektif. Lebih didahulukan penanganan terhadap penyebabnya seperti sirosis hepatis, gagal jantung dan gagal ginjal. Pada limpoedema ringan bisa digunakan perban kompresi Pada limpoedema lebih berat untuk mengurangi pembekakkan bisa juga digunakan stocking selama 1-2 jam sehari Jika pembengkakkan sudah berkurang penderita menggunakan stocking setinggi lutut setiap hari, setiap bangun tidur sampai sebelum tidur lagi.

Perbaiki

hygiene and skin care untuk hindari

infeksi. compression stockings Kurangi BB (if overweight) Menghindari trauma Elevating affected limb

Surgical option Surgical treatment is palliative, not curative, and it does not obviate the need for continued medical therapy. Procedures are divided into physiologic (to improve lymphatic drainage) and excisional (removal of the affected tissues to reduce the lymphedemarelated load) surgeries

KOMPLIKASI

Necrosis, limfangiosarcoma

PROGNOSIS

Limfedema tidak dapat disembuhkan, tapi pengobatan yag ketat dan pencegahan untuk penyakit berikutnya bisa meminilisir pembengkakan dan gejala penyerta.

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