A SEMINAR ONLIPOEDEMA: CLINICAL MANIFESTATTIONS, DIAGNOSIS AND

TREATMENT.BY

MLS. ODUMOSON, NEWTON CLESTON (Intern) TO

THE DEPARTMENT OF HISTOPATHOLOGY, MEDICAL LABORATORY SERVICE,

FEDERAL MEDICAL CENTRE, YENAGOA.

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE ADMISSION AS AN ASSOCIATE MEMBER, MEDICAL

LABORATORY SCIENCE COUNCIL OF NIGERIA (AMLSCN).

SUPERVISOR: MLS. MIRINN KENNETHAUGUST,2016.

OUTLINE INTRODUCTION LIPOEDEMA GENETIC COMPONENT PATHOMECHANISM CAUSES OF LIPOEDEMA STAGES OF LIPOEDEMA TYPES OF LIPOEDEMA SIGNS AND SYMPTOMS LABORATORY DIAGNOSIS TREATMENT CONCLUSION RECOMMENDATIONS

INTRODUCTION

What topic does not receive as much main stream media coverage as it should?

LIPOEDEMAHence, the growing interest by clinicians

to understand the morphology, unique features and definitive diagnosis and treatment of lipoedema.

LIPOEDEMA

First described in 1940

Adipose tissue disorder

“Painful fat syndrome”

Genetic component

Prevalence in women

(Allen & Hines, 1940).

GENETIC COMPONENT

(Child et al., 2010).

PATHOMECHANISMAetiology is unknown According to hypothesis, lipoedema is an oestrogen-

regulated polygenetic disease, which manifests in parallel with feminine hormonal changes and leads to vasculo- and lymphangiopathy. Inflammation of the peripheral nerves and sympathetic innervation abnormalities of the subcutaneous adipose tissue also involving oestrogen may be responsible for neuropathy. Adipocyte hyperproliferation is likely to be a secondary phenomenon maintaining a vicious cycle. (Child et al., 2010).

CAUSES OF LIPOEDEMA

Hormonal Genetic factorInflammationAuto-immuneEndocrine issueAbnormalities of the lymph and vascular

system

(Harvey et al., 2005).

STAGE 1 Skin surface smooth (with prominent

pores), thickened fat layer, but uniform Disproportionate pear shape, with somewhat increased fat. Leg still has shape but may be considered

somewhat larger or thicker than average by others.

Some swelling during the day but usually resolves overnight or with rest and elevation May have to start wearing significantly different size pants than tops.

STAGES OF LIPOEDEMA

(Stutz & Krahl, 2009)

STAGE 2 Skin texture change more uneven

with indentations ("orange peel" or "mattress" skin).

Fatty deposits grow around knees and thighs, and some develop larger arms.

Legs begin to thicken more, decrease of calf and ankle contour.

Skin rubbery/spongy begin to feel nodular in places.

Oedema can occur but doesn't resolve as easily as it has in the past.

Heat and on feet all day or sitting all day may exacerbate swelling.

(Stutz & Krahl, 2009)

STAGES OF LIPOEDEMA CONTD…

Stage 3 Increased texture "orange peel,”

“mattress,” “cottage cheese” look, Fat nodules easy to detect.

Large masses of tissue form folds and ridges (lobular deformations), especially above and below knees and thighs.

Decreased muscle contour worsens forms "overshoulder" of the ankle= ankle cut off sign.

Swelling more consistent and doesn’t resolve with rest and elevation.

(Stutz & Krahl, 2009)

STAGES OF LIPOEDEMA CONTD…

Stage 4

Larger masses of skin and fat overhang, complex folds and ridges with consistent swelling.

Large gains in weight occur, mobility becomes affected.

Skin becomes harder and/or discoloured.

In severe cases, lymph fluid can leak from lymphatic vessels (lymphorrhea). Significant increase risk of infection-

cellulitis. (Stutz & Krahl, 2009)

STAGES OF LIPOEDEMA CONTD…

TYPES OF LIPOEDEMA

1. Pelvis, buttock and hips (saddle bag phenomenon)2.Buttock to knees, with formation of folds of fat around the inner side of the knee3.Buttocks to ankles4.Arms5.Lower leg

(Harvey et al., 2005).

SIGNS AND SYMPTOMSPain mostly on legsEasy bruisesLegs and arm swellingFatty lumps on legs, abdomen and armsHeavinessFatiqueSwelling and fatty deposition worsening after

puberty,pregnancies, contraceptive pills. (Schmeller et al., 2011)

DIAGNOSIS (PHYSICAL EXAMINATION)

Symmetrical fatty deposition on legs, abdomen, arms.

Superficial varicosities may be present

Tenderness to palpation most prominent at pretibial area

Bruises, varicosities Hypermobile joints Non pitting oedema, usually

feet are spared(Rapprich et al., 2011)

HISTOLOGICAL DIAGNOSIS

TISSUE BIOPSY

BIOCHEMICAL DIAGNOSIS

Low vitamin D = usually ‹15ng/mL

(deficiency)

Elevated CHO= Presence of chronic

inflammation

LABORATORY DIAGNOSIS

(Harvey et al., 2005).

Lipoedema Biopsy

Complete Decongestive Therapy (CDT) Manual lymphatic drainage

Compression Bandaging

Garments Pneumatic pumps

Skin care Nutrition Anti-inflammatory RAD diet

Psycho-social support Exercise Aquatic therapy Liposuction

TREATMENT

(Harvey et al., 2005).

CONCLUSION

The diagnosis of lipoedema is and may be challenging to

determine among patients who are overweight or obessed.

Therefore, it is important for the clinician to understand the

morphology of lipoedema, as well as its unique features and

definitive diagnosis and treatment

RECOMENDATIONS

Create Awareness and recognition of lipoedema among doctors, therapist , and politicians

Aquatic exercise or hydrotherapyliposuction