CP Exam 3: Lymphedema

Question 1

What is lymphedema?

Answer 1

accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in arms, legs and other parts of body

Question 2

What is another definition for lymphedema?

Answer 2

a chronic inflammatory lymphostatic disease caused by mechanical failure of the lymphatic system

Question 3

What is 4 main roles of lymphatic system?

Answer 3

1. filters harmful substances from blood
2. produces lymphocytes (WBC)
3. Immune system role- detects and combats pathogens
4. circulatory system roles- drains waste products circulatory system at capillary beds

Question 4

What are the two anatomical distributions of the lymphatic system?

Answer 4

1. superficial- skin and fat

2. deep- organs, muscles and tissues

Question 5

What are characteristics of lymphatic system?

Answer 5

its a one way system moving distal to proximal that starts in interstitium (3rd space)

Question 6

What is lymphatic fluid made up of?

Answer 6

water, protein, broken up fat and cells

water will return to circulatory system

Question 7

What do lymphatic vessels look like?

Answer 7

finger like cells that collect stuff, they are perpendicular to the capillary beds

Question 8

What are the four types of lymphatic vessels?

Answer 8

1. capillaries
2. pre collectors
3. collectors
4. trunks

Question 9

What are the primary lymphatic organs?

Answer 9

bone marrow and thymus

Question 10

What are secondary L.O?

Answer 10

spleen, lymph nodes, tonsils, lymphatic tissue

Question 11

What is the role of lymph collectors?

Answer 11

transport lymph to regional nodes and trunks, these are well developed valves

Question 12

What are lymphangions?

Answer 12

these are smooth muscle between distal and proximal pair of valves

when they are stretched they begin to contract and pulse fluid through lymph system

Question 13

What are other characteristics of lymphangions?

Answer 13

regulated by ANS, approx 10 contractions a minute

affected by muscle contractions and pulsation of blood- biggest factor!

Question 14

What are lymph nodes function?

Answer 14

1. protect- filters harmful material in lymph fluid
2. immune- produced antigen stimulated lymphocytes
3. thicken lymph fluid

Question 15

Where are the five major regional lymph nodes?

Answer 15

1. head, neck, cervical
2. axillary
3. cubital
4. inguinal
5. popliteal

Question 16

What are the lymphatic trunks?

Answer 16

large vessels leading to the thoracic duct

Question 17

Are there lymph nodes in the ankle?

Answer 17

No

Question 18

What happens if there is lymphedema in the neck?

Answer 18

can raise HR and even drop it to point of stopping it aka “lizard neck”

Question 19

How much circulatory plasma protein is there at any 1 time?

Answer 19

150-200 grams, atleast 1/2 leaves vasculature into insterstitial

Question 20

What is normal lymph fluid volume?

Answer 20

2-3 liters per day

Question 21

What is pathological lymph fluid volume?

Answer 21

over 3 liters per day

Question 22

What is difference between right and left side of lymph system?

Answer 22

only R UE drains into right side everything else goes to L side

Therefore left side harder to treat as there is more traffic

Question 23

What is primary lymphedema?

Answer 23

lymphatic vessels are missing or impaired, usually hereditary and can affect more than 1 body part, usually with vascular abnormalities

Question 24

What is secondary or acquired lymphedema?

Answer 24

self induced or trauma related, can develop immediately or may take years to develop

Question 25

What are the number causes of 2nd lymphedema world wide and in developed world?

Answer 25

world- infection (filariasis is #1, cellulitis, lymphangitis) developed world- can treatment/ radiation

Question 26

What is something random associated with lymphedema?

Answer 26

long airplanes this is why cabins must be pressurized to 8000 ft

Question 27

What are most common locations of lymphedema in males and females?

Answer 27

M: genitals F: lower extremity

Question 28

What is important to remember about bilateral lymphedema?

Answer 28

almost always asymmetrical

Question 29

What are most common cancers that cause lymphedema?

Answer 29

breast cancer, melanoma, head/neck

Question 30

What are some major concerns with head/neck lymphedema?

Answer 30

limited cervical ROM, difficulty swallowing, breathing, talking, malnutrition

Question 31

Who is at major risk for lymphedema?

Answer 31

high BMI, lymph node removal followed by chemo, radiation and low physical activity

Question 32

How is lymphedema diagnosed?

Answer 32

1. history and physical examination | 2. measures and tests (volume measurements, changes in electrical conductance)

Question 33

What are three cardinal signs for lymphedema?

Answer 33

1. increased size of involved body part, bony landmarks less visible 2. skin discoloration- due to broken down RBC 3. tissue/ texture changes of skin- due to fibrosis and hardening

Question 34

What are other signs for lymphedema?

Answer 34

1. pitting | 2. stemmers sign- pinch skin and it stays up

Question 35

What are symptoms patients may complain of?

Answer 35

heaviness, tightness, fatigue that isn't muscle soreness, coldness, pain but not unbearable

Question 36

What is CTCAE criteria for neck edema?

Answer 36

stage 1-asymptomatic localized neck edema stage 2- moderate neck edema, slight obliteration of anatomic neck landmarks stage 3- generalized neck edema, limiting self care ADL

Question 37

What is gold standard of care for lymphedema?

Answer 37

complete decongestive therapy

Question 38

What does CDT consist of?

Answer 38

1. manual lymph drainage 2. compression bandaging 3. exercise 4. self care 5. compression garments

Question 39

What are the two phases of CDT?

Answer 39

phase 1. approx 2-4 weeks intensive phase usually directed by PT Phase 2- improvement phase or pt management lifetime

Question 40

What is MLD?

Answer 40

decongestion of regional lymph nodes, begin proximally to make room for fluid movement then slowly move distally light skin stretching technique to remove fluid by stimulating the lymphatic system

Question 41

How does compression bandaging help?

Answer 41

provides pressure to facilitate angiomotoricity, encourages movement of fluid, prevents refilling, softens tissues

Question 42

What is big difference in lymphedema type bandaging?

Answer 42

use short stretch rather than long stretch

Question 43

What does exercise do to help?

Answer 43

uses muscle contractions, performed with compression, includes active, repetitive non resistant movements

Question 44

What are contraindications of CDT?

Answer 44

absolute- CHF, renal failure, acute infection, PAD, pulm embolism, DVT relative- high BP, arrhythmias, stenosis, polyarthritis

Question 45

Contraindications for MLD?

Answer 45

arrhythmia, thyroid disease, carotid sinus hypersensitivity, over age of 60 (relative)