lymph Flashcards
(35 cards)
pitting edema
pressure causes an indentation that comes back in a short duration once pressure is released. little or no fibrotic changes in skin or subcutaneous tissue
brawny edema
pressure feels hard with palpation. this reflect a more severe form or interstitial swelling with progressive, fibrotic changes in subcutaneous tissues
weeping edema
most severe and long duration form of lymphedema. fluid leaks from cuts or sores; wound healing is significantly impaired. occurs almost exclusively in LE
primary lymphedema
confidential lymphedema - Milroys disease (0-2yo)
lymphedema praecox - meige disease (10-25yo)
lymphedema tarda >35 yo
secondary lymphedema
injury to one or more components of the lymph systems
lymph node removal
infection
tumor
trauma
chronic venous insufficiency
fibrosis
filariasis
stemmer sign
a positive stemmer sign indicates stage 2 or 3 lymphedema
positive if the skin on the dorsal surface of fingers or toes can not be pinched or is difficult to pinch
stage 0 lymphedema
latency stage
no clinical edema, occasional reports of heaviness, stemmer sign negative, tissue and skin appears normal
heaviness, no edema
stage 1 lymphedema
reversible stage
edema present (soft and pitting), edema increases with standing and activity but reduces on elevation, stemmer sign negative
reversible and pitting
stage 2 lymphedema
spontaneously irreversible
hard swelling present; progresses to non-pitting “brawny” edema, stemmer sign positive, tissue appears fibroscleotic; proliferation of adipose tissue
stemmer
stage 3 lymphedema
lymphostatic elephantiasis
edema present; severe brawny non pitting edema, stemmer sign positive, skin changes (papillomas, deep skin fold, warty protrusions, hyperkeratosis, mycotic infections), repeated bacterial and viral infections are common
flow of lymph
fluid is transported from the lymphatic CAPILLARIES –> lymphatic collecting VESSELS –> along the length of these vessels, lymph NODEs occur to filter lymph –> lymphatic TRUNKS –> COLLECTING DUCTS –> subclavian veins
CV NTD
what is drained by the thoracic duct
R - right side
U - UE and face
L - lymphatic duct
grading scale of pitting edema - 1+
mild, barely perceptible indentation; <1/4 inch pitting
grading scale of pitting edema 2+
moderate, easily identified depression; return to normal within 15 seconds; 1/4-1/2 inch pitting
grading scale of pitting edema 3+
severe, depression takes 15-30 seconds to rebound; 1/2-1 inch pitting
grading of pitting edema 4+
very severe, depression lasts >30 seconds or more, >1 inch pitting
lipedema
a bilateral condition affecting the LE
affects proximal areas such as butt and thighs, not feet
affects skins elasticity, the skin sensitive to pressure and touch makes it bruise easily and painful
2 lips = always bilateral
ankles need to be intact to go on toes to kiss
lymphedema
unilateral or bilateral - asymmertric
cellulitis is common
pain on pressure is absent
distal edema in foot is present
stemmer sign is positice
lipide
bilateral LE - symmetrical
cellulitis is rare
pain on pressure is present
distal foot edema is absent
stemmer sign absent
if question asks proximal
answer will be girth measurement
if question asks distal UE/LE
answer will be volumetric
if question asks pre/post surgery
answer will be bioelectric impedence
if question asks lymphatic insufficiency
answer will be lymphoscintigraphy US doppler
palpation normal
soft, non tender, non palpable, movable
