Lecture 5a - Lymphedema & Misc Wounds Flashcards
(74 cards)
in the US and Europe, lymphedema occurs most often due to what?
treatment, surgery, radiation
breast, ovarian, cervical, endometrial, prostate cancers
2 functions of the lymphatic system
regulation of fluid balance
assistance with infection control
manages 10-20% of fluid removed from interstitial space
what system does the lymphatic system mirror?
venous system
once interstitial fluid goes into the lymph system it becomes
lymph
composed of water, protein, dead/dying cells, cellular components, foreign material, debris
exist as clusters; filter stations with lymphocytes that identify and destroy foreign material and provide immune support
lymph nodes
the area of the body that drains to a single lymph node, seperated by watersheds
lymphatic territories
2 things that help us keep lymph moving
- lymph vessels dont have valves so fluid can move both ways
- anastomoses
what are anastomoses?
peripheral collectors allowing regional lymph nodes from one area to use regional lymph nodes from another area as supplemental or alternative drainage
lymph movement is governed by what pressures?
hydrostatic and osmotic pressure
dynamic insufficiency
lymphatics unable to accomodate and remove fluid due to increased load
(aka system is not damaged, fluid is too much - edema, infection, CHF, DVT)
mechanical insufficiency
lymphatic system unable to manage normal load (system damage)
what leads to sclerosis and fibrosis of lymphatic vessels?
- fibrogen in interstitium accumulates (fluid stagnation usually due to insufficiency)
- macrophages migrate and activate fibroblasts (inflammation response triggered bc high protien content)
- collagen and connective tissue develop in the area
- fibrosis occurs
- hardening of the area
- sclerosis and induration
how does limb size affect diffusion?
increased limb size = increase diffusion distance for O2 and nutrients to reach cells = increased tissue pressure required for diffusion to occur = swelling = collapse lymphatic capillaries
edema or obesity can put pressure on the interstitial contents (think like compartment syndrome)
occurs without obvious cause, result of congenital malformation or impairment (10% of cases)
primary lymphedema
acquired lymphedema, caused by disruption in system by outside force
secondary lymphedema
you’re treating a patient with lymphedema, with no open wounds. could you see this patient in a wound clinic?
yes- because they need specialized treatment for compression
weeping, no actual open area but fluid drains through and beads on skin surface because the skin is stretched too far to act as a barrier
lymphorrhea
ulceractions may occur because of the stress to skin or with trauma in these pts. what can you expect to see with these wounds?
drainage to be a large issue, may have slough
what may present in an lymphedema periwound?
skin is often dry, flakey, scaly, and fibrotic (bc skin is stretched)
may have edema, papillomas, or papillomatosis
cauliflower like projections of epithelium causes by distended and dilated superficial lymphatics
papillomas
cobblestone-like appearance to skin seen in stage 3
papillomatosis
lymphedema risk factors:
- __________ of lymph nodes
radiation therapy
surgical complications
____________ time since surgery (removal of lymph nodes or radiation)
_________ BMI
air travel without __________
removal of lymph nodes
radiation therapy
surgical complications
increased time since surgery
increased BMI
air travel without compression
how to take lymphedema circumferential testing
measure every 3,4,8, 12 cm
try to use landmarks for documentation
measure both limbs! even if only 1 affected
lymphedema risk factors continued:
_____________ lymphatic load
________ lymphatic return
prone to scarring
increased lymphatic load
decreased lymphatic return
prone to scarring
